Lessons from Elizabeth Burstein, Neura Health: Closing the access and quality gap in neurological care
Elizabeth Burstein, CEO and Co-Founder at Neura Health, a virtual neurology clinic with a mission to improve the access and quality of neurological care.
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.
This week, we’re super excited to have Elizabeth Burstein, CEO and Co-Founder at Neura Health. Founded in 2020, Neura Health is a virtual neurology clinic with a mission to improve the access and quality of neurological care: increase convenience, improve outcomes, and lower costs. Neura Health's platform connects patients to neurologists, with built in neurology-specific symptom monitoring and condition-specific diagnostic tests.
Elizabeth’s path to co-founding Neura Health:
Elizabeth’s career over the last decade has been focused on building products for mission driven companies, leading product teams at LinkedIn, Blue Apron, ZocDoc, and most recently, the Maven Clinic.
At the beginning of the pandemic, Elizabeth started to face a chronic pain issue called peripheral neuropathy, and realized there was so much opportunity to build a better patient experience. Going through the patient journey herself, it was shockingly difficult to get an appointment with a neurologist, she wasn’t able to be helped by her primary care doctor, and there was no way to share her pain data with her providers.
At Maven Clinic, Elizabeth had seen firsthand how impactful virtual apps and clinics could be for women’s health. Maven’s app was focused on decreasing the likelihood of adverse conditions like postpartum depression, gestational diabetes, and more, but nothing was being built for the areas within neurology. With over 160 million Americans (including herself) suffering from a neurological condition and the tailwinds towards telehealth happening during the pandemic, Elizabeth had a vision to build a better patient experience for people suffering from chronic pain and the surrounding area of neurology.
Elizabeth’s co-founder is Sameer Madan, a classmate from Stanford. Sameer also had a personal story tied to inconvenient neurological care. When Sameer was in his early 20s, he had a chronic discectomy and flew back to India to get his MRI and treatment— flight included, the entire experience was cheaper than going to Stanford healthcare. Bonding over these difficult patient experiences over drinks, Elizabeth and Sameer saw an opportunity to make a massive dent in improving our healthcare system and incorporated Neura in October of 2020.
Neura is a direct-to-consumer virtual neurology clinic, currently focused on serving patients with chronic headaches and chronic migraines.
“It’s arming patients with everything they need to partner with them and their journey towards relief.”
Neura currently has a membership model at $28 a month and $1 for a first week trial, setting patients up with board-certified neurologists with initial visits at $150 and follow-up visits at $75. The membership includes unlimited messaging access to a dedicated care team with at least one board certified neurologist at the helm, a care coach to help implement lifestyle changes, and a care concierge helping with the administrative burden of living with chronic headaches: authorizations, getting referrals, understanding your insurance coverage, etc.
The membership also covers a proprietary headache tracker, the ability to get same or next day video visits with a board certified neurologist, as well as personalized educational content and recommended action items.
Elizabeth shares that one of the inherent challenges of the entire neurology domain is most of these conditions don't have cures and there is no straightforward path to relief, and so that is why having a tech enabled high touch service is really needed. By connecting patients with certified neurologists, Neura short circuits the cycle of trial and error in finding the right medication.
Neura’s short-term mission is focused on improving access and quality of care for neurological conditions, starting with chronic headache
Elizabeth shares that Neura’s short-term mission for the next 5 years is about improving access and quality of care for neurological conditions, starting with chronic headache and moving into other neurological conditions like epilepsy, chronic pain, Parkinson's, Alzheimer's, and more. While they build this tech enabled, full-stack virtual neurology clinic, Neura Health is collecting a dataset that has previously been incredibly siloed.
Treatment data might be in the electronic health record, but clinics and hospitals don’t see end-to-end results on their patients. With access barriers and patients changing clinics, Elizabeth believes the missing piece is outcomes and symptoms data, which is what they hope to gather through building an accessible mobile app and marrying the headache tracker with the service itself. Neura’s long-term vision is to take this data and partner with pharmaceutical companies to help accelerate cures.
Building an MVP and getting to 100 patients
With the healthcare stack available today, avoid unnecessary bells and whistles when it’s time to build your MVP.
“Nowadays, there’s so many companies focusing on different parts of the healthcare stack. This process of standing up the first MVP was very much equally weighted towards vendor diligence and all the different tools that are out there, in addition to building our own patient facing app.”
Elizabeth shares that if they had been building Neura 5-10 years ago, they would have needed to build much more of the product in house. She and her team did a lot of research on the different vendors out there for digital health companies to build on top of to create a minimum viable product— how could they get high quality neurological care to a patient with same or next day video visit experience, integrated with a tracker where the doctor can actually see the data that's being collected to make appointments more efficient?
User research is key, and it can help you get your first cohort of patients.
Elizabeth shares that Neura acquired their first 500 patients off of Facebook after doing a lot of user research up front with a high volume group. The screener was having chronic headaches or migraines, and the MVP was a combination of a basic tracker, Zoom for telehealth visits and a basic HIPAA compliant messaging tool called SendBird.
After testing their MVP with these patients, Elizabeth shares that they spent a ton of time talking to these patients about their patient journeys pre and post Neura.
“Some patients were going to a brick and mortar clinic, but they were waiting on a six months waitlist to get that next appointment. Another cohort of patients were in a rural town and had literally never met with a neurologist. Some of them in fact, didn't even know that they had the formal diagnosis of migraine, they just knew they had a lot of headaches. We had both groups of patients, both people that had previously been diagnosed and not been diagnosed, and really understood in a lot of depth what it was like before and after with Neura.”
Elizabeth shares that this research was essential to set a more specific focus within the broad domain of neurology, eventually picking migraines because it's a massive market (40 million people in the US!). Migraines are relatively safe and effective to treat over telehealth, and with diagnoses largely dependent on self-reported data, it's very amenable to Neura’s all-in-one model with the integrated tracker.
Involve clinicians early on in the clinical model to guide key product decisions
Elizabeth believes involving doctors that are aligned with the company's vision for healthcare is essential. Neura’s focus isn’t to change the healthcare decisions made by clinicians but to make them more accessible to patients, so working with doctors is essential to their mission. Neura’s current medical director, Dr. Tom Burke, is a professor of headache medicine at NYU; not only is he up to date on all the latest medications and devices, he’s also a big proponent of lifestyle coaching to help patients through changes in diet, mobility, stress management, and more.
Especially as founders with mainly product and tech backgrounds, bringing a clinician in as an early leader helped guide their decisions. Elizabeth used LinkedIn to recruit doctors, but has heard other founders have success with Doximity as well.
Elizabeth shares that a huge part of why they built Neura was to empower neurologists to be more efficient and increase their caseload, which the platform does through synchronizing the intake portion of the neurology appointment. Involving clinicians as early leaders in the company helps guide key product decisions.
Both quantitative and qualitative metrics are important to understand the patient experience.
Neura initially focused on daily, weekly, and monthly active users, retention/churn, and post appointment ratings to understand the patient experience over a longer timeframe.
Qualitative user research helped their team validate and invalidate their hypotheses on what was actually making a difference for their patients.
“The user research really helped illuminate more specific questions… not just, oh, are people using this product and are people using these visits? But— are people happy with this experience? How are they perceiving it as different than their status quo experience?”
Choosing a consumer go to market strategy
Starting with direct to consumer is flexible and fast.
“I think consumer has been a wonderful way to start because of the speed. Partnering with the hospital and employer or payers— those are all paths that so many digital health companies have succeeded in as they scale up. But, for the initial phase, unless you're building out of an offshoot of a hospital group or an academic group, it's so efficient to make these relationships direct to consumers online for patients who are not necessarily constrained by the fact that they're tied to a specific employer.”
Elizabeth shares that building DTC has given Neura an independence from employers, avoiding disruptions to the patient journey even when patients change providers.
She also believes the tailwinds of telehealth with the pandemic have made this a better space to work in.
“Again, 5-10 years ago, the idea of meeting a new doctor on the internet, without ever having met them in a brick and mortar setting… I think it would have been just a very kind of novel and potentially less comforting concept, whereas now it's happening so frequently.”
To figure out what channel to focus on for a given moment in time, pick what works best with the stage of your company & the skillset of your team.
In an era with so many different business models in healthcare, Elizabeth shares that one of the biggest challenges for Neura was focusing on the right channel at the right time. She doesn’t believe that digital health companies have to stay in one channel for their whole lifetime— it's more important to understand the stage of your company (seed, Series A, Series B, etc.), the market, the landscape, and the skillset of the team. Based on that information, you can figure out whether to start in consumer, B2C, etc.
Think strategically about what part of the stack your company provides unique value.
Elizabeth outlines Neura’s strategy, heavily influenced by her and Sameer’s PM background, to understand and prioritize what to build.
What part of the stack is unique to our company— where do we differentiate ourselves? Is tech one of our moats?
If tech is a moat, then which part of the tech stack is our moat vs. something that we can purchase?
What are the other components that we need to purchase?
Create a spreadsheet of the features you’re interested in: the need to haves, the nice to haves, etc. Research across resources like newsletters and Slack groups to find the best vendors, then evaluate them based on pricing and which will have the most ROI.
When it comes to how much you should raise, think about the fundraising landscape and how much upfront capital your business model requires.
While tech enabled healthcare service businesses are different from brick and mortar clinics, Elizabeth shares that to scale to their first consumer growth milestone, they were focused on upfront costs like licensing requirements, employing initial doctors, marketing costs, etc.
Elizabeth mentions that they ended up raising more than originally intended, but still ended up turning down additional funds because they were early-on— in retrospect, she believes that raising more cash wouldn’t have hurt.
“The macro landscape of how much money is being pushed into pre seed and seed is changing so rapidly, that I think that being really mindful of that, constantly talking to founders/investors about what they're seeing and incorporating that into fundraising amount targets is really helpful.”
Exciting areas for the future of health tech:
In women’s health, Elizabeth sees a huge opportunity to improve support for pediatrics. Finding support for children's health is a big struggle, both in terms of caretaking as well as doctor services, and a nationally recognizable brand hasn’t been built there yet.
While Neura builds in the consumer space in neurology, Elizabeth believes there's so much tooling that can be improved from the health record to better recruiting for clinical trials. It's incredibly expensive and difficult to recruit for patients in domains. There’s plenty to improve in terms of access, driving disruption through these telehealth models, and really kind of providing people that support that doesn't exist.