: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Outcomes rocket listeners welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. I really want to thank you for tuning in again and I invite you to go to outcomesrocket.health/reviews. Tell us what you thought about today’s episode. We’d love to hear from our listeners and our guests are so amazing and we want to hear what you think about them. So without further ado I want to introduce our outstanding guest today. Her name is Mylea Charvat. Dr Mylea Charvat. She’s the CEO and founder at Savonix at Savonix they deliver a valid research based mobile digital cognitive assessment. Less than 5 percent of the cost and efforts of current pen and paper and most web based computer assisted methods. The Savonix mobile assessment platform evaluates all core domains of cognition including areas such as attention emotion regulation impulse control and approximately 30 minutes all from a smart phone and mobile device. Pretty cool stuff that they’re doing over there globally. And besides that you know Mylea has got a tremendous amount experience across consulting as well as health care in general. But what I want to do is open up the microphone and let Malia fill in any of the gaps. Welcome to the podcast.
Mylea Charvat: [00:01:39] Hi, Saul. Thanks for having me. That’s such a great intro wow. I’m like we do all that? Sometimes I get surprised when I hear other people talk about what we do because day to day you can sometimes get down in the weeds. It’s so great to talk about the big vision because when I think about savant it’s what I think about is a technology that helps us move one step closer to a world without dementia. And when we talk about dementia most people think of that as an age related progressive decline that dementia can also occur secondary to conditions like type 1 diabetes or secondary to stroke or secondary to thyroid. These these are often treatable and in fact much of dementia is preventable or treatable. And as we look to the future with living longer lives and looking at the actual self. One of the things that I really want to do is move us to a healthier world by recognizing cognition is a vital component of our health.
Saul Marquez: [00:02:35] Think that’s a great call out Leon. Thank you for filling in the gaps there. You know a lot of times and I think it’s getting better now we’re beginning to incorporate that cognitive health as part of the entire wellness picture and I think what you guys are doing there are you and your team is just critical. And so a big thanks. Me and everybody that’s listening for what you guys are doing so far.
Mylea Charvat: [00:02:56] Thanks. For me it started you know people ask when did sonic start. And we founded the company in 2015 as a C corp. I started working on it fulltime a year before. But you know most founders know how that is usually a year with no money getting it all together. Right. And then you go out. You raise the money and you put the company in the market. But this really started for me when I was a teenager and I was yelling and my mother’s kitchen and I was interacting with my grandmother and we were doing something we were making. Additionally a cook hundreds of times before and I handed my grandmother something and she didn’t all of a sudden she didn’t know what to do. And I didn’t know what to do because I was a young girl. I was 13 and it was the first time I encountered cognitive impairment. And then you know I went on to train to be an earth ecologist and to be a neuroscientist and as you know another salient time where this hit my life was diagnosed a woman with early onset Alzheimer’s disease who was in her 40s and she had twin girls who were 2 years old. And you you go through that and you’re very clinical and you help the family and you are the rock her husband and her mother who was still alive and just devastated as you can imagine. And then I remember setting in my car that evening before I drove home and just weepy because I was thinking of my own relationship with my mom and how much I valued as an adult woman and how those girls would never have that joy. And that woman would never see her daughters grow up and graduate college and start careers and get married and have families. And it is such a horrible devastating disease and then anybody has read my bio knows that my husband experienced a traumatic brain injury and that was actually just a few months after that case. And so there’s this blue line through my entire history around cognition and it’s critical importance to how it is for me is something that the world needs but it also happens to be something that I think through both personal experience and professional training I feel very uniquely hopefully qualified to address now.
Saul Marquez: [00:04:48] And you know I think you guys are doing a phenomenal job. Let’s take. And again I want to thank you for sharing those stories it’s without a doubt. You are the right person at the right time for the job and so it’s a sad reality when it does hit our families and when we get to this topic of mental health in particular the areas that you’re focused on Mylea what do you think should be on health care leaders agenda and how are you guys approaching that.
Mylea Charvat: [00:05:15] Yeah that is such a really really that discussion that we should be having right now because we go to the doctor every year and we get her vital signs tested right. And I just gave a talk recently and it was to a group of physicians and everybody in the room knew their LDL cholesterol level. I knew mine everybody knew their blood pressure rate pretty much everybody looked 98 percent of the room they knew their resting pulse rate. They knew their weight. They knew there. You know all these things about them but they didn’t know anything about their working memory or their executive function. And yet as I pointed out to them we were all going to leave that meeting and we were going to get in our cars and drive which is going to require visual spatial memory and working memory and executive function. Then we’re going to maybe stop on the way home at the grocery store and we have to remember what we need by working memory executive function thinking and planning meals for the week right. Thinking of oh yeah the kid has got a field trip. So I have to do that right. You’re holding all this in your head and our cognitive abilities have the most fundamental impact on our day to day lives. And yet we don’t measure it at every annual check out. And when we think about that when we think about that cognition drives our personalities and it drives our ability to just drive our car shopper groceries. Remember what’s going on with our kids who has to be where and when when that falls apart. It’s like the person isn’t even there anymore right. And we’ve all probably experienced this in our families or with friends and so there’s nothing more fundamental to our health and yet we’ve nor this area of health care and I think to our own detriment.
Saul Marquez: [00:06:41] What a great point and something that you know I keep watching over here and it’s just like you’re so right. If we take the time to measure all of these other vitals why not measure something that’s so critical to our day to day. And so what would you say. The answer to that is.
Mylea Charvat: [00:06:55] No. You know that was what got me started thinking about founding Savonix because when we needed cognitive testing for instance for my husband when he was hit by a car and you did all these things he needed a ton of tests that cognition was one of them. And it was a 16 month waitlist neuro psychologist. Yeah.
Saul Marquez: [00:07:12] Months? 16 months?
Mylea Charvat: [00:07:14] 16 months because at last count there are only 1000 to board certified neuro psychologists in the U.S. and Canada. Now while there are more than forty eight million Americans that have some kind of cognitive impairment. Now think about that. Just hold that 48 million people that have been diagnosed let alone all the people that have it. That’s right one thousand and two providers now cardiovascular disease. So 27 million Americans. About half the number right have some kind of cardiovascular disease. There are 23000 board certified CT cardiologists. So you’ve got a service gap here. We have our education system is lagging around the way we educate neuropsychologist to test pen and paper tests have been around since the 30s and 40s largely came out of the military in World War II and testing soldiers. They’re very effective. But you need one of these neuropsychologist to administer them score them and report them. And the average cost is eight thousand dollars to get a cognitive screen. So it’s not only it’s time consuming it’s cost prohibitive and there are waitlist and it’s all task based metrics that connect the dots. It’s push the button for the color and not the words that you see on the screen. These are all tasks and I started thinking you know and they’re all measured based on accuracy and reaction time. That’s how they’re scored accuracy in reaction time. And when my husband needed I say look the digital tools that were available a lot largely desktop I didn’t like them. They were all pointing click when you do cognitive testing my patience and I was testing them they were drawing copying figures and rearranging objects in space for visual spatial path. And there’s a tapping test it’s called the go no go. There’s also the mapping test your frontal lobe test. They’re great but you can’t turn the entire battery into a tapping test or you’re losing a piece of measuring functionality. So I started thinking about what would it take to do it right. If we were going to put these tests into the computer and let’s all just admit everybody says if it is good it is good if the pen and paper. I don’t know. You tell me do you think the computers better measuring reaction time. I think so. And get to a thousandth of a millisecond the human eye is accurate to about a second. Is it better at measuring accuracy. Yes because it doesn’t make mistakes and people do and it’s not biased. It didn’t lose sleep last night as a toddler was crying didn’t have a fight with the spouse re the computers period. And I thought about all this and I was like what would it take to build it and I started investigating this. This was while I was at Stanford I was thinking like what would it take. And I looked into it and I looked into the kind of engineering and I decided it would take building a gaming engine that this wasn’t going to be cheap to build it was going to take a lot of money because to do it right we had to use very sophisticated twitch based mechanics similar to those used in the world’s most sophisticated interplay game like World of Warcraft. So I had a consulting business on the side and I was spending some of my own time and money looking into the US and then I came to a decision points. I had an offer from a very prestigious medical school to join the flock. It was either go into academic medicine and continue to practice or start this and you this and I felt very strongly that what the world really needed more for me wasn’t for me to just be in the treatment room and educating students which I can still do in my current role in many ways in a different version. Yes. What the world really needed was a solution to this problem if we look 20 especially 20 years out with an aging population and my vision and we have achieved it. Is that an 80 year old woman in rural China with no money who’s very poor can’t afford and can take a cognitive screen that is designed and delivered by Stanford doctors. That was the world they wanted to create with this company.
Saul Marquez: [00:10:57] I love it. Love your vision. Mylea and this is the really fascinating thing of this whole perspective and this journey that you’ve decided on is that you mentioned the numbers for a cardiologist to the number of patients with heart failure. So that’s because of the codes right. These payment codes are aligned with the professions and you’ve taken a route that’s been I think of kind of like Dean Ornish you know he had his thought about what he did and what can help. Heart failure patients and he spent 16 years working on it and then finally got a Medicare Medicaid approval code for what he’s doing. This is the long game and you’re going after a space that is definitely needed but may not be as paid for as it sits today.
Mylea Charvat: [00:11:46] Yeah it’s true. So reimbursement for cognitive testing is really low which is one of the challenges. There are petty codes that exist for to get reimbursed for cognitive testing but it reimbursed is very low it reimburses somewhere anywhere on the low end but around 25 dollars on the high end about three or four hundred. But when you think about the cost of administering pen and paper passed it’s an upside down thing for the health care system or the doctors right it’s costing them way more money to employ a nurse psychologist or to hire one on referral and to issue this testing than they will ever get back. So the beauty of digital tests and we are currently in the market and reimbursed in the U.S. healthcare system can we reinvent the wheel we digitize gold standard metrics that have been around. You know again it clarified that 78 years. Right. Yeah. These are tests that neuropsychologists would recognize and that when we put them in front of doctors they like oh trails. They’re like oh God I don’t know what that is. So we are reimbursed and the key is we cost less than the reimbursement pay. So we flip that economic dynamic for the provider and what that does is it makes it much more possible to do this. We also represent our results graphically in real time on mobile and on desktop to clinicians and that’s critical because they’re not waiting on a big twenty five page PTF report which is what neuropsychologist typically regenerate and trying to sort through paragraphs and paragraphs of text to find the things that they really want to know which is working memory. Where’s it at. Is it in the low range of the average range the high the average range the high average range in the high range. And what is the percentile score and what are the implications behaviorally for that score. So we just present that in a group like a graph in quintile it’s color coded so that you can kind of see 0 red. Not good. Right. Very low. You hover over it. You get the percentile. And then if you click on that what you get is that this patient scored poorly on visual spatial memory. They’re going to struggle with day to day activities like X Y and Z. So we try to present the results in a way that’s just really fast and easy to digest for providers because having worked in very busy hospitals you know I understand clinical workflow and the fact that you don’t have a lot of time that we need to give you as a provider the data in a way that you can utilize it rapidly.
Saul Marquez: [00:14:07] I think that’s so awesome. So you’ve got a lot of things going on a lot of things cooking new projects. What would you say today is one of your most exciting projects within your company.
Mylea Charvat: [00:14:17] I can’t say who the partner is yet because we’re going we’re kind of doing this on stealth and we’ll probably make an announcement in 2018. All right. Yeah right. We have me back and we’ll talk about it working with a global healthcare company and we’re kicking off a pilot project in diabetes type 1 diabetes Type 1 is auto immune disease. I just wrote an article on LinkedIn talking about the relationship between auto immune diseases and cognition which is very strong. There was Betty Diamond gave a talk that had made this year about that she studies lupus and she talked about how her patients are always referred to psychiatrists for their cognitive problems as though it’s a separate disease. It’s not. It’s part of the disease especially when it’s not well managed. So to recognize looking to track cognition the way that we track influence behavior and the way that we track blood glucose in a 1C level in these patients because it’s such a vital part of their ability to manage that disease when cognition starts to slip it’s very good indicator. In many of these diseases for what’s going on with the larger disease state because it is a symptom that then when it gets worse everything else gets worse. Because when I cannot pay attention and think and plan and remember I can not manage my own diabetes I cannot manage my lupus. I cannot manage my hypertension. And then the healthcare system says to me Oh you’re a noncompliant patient that patient bad without considering that in fact what is happening is my disease is causing cognitive impairment that that has a negative feedback loop around a downward spiral around that disease.
Saul Marquez: [00:15:57] Wow that’s so interesting. I mean the thing that keeps going through my head. Mylea and congrats on that by the way I think it’s fascinating that you guys have linked up these two. It’s like why doesn’t this you know like I go to my primary care every single year and I take these tests like we talked about at the beginning of the podcast. Why not just include a cognitive test as part of the standard standard.
Mylea Charvat: [00:16:18] Hey you’re preaching to the choir right. Yes.
Saul Marquez: [00:16:23] I mean it just makes so much sense. What’s holding it back. Why can’t we get there.
Mylea Charvat: [00:16:29] There’s a lot of things. I mean I think doctors are. You’ve got to look at the way our healthcare system is structured in the United States and I don’t think anybody would disagree when I say it’s broken. Right. The incentives aren’t aligned. Keeping patients healthy isn’t aligned with the economics of our healthcare system with third party payers. It doesn’t work well. And part of that is payment so reimbursement to providers has dropped horrifically over the past five years. Most people don’t realize that the average doctor the average hospital the average physical therapist is struggling to keep the lights on. I’ll give you a really good example my own health care insurance provider BlueCross BlueShield. I was seeing a physical therapist after a car accident and in the middle of my treatment regime she informed me that my health insurance company was dropping the reimbursement on the code. She is from my visit from 120 dollars a visit they were paying her to seventeen dollars. Wow. Print out of her time. And how is she supposed to pay her front desk person or her billing coding person and keep the lights on at seventeen dollars an hour. That’s not even a livable wage in San Francisco let alone enough to operate a business around a reimbursement paradigm. And she knew I was a health care provider so I don’t think she shares this with her average pay. Sure but that’s a good example of the kind of problems that we’re facing and nobody really wants to call out the insurance companies and say you know what. You’re making billions of dollars in profit. You’re doing it on the backs of patients and providers and we need to get this under control. It’s a really big problem. We have the only health care system in the world where we’ve got this middleman called the health insurer that’s just this a publicly traded company that is beholden to their shareholders not to doctors not to patients. And I’m not going to make a lot of friends talking about this and it’s not that I think that insurance companies can’t be our allies because we work with insurers at Savonix and there are amazing insurance companies that are really operating very ethically and decently. But is a lot of waste in the system. I read a statistic that administrative costs in the U.S. healthcare system are more than 50 percent of what you and I are paying for. And everybody who approves the V.A. I’ve been a provider within the V.A. It has its problems but it has the best electronic medical records I’ve ever seen in terms of interoperability that it should have. Yeah they should have like commercialize that and take an epic out of business because it’s really good that everybody who’s worked on it says the CPRS. They say the same thing about it. The other thing is administrative costs. I believe last statistic I saw around 2 or 3 percent not over 50 though at least the money is going to health care not just somebody to step in the back room and know what the billing code is for this insurance company versus this insurance company versus this insurance company. So if we could solve interoperability and standardization and take care of way around administrative cost I think we could do a lot in the US. So there’s that hindering adaptability of digital tool because you’ve got these larger problems that people are trying to solve.
Saul Marquez: [00:19:31] Yeah I think that’s that’s a great call out and definitely the reality of the situation. Then there’s the employer that employer sponsored plans. I mean you know I think there’s starting to be a movement right now where employers are starting to get fed up with the cost. And so yeah there’s a groundswell happening and I think there will be some change I don’t know what that change looks like but yeah totally. I think that’s a great call out that you’re making right now. Mylea.
Mylea Charvat: [00:19:57] No thanks I’m going back to the provider if I’m worried about how to get reimbursed and keep the lights on with what I’m doing right now it’s really hard for me to adopt new saying we artificially control the number of providers that we graduate into our healthcare system. We artificially control licensure passing rates in state for medical providers. So there is a lot of things that we could do to also expand the number of people that are available to provide care would also help. Because part of the problem is access. Right. And I’m hitting the high button in and there are no. Everybody’s like what’s the one answer. There is one answer. That’s like saying what the one answer to all gamers. Right. Right. Not one answer. It’s multifactorial and it’s a complex. Who knew health care could be complicated. Right.
Saul Marquez: [00:20:44] No it’s good and you know what it is and that’s why it’s such a really fun place to work and just gratifying when you do come up with the solution and you can scale it kind of like you guys are doing at Savonix. So I think it’s biting. I’m so thrilled to hear of the progress that you guys are making and so let’s pretend Mylea that you and I are building a medical leadership course on what it takes to be successful today. It’s 101 are the ABCs of Dr Mylea Charvat and we’re going to write out a syllabus for questions lightning round style and then you’ll give the listeners a book that you recommend to them.
Mylea Charvat: [00:21:23] Oh goodness. You should prepare me for this one.
Saul Marquez: [00:21:28] It’s part of the fun.
Mylea Charvat: [00:21:29] OK.
Saul Marquez: [00:21:30] All right. What is the best way to improve health care outcomes.
Mylea Charvat: [00:21:34] Get more data per individual and stop treating the patient averages. We must move toward individualized medicine.
Saul Marquez: [00:21:43] What is the biggest mistake or a pitfall to avoid.
Mylea Charvat: [00:21:45] Not being willing to admit what you don’t now. And I’ll give an example the famous aspirin study right. That was done about preventing heart attack. It was done in 22000 white male physicians. If I’m an honest doctor and I have an African-American woman patient in front of me and she has heart disease and I look at her honestly and say taking aspirin will help based on that study I can’t. And so I think it is imperative that we as providers as doctors as nurses that we practice deep humility around the human condition and what we know and what we don’t know are.
Saul Marquez: [00:22:18] How do you stay relevant as an organization. Despite constant change.
Mylea Charvat: [00:22:22] I think we we are constantly at Savonix. In fact we’re right we’re doing it again. We’re going back to our mission vision and values statement and saying Is it still relevant. Is it still the right thing. Is it still what the world needs and it is are we working toward the right thing. We do that annually and I think that’s a big part of how we stay relevant and how we make sure we’re on course.
Saul Marquez: [00:22:42] Love it. What is one area of focus that should drive everything else in your organizations.
Mylea Charvat: [00:22:48] Commitment to personal purpose. Every single person at my company has shared with me in some way what we’re doing at Savonix matters to them whether it’s a child with a learning disability or a parent with cognitive decline a grandparent with Alzheimer’s disease. And I think it’s so important. I like to say that a key diagram in Japanese. You know my purpose is where what I’m good at what I’m passionate about what the world needs and what I can get paid for come together and what I want for my employees. What I think makes our culture special and makes our company so powerful is that I actually want to have team members where what we’re doing at Savonix hits on all four of those cylinders.
Saul Marquez: [00:23:30] Beautiful. And finally Malia what book would you recommend to the listeners on the syllabus.
Mylea Charvat: [00:23:36] It’s related to cognition. It would be Descartes Error The cart’s error. Who’s the other. Antonio Demacio here it is.
Saul Marquez: [00:23:45] Here you go. Listeners you heard it Descartes’ error Antonio Demacio we’ve got a syllabus here for you. All of the things that we just talked about you don’t have to worry about writing them down. Just go to outcomesrocket.health/mylea. That’s why L. A. You’re going to be able to find all of those including a link says Sovann Onix as well as the book that she just recommended, Mylea. All good things have to and including this interview. But if you’d like I’d love to just have you share closing thoughts with the listeners and then the best place where they can get a hold of you.
Mylea Charvat: [00:24:22] I think my closing thought would be. Everybody asks me. You know I give these talks at conferences and when people approach me personally afterwards it’s never about the product. It’s never like they’re happy to take a test code and take a cognitive test but usually they want to know what can I do. I’m scared. You know my grandmother had dementia. What can I do to stay healthy cognitively healthy and everybody wants to know does brain training where I can do crossword puzzles work. And the bottom line is there’s evidence there is very strong evidence for for things that are critical to staying cognitively healthy into late life and you need to start doing them early. You can’t wait until you are 60 and turn this on in fact let us have it. So here it is. Let us have got him. How you got. You got to eat a healthy diet and I’m talking Mediterranean Diet. Get soda out get fast food out get processed food out. You got heat. It’s so critical. The other thing is you need to exercise physically every day. The only thing ever that has been shown to cause neurogenesis the growth of new brain cells in the brain. Do it every day get your heart rate up for at least 30 minutes a day. The third thing you got to get enough sleep and that varies by individual. I need six hours up kind of like in my family even that’s how we’re wired. Some people need more but you gotta do it because you’ve got to give your glial cells an opportunity to clean up all the mess you make use in that big brain all day. And then the fourth thing you got to interact with people you’ve got to socialize and have social engagement and it must be face to face chat bots and phones don’t work because when we look in MRI studies our brain is most active meaning it lights up in the most unique areas when we are looking at another human face. We’ve evolved to read other people not to read devices and we use more of our brains when we’re looking at interacting with another human face than when we do any activity and so face to face and her actions are so crucial to our health our cognitive Pownall as well as our physical health. Those are things and you’ve gotta do a.
Saul Marquez: [00:26:24] Love it. Mylea. Huge value their listeners. Make sure you listen to this again and again and again and then go do it. I know I’m definitely going to be taking action here and I encourage everybody that’s a scene to do it as well. Molly this has been so valuable. Thank you. What’s the best place that the listeners could follow you or get a hold.
Mylea Charvat: [00:26:45] So I’m on Twitter which is just my name @myleacharvat not. So that’s my handle on Twitter and I’m pretty active on Twitter usually and tweeting or posting original content pretty regularly. I have a blog on our Web site and I’m also now a contributor. As of yesterday I did my first article. I am a contributor and invited contributor on cognitive assessment and trends in digital cognition for Psychology Today and I’ll go and I’ll be publishing at least once a month on psychology today going forward about cognition and its relationship to various diseases. If people have particular thing they want us to go help them find content about they can e-mail us at email@example.com and my social media and content marketing person will pick those up and come and say wow what do we know about cognition and say hypertension which was something somebody asked us about and we’ll try to get that into our flow of content because I’m really interested in helping people answer the questions that they have about how cognition relates to their health.
Saul Marquez: [00:27:49] Well I think that’s wonderful and you know I think definitely and having worked with Vanessa She’s outstanding. Shout out to Vanessa you’re awesome. And yes the listeners take advantage of these resources that Mylea is sharing with you and Malia just want to take a moment just to say thank you on behalf of all of us and really looking forward to keeping up with Savonix and everything that you’re up to.
Mylea Charvat: [00:28:12] Thank you so much. Well it’s really fun being here with you today, Saul.
: [00:28:18] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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