Re-imagining the future of healthcare

Twice, medical imaging failed Alex Dresner’s family, resulting in missed diagnoses and delayed treatment. The first instance occurred when a radiology report failed to identify lung cancer in Alex’s father, leading to a terminal outcome due to the late diagnosis. Years later, Alex experienced a similar ordeal, receiving a false-negative report before a second opinion correctly identified his cancer. His own struggle with the healthcare system and the inadequacies of diagnostic imaging left him wondering why the system couldn’t do better.

This experience ultimately became a turning point in Alex’s life and career, as he co-founded Imagen, a company dedicated to changing the way patients get diagnosed, treated, and managed. Imagen offers the first-ever diagnostics-as-a-service (DaaS) platform, partnering with primary care physicians to provide imaging capabilities directly in their offices. The platform provides everything needed for diagnostics, including equipment, staff, specialists, and internally developed, FDA-cleared AI software.

Currently, few primary care physicians (PCPs) have in-office imaging capabilities, resulting in over 1,000 patients per year being referred to high-cost and hard-to-access care settings. Imagen’s platform changes this by providing patients with immediate diagnostic tests, results, and next steps all in one visit to their PCP.

By enabling PCPs to provide on-site diagnostic imaging, Imagen is helping to reduce costs, increase efficiency, and improve patient outcomes. Imagen’s DaaS platform is setting a new standard for healthcare, and Alex and his team at Imagen are at the forefront of this movement.

We caught up with Alex to talk about the future of primary care and the impact Imagen is having on the healthcare industry.

Q: I’m not sure whether to define you as a technologist or as a business guy. Maybe it’s neither — I saw that you studied history and government at the London School of Economics (LSE). Let’s start there.

Alex: I’m not sure how to define myself. I don’t think of myself as a businessperson or as a technologist or some other category. I have a passion for solving problems more than I do trying to become a subject matter expert in a particular area.

Q: When you were studying for your degree, did you toy with the idea of a career in government or academia? Or was it just more of a desire to get a grounding in the liberal arts?

Alex: My academic focus was to get a broad-based liberal arts education. I was very interested in politics when I was at LSE. After graduation, I wound up working at the White House in the speech writing office from 2009 to 2010. But I rarely wrote the speeches — it was more getting a lot of coffee and doing a lot of research in the middle of the night. Still, it was an interesting experience.

Q: After the White House, you left to work for Bridgewater in investment management. Given your subsequent career path, it’s a bit out in left field.

Alex: I’m not sure I thought of it as investment management. I thought of it more as being in an environment with a bunch of very smart people working on hard problems. And it just so happened to be in the investment space. You have to justify yourself on a day-to-day basis while you’re doing the work. But it was way more challenging than the government.

Q: What did you get out of that experience?

Alex: It’s not that they’re perfect, but Bridgewater is so rigorous about everything that it attempts. There was a lot of focus on how to draw unique insights out of an assessment process and find the diamond in the rough. A lot of it was very theoretical, but I’ve been able to put a lot of those skills into practice, which has been great.

Q: How did your family experience with the healthcare system impact how you formed your thinking about what needed to change?

Alex: The most profound insight for me was about empathy in the healthcare journey, and what it’s like to lose somebody. That helped me see a problem that I experienced personally and that led me to pursue what I do now. In terms of other insights, I would say one was born out of a terrible patient journey, both for my father and me that involved the long process and multiple steps to get the right diagnosis. It took us a very long time to navigate the system. After having experienced what we thought was the right answer at prior points in the journey, we ultimately realized that it wasn’t the right answer, and it was a misdiagnosis.

Q: At what point did you think about trying to take on the challenge of fixing the problem by starting a company?

Alex: I’m an accidental entrepreneur. Something important happened in my life and I felt compelled to fix it, versus someone who was looking for a business or an idea to build a business around. I describe it as sort of a little big bang theory. When I was still at HSS, I was introduced to a team of doctors as well as to my Imagen co-founder, Rob Lindsey. The doctors were complaining that they were seeing more misdiagnoses from urgent care and primary care groups around the country, and wouldn’t it be great if someone could build software that could automatically detect things. So, over many meetings over the next six months, we all got interested in this idea. Eventually, I went to the CEO and told him that I need to leave and go work on this. I don’t know if there’s any money there and I don’t know what this thing is. But it’s just so cool that I’ve got to go do it. That’s how Imagen came about with a bunch of random people getting excited about the same thing at the same time and who really wanted to work together.

Q: Was the idea to improve diagnostics always the goal, or did that just emerge from this creative scrum?

Alex: The business went through a couple of manifestations, and I would say that we have a different North Star today than we had then. Before, it was very much, “Hey, wouldn’t it be amazing if we could build AI that could detect things more accurately than humans could and therefore do it better, faster, and cheaper.” That technology had never been built. And so, we spent the first several years figuring out whether this software could be built. We operated like an R&D lab for two to three years and eventually landed on a business model, which is our business model today that is successful and has taken off. But that original North Star was primarily diagnostic-focused, whereas nowadays it’s less about one stage of the healthcare process and more about a setting of care, which is primary care.

Q: When you speak with PCPs, how do you convey the business value of what Imagen does?

Alex: Broadly speaking, a primary care group will have several priorities. They’re going to want to drive better outcomes, better economics, and then better experiences for patients and providers. We can help them with all of these. What we’re able to provide with our platform is to improve accuracy of, and access to, core diagnostic tests, which means diseases can be identified in their earliest stages, and therefore the likelihood of a better, lower cost and higher value outcome is greater. And by improving access to core diagnostics, we are ultimately driving better outcomes.

PCPs are paid in one of two ways; they’re paid on a fee for service, so for every test, procedure or interaction that they engage in, they bill the insurance company or the person and they get paid per test, or on the other end of the spectrum, you have primary care groups that get paid lump sums of money to take care of patients. So instead of being incentivized to do more procedures, they’re incentivized to catch disease in its earliest stages, intervene, and ultimately manage patients — not once they get to the hospital. Ultimately, we want to keep people healthy.

Q: For doctors who work with Imagen, what is provided?

Alex: Imagen provides everything. It’s really an end-to-end diagnostic platform. We call it diagnostics as a service, where we handle everything. We bring in imaging or diagnostic equipment to the staff to operate it. We also do the IT and workflow integrations, the marketing, scheduling, billing support — all the way through to FDA cleared AI-enabled interpretations.

There are specialists who read the output of the diagnostics. An X-ray gets read by a radiologist, and an echocardiogram must be read by a cardiologist. And then lastly, if there are abnormal findings or areas of concern for either the patient or the PCP, they will have the ability to do a virtual consult at the point of care to figure out appropriate next steps. So, what you’re getting in that single PCP visit is the primary care and specialty perspective in a single patient visit.

Q: As a startup operating in one of the most established industries you can find, what obstacles have you navigated?

Alex: I don’t think of them as obstacles to success. I just think of them as the difference between a good business and a great business. Diagnostics is 5% of spend in the US healthcare economy, and it accounts for 70% of decision making. It has this big impact on care, but we don’t pay that much for it as a system. As groups shift towards these quote-unquote value-based care models, there’s a great opportunity to both highlight and demonstrate how impactful diagnostics is if you’re managing a full patient episode, as well as how economically advantageous it is to properly manage diagnostics internally. There is massive change in the US healthcare system and PCPs are taking on more risk. They’re having to change how they operate and how they think about the world. And a core part of that is how do we change their view on the value of diagnostics.

Q: And what are the opportunities for Imagen?

Alex: Imagen is one of the few companies in healthcare that has a legitimate chance of becoming a $20 billion dollar business. Have we figured everything out? Absolutely not. But we are operating in one of the largest TAMs in healthcare, in a massively under-penetrated market, and we’re seeing the demand materialize far quicker and more broadly than we initially anticipated. Imagen has struck partnerships across the US, including with many of the largest and most sophisticated primary care networks — networks that have historically been impossible for 99% of companies to penetrate. So, the immediate opportunity is significant, and it’s about servicing the heavy demand we’re seeing — particularly as PCPs shift into risk-bearing models, our platform is being seen by these groups as a core piece of infrastructure needed to successfully manage risk. And it’s not just about net new customers; one of the really exciting things we’re seeing is the stickiness of our platform and the growth inside existing customers, with more than 70% of our customers adding additional Imagen capabilities once we’re inside.

Q: How many job candidates come knocking on your door with their own stories of the healthcare system failing them and saying, “Hey, I want to be involved in something that will remedy this”?

Alex: It’s high. Anecdotally, I would say those numbers are probably 20% to 30%. Interestingly, that also aligns with stated diagnostic error rates.

Q: Startups talk all the time about being motivated by passion. But it seems as if this sense of mission is very personal to you as well as to a fair number of people on your team.

Alex: That’s very true. Having had a significant negative experience with the healthcare system is certainly not a prerequisite for working here. But I do think there is a deep passion and sense of responsibility to patients to fix these problems. This is a space where you can put your energy and talents to work to make things better. These are people who care enough that they’re not willing to let their egos get in the way as they debate and try to get to the right answer.

Q: As an entrepreneur, what’s proved to be your biggest challenge?

Alex: Having to do or solve so many things that I’ve never encountered before. The speed at which I must figure out whether I’m good or bad at something and then come up with a solution is really challenging. You can always solve the problem with the right hire, but you often don’t have that luxury in the short term, requiring leaders to dive in, develop a deep understanding of the context and problems, and then solve them.

Q: You’re running hard most of the time. Is there a single lesson that you’ve been able to learn about yourself by going through this entire process?

Alex: This isn’t unique to me, but it’s amazing the power and energy one can get if they’re motivated by something.

Q: How do you blow off steam when you’re not working?

Alex: I love going to new restaurants and I love making food at home.

Q: Favorite book?

Alex: The Wright Brothers by ​​David McCullough. I still re-read it. At heart, it’s a story of two of the most successful entrepreneurs in US history. Massive ups and downs — including crashing a plane that the president was in, if I recall correctly. But they made it through!

Q: Favorite movie?

Alex: Anything mindless — “You, Me and Dupree.”

Q: Who’s the one person in your life who’s had the most impact on your professional career?

Alex: Hands down, one of my co-founders, Tom Hotchkiss, who has had 10 times the influence of anyone else on my career. He’s one of the sharpest minds I’ve ever worked with. When you work around great people, you must step it up and be on your A game. That’s very much what he gave me — and continues to give me.