I got the health scan that 100,000 people are on the waitlist for

I’m typically the first person to raise their hand to try out any of the latest health gadgets, tests or other health-related trends in the market. I have no aversion to needles, I haven’t had any experiences with “incidentalomas” and I’ve long been fascinated by this stuff, both in terms of what we can learn from it and how it will ultimately get paid for. I’ll also state upfront that I’ve come around on being very open to new ideas - there’s this knee jerk sentiment I hear a lot in medical circles that anything new must be a bunch of uneducated, arrogant tech bros.

My view on this is that until the USA can say that we’re no longer one of the worst countries in the world for health outcomes relative to our spending level, we should at least be open to innovators coming from outside medicine. Particularly those who have a respect for medicine, and want to collaborate (YES, there are some bad actors out but innovation is often disruptive). That said, I remain pragmatic about technology. I try to evaluate each new product or idea on its individual merits.

So when the Neko team invited me to Sweden to try out the health scan that just raised $260 million for its series B and counts Spotify CEO Daniel Ek as its cofounder, I knew I’d have to make the trip. I’d also spend some time with Neko CEO Hjalmar Nilsonne, who comes from a family of doctors.

Well, this week I finally made the trip. As an aside, Stockholm is quite lovely and a highly recommend it for a summer getaway!

I got the scan this past Thursday so wanted to share a review and some thoughts on it while still fresh. A quick note for my American readers: The Neko scans are available in London, UK and in Sweden but not yet in the U.S., so if you want one you’ll have to take a trip to Europe. No one knows yet what the scan will cost when the company makes its way to the States. But my hunch based on the European price point is that it will land in the $300 to $500 range per scan and visit, and I suspect it’ll start off as cash pay.

So here’s what happened in as much detail as I can remember - and where I think the company might adapt for the U.S. context! Neko has already publicly signaled the U.S. market is a priority, after raising a substantial Series B.

After I arrived to the location in central Stockholm, I met with two of the team’s nurses who promptly signed me in. My nurse was Anna, who is featured in the photo below on the right. I was directed into a room to remove any jewelry and clothing and don a robe and rubber sandals. I kept on my glasses, but didn’t wear them for the scan itself. So I recommend wearing contacts if you’d feel uncomfortable without your specs for any period of time.

There’s also a weight scale in the room, so you have an accurate measurement as it’s one of the first questions the nurses will ask.

The first step is the scan itself, which feels the most futuristic, but the rest of the experience actually felt much more like traditional primary care. People get fixated on the scan part, but it’s a very short few minutes.

So how does it work? You remove the robe, step in, and a prerecorded voice informs you that thousands of images are being taken of your body — as an aside, I suspect Americans might need messaging around how their data will be protected, as we lack some of the same privacy protections as our European peers.

As I discovered later, these images are used to create the 3D scan of the body that every patient and their doctor will review during the consult. There’s also a dermatology component to the checkup, which stood out to me as one of the more compelling parts of the visit as I have a family history of melanoma. Hover over any rendering of your body, and the care team can pull up any mole or skin mark that looks even mildly concerning to take a closer look.

The scan was completed in a few minutes, and Anna handed me back my robe and escorted me to a bed where she walked me through the rest of the visit, which includes a check of my heart, vital signs, and some bloodwork (blood sugar, blood fats, cholesterol & more).

Once I laid down, I received a battery of tests that included the bloodwork - the vials of blood are put into a machine, you hear a swoosh sound, and then the vials disappear - an ECG, and a blood pressure check at the arms and the legs. That part of the experience takes about 15 to 20 minutes. We chatted throughout, and Anna asked me a few questions as my results came through. I’m one of those people with naturally low blood pressure (at this point it was about 96 over 60, but that’s common for me). Anna pointed out that it can be valuable to have multiple measurements over time in the system to get a sense of what’s normal for a patient.

Once all the information was collected, the general medicine physician arrived to introduce herself and begin the next portion of the visit. At this point, I noted to myself how quickly everything seemed to be speeding along. There was no wait for the doctor or the nurse, which already stood out, particularly given my experience of medicine both in the U.K and the U.S where each medical visit is comprised of a series of waiting periods in different rooms. I also didn’t spot the clinicians performing much documentation, and I appeared to have their full attention throughout.

The doctor asked me to disrobe, so we could proceed with the mole and skin check. We didn’t see much of anything of concern, but I highlighted one newer mark and my nurse took a few additional images beyond what had already been captured by the scan. It had been a few years since I’d had my skin checked by a dermatologist, so this gave me some peace of mind. This is also where it’s beneficial to take an additional scan. Because Neko essentially had a record of my body in 3-D, they’d theoretically know if any new suspicious moles had developed between visits.

About thirty minutes had passed since the scan. And the results were ready, including the bloodwork. I’m not used to such a quick turnaround with labs! But I’ll note that there are some tradeoffs — not all bloodwork can be done so quickly. A subset of patients will require further bloodwork and testing, which means a follow-up visit or a trip to a specialist. Still, we covered some of the basics for a primarily care visit, primarily covering my cardiovascular-related risks and dermatology.

My doctor led me into a new private consultation room to discuss.

Well, I’m generally healthy - although I had some areas of potential concern for the future, which I’ll discuss with you.

As a lifelong follower of a vegetarian and occasionally pescatarian diet, I had very low levels of the bad kind of cholesterol. My doctor was pleased with those results and my cardiovascular health overall, with the caveat that she had some suggestions for dietary changes. She suggested introducing more “good” fats, like avocado, fatty fish and olive oil. For your reference, I’m 37.

My heart also looked and sounded good, and we actually played a clip of its rhythm.

Based on a test for muscle strength where I squeezed a device as hard as I could, I learned I need to start doing more weight training - and to be fair, I’ve been on that kick for the past few months (but not taking creatine). But I could use improvements there, especially as I age, when it becomes even more important for bone health. We also talked about the importance of yoga and pilates, which offer both health benefits but are also good for balance and relaxation. What I liked about these recommendations is they felt data-driven and unique to me, even as I’d heard all of this before from primary care physicians. Some patients will appreciate that, even if they’ve heard the advice before.

What I believe some patients will also like is that Neko does show the data today but makes predictions about how it will look in the future, based on current behaviors. That’s a big part of the visualization and the scan — it’s a snapshot of today, with extrapolations about tomorrow. That idea is a powerful one, and I’d appreciate seeing a study on whether it has a greater impact for people than simply hearing that they should make behavioral changes related to their cardiovascular health.

Interestingly, the doctor did spot a potential trend midway through the visit that could be of concern related to my insulin resistance. I recently learned that I have PCOS, so there could be a potential flag there. Neko didn’t diagnose me with it, but saw some signals that pointed to it. The doctor made a note to watch this over time. I will also follow-up on Neko’s suggestion to get my iron levels tested, as my last test after having a baby showed a Ferritin level of 7 (that’s very low). I’ve been supplementing with iron since, but I’d like to see whether I’ve seen sufficient improvement.

Shifting into my investor hat, this experience is clearly built with patient retention in mind. The Neko experience is designed to encourage people to return every year. Centered on the idea that bodies are constantly changing, both for the better and for the worse, so a primary care visit should reflect that. The visual record of what you see today is interesting enough, but it’s far more so when you can compare yourself to the year prior. Did any positive changes make a difference? And how will you look in 20 or 30 years if you make changes, and if you do not?

The dermatology aspect was also a big part of the visit, and it lends itself well to this all-important retention metric. A lot of people skip getting mole checks. It can be hard to keep track of moles and skin marks, especially as I learned the average person has over 1,000 of them! So I liked that this was a substantial part of the visit, although arguably there’s a cheaper way to do it with an in-network dermatologist.

To put a finer point on it, retention is a key metric for Neko’s investors. One of the biggest uses for VC money is the marketing budget, especially given how competitive it is in the U.S. It is expensive to acquire patients - so it’s generally important to keep them coming back, unless the intervention is curative. It makes me wonder whether a membership model might be in Neko’s future as it migrates to America.

What I’m also curious about is the portability of the results and the integration with the system. I did wonder how and if I’d be able to share my Neko scan and bloodwork with a primary care doctor in the U.S., especially given it is cash pay. Once the company makes its move to the States, it will need to determine whether it integrates with the electronic health record or instead provides patients with their own downloadable record they can take with them to specialist visits. Likewise, the company will also need to determine its strategy for how it makes referrals for patients to see specialists.

I haven’t peeked under the hood, but I’m very curious about the unit economics, particularly if Neko partners with a Quest or Lapcorp for the bloodwork. Can they ensure the visit is still profitable at the current price-point, while also providing immediate results and not substantially raising the cost of the visit? In general, everything is more expensive in America from the corporate real estate required for the offices, to the cost of hiring operators and clinicians, to the medical supplies.

Currently, it seems like there’s immense organic interest in Neko’s scans, but marketing spend will increase over time once the early adopters have all had their annual scans. Although that will depend a lot on whether the company partners with health plans and employers, which we’ll discuss.

One of the most striking visuals I saw during the visit was a 3-D rendering of my own body. I’ll be honest, it was a bit uncomfortable. I immediately wondered if Americans would be as open to the experience, as Europeans seem a bit less body-conscious overall. I have been to the beaches of the Mediterranean and can attest to that! All in, I think some people will find it alarming to see themselves so laid bare. But then again, perhaps it’s a good thing? Who knows. I don’t claim to be an expert in human psychology, but I wonder if it will be motivating to some. Especially in the context of a discussion about preventative health.

There’s also lot of benchmarking, which I suspect Americans will be drawn to - at least the kind who obsess about their status on the Peloton leader boards. But I wonder if the data-set currently is skewed to Europeans, who tend to be less obese and with lower rates of cardiovascular disease. In general, Europeans also have better life expectancy and health outcomes. I’d also argue they have a much better food system. So is that a fair representation? Should Americans only be compared to each other? Or to a global population?

Americans will also appreciate the lack of wait times and the expediency of the whole thing. But there’s also a subset that will appreciate even more data, so I wonder if a tiered system could make sense here. An hour at a lower price-point to cover the basics, or 90m for more extensive bloodwork and more time with the care team.

Of course, THE question underlying all of this is whether from a population health perspective is whether it’s worth subsidizing. At the level of the individual, I can attest that it’s extremely cool and I genuinely found the experience useful. I also can afford to pay $300 out-of-pocket once a year for an experience like this. But I’d need to see a lot more data on outcomes to argue that this should be covered by insurance, and therefore accessible to low-income Americans. Especially if the primary care alternative is free or available at a low co-pay.

That said, there’s enough Americans who will be willing to pay that I suspect the company can determine its strategy down the road, whether it’s Medicare Advantage, commercial health plans, or some subset of self-insured employers with a population of generally high paid individuals that don’t churn (banks, law firms, tech companies, and so on). This visit did feel like a more aspirational take on primary care, with a good balance of tech with human interaction.

The people who need access to this kind of preventative care the most are usually the most complex and may have the least capacity to pay out-of-pocket. I don’t view Neko as competitive to companies like Function Health and Lifeforce. There were elements of longevity - for instance, visualizations showing what my data would look like in 20 years without making any significant changes - but mostly it felt like a fresh take on primary care. There also weren’t any products to buy that I’m aware of, like over-the-counter medicines or supplements. With fewer Gen Z and millennials opting to visit the primary care doctor or have a longitudinal relationship with a doctor than ever, I could see this meeting a need. But then again, the out-of-pocket cost could be a deterrent.

Neko comes in as less expensive than the whole body MRI scans from companies like Prenuvo and Ezra, but more than a primary care check-up when a patient uses their insurance. It is slightly more expensive than One Medical, but not far off when you consider the annual membership and the co-pays. I’m curious where it lands in terms of the ideal buyer for the product in the U.S. Will it be the super health-conscious or skewed to individuals that want to start making positive health-related changes and are willing to allocate some budget to getting there?

In terms of the competition, I’d generally rank it in terms of a few different categories:

1) Tech-backed primary care clinics, along the lines of One Medical, and including those that are focused on the self-insured employer (Crossover Health, Premise Health). Within that group, I’d also include functional medicine companies like Parsley Health that focus on “root cause” medicine and prevention, rather than putting out the house fire once it’s already raging.

2) Longevity companies, including both the whole body MRI scans (Ezra, Prenuvo) and those that offer access to extensive bloodwork and health-related coaching and consults (Function, Lifeforce, Superpower).

3) Concierge medical practices along the lines of Private Medical or the Comite Center, although the price points tend to be higher so I would imagine the target market is different.

4) Prevention-focused specialty care with focusing on dermatology and cardiovascular disease including Heartbeat Health and Omada Health

In my mind, the strongest competition is likely in category 1) and 4) for now, although there’s certainly some overlap with 2) and 3). I could see the health-conscious subset opting for both for different reasons. 3) I view as more of the healthcare for the one percent, who can afford higher annual membership fees. Women will be the likely biggest drivers for all of these companies, given their tendency to seek out medical care and their status as the healthcare household decision-maker, with the exception of those that specifically target to men.

The whole body MRI scans do provide people with more information than there Neko scan, particularly related to checks for cancer and MSK-related issues. These are also more expensive though, and seem to draw a very mixed reaction from the physician community.

The big question overall with Neko and all of these companies is how to ensure copycat businesses don’t emerge and bring down the price. What I’ll be watching is whether Neko builds its own lab infrastructure, for instance, or partners with a third-party. The former would be more expensive, but could be a good strategy to make this experience less likely to become a commodity. The scan itself is also unique, but again is less extensive than the whole body MRI.

Was there anything I didn’t like about the experience?

Nothing per se that I’d point to that felt uncomfortable or totally unnecessary. I also didn’t get the same vibes of it feeling like tech bros trying to do health care, like I did with other experiences (I will not name names, but you can probably guess). But I did have some ideas for how this experience could evolve.

I pondered with my doctor whether a version of this experience could be designed for women specifically, especially given the renewed focus on hormones, menopause and fertility. We didn’t spend as much time on menopause, for instance, potentially because I’m not yet showing perimenopausal signs or symptoms. But there could absolutely be a highly tailored experience for women who are looking to start or expand their family, or are having symptoms.

Could Neko incorporate any screenings here for women’s health? The dermatology screening was one of the preventative aspects of the visit I most appreciated. How about checks of women’s breasts?

AI and virtual are all the rage these days. But I appreciated that this is a four wall business. I predict that in the U.S., the first clinics will open up in dense urban areas, although I could see Neko doing deals with employers for onsite or near site clinics.

What I did I like best about it? Well, it was probably the time I spent with my care team where I felt like they were really listening. All of the “tech” involved the visualization of the body and the scan. There didn’t appear to be any vision to replace the doctor or the nurse. My visit was an hour, versus the usual 10 minutes or less I get for primary care check-ups covered by insurance. This may not be scalable at a population level, but for those who choose to get a Neko scan, it’s a big perk.

All in, I would recommend it to any friend passing through London or Sweden if they can get an appointment before Neko lands in America. And I’d be intrigued to try it again next year!

If you have ideas where I should be a guinea pig and write about it, send me a note at [email protected]. Also, if you’ve gotten the scan, I’d be keen to hear about your experiences? If you’re a clinician, do you have thoughts on Neko versus the competition?