As we walk through my own experience visiting Neko Health’s first NYC location last month, Hjalmar Nilsonne warms up.
We’ve had startup founders on the show before whose products I’ve personally used. Neko’s the first, and hopefully only, one where doing my homework meant giving up my blood.
But that squeamishness has paid off as a Band-Aid of honor. And Nilsonne, who, as the son and brother of doctors, now finds himself the CEO of one of the fastest-growing businesses looking to rethink the doctor’s visit and preventive health, seems to appreciate it. During test periods, he’s done a few scans in one day. He loves to geek out about his product.
“People sometimes think that there’s some machine, and you go in, and you get a kind of paper receipt telling you if you’re gonna die or not,” he tells me. “In reality, it’s the exact opposite.”
Neko – with sleek design and a savvy marketing team helping to fuel its popularity, one selfie at a time – calls it “the most valuable hour you can spend on your health.”
And after experiencing it first-hand, Nilsonne and I dive into the how behind Neko’s space-age, but still somehow warm experience. And, at $499 per year and HSA eligible (my first question to the doctor who examines me, and, he responds, his first question, too), we get into the why behind Neko: accessibility to the standard of care, and white-glove experience, which in recent history has only been available to those who can afford private visits to Switzerland via private jet.
Neko’s now valued at a reported $7 billion; just yesterday, after we taped this episode, Nilsonne revealed on X that the company’s NYC waitlist has already swelled from 30,000 to 50,000, prompting it to announce three more upcoming locations in the city, the next one coming at Brookfield Place. Miami, San Francisco and Washington, D.C. clinics are also in the works.
On this week’s episode of The Upstarts Podcast, Nilsonne talks about the fateful Twitter DM from Ek that got Neko going; why the doctor visit hasn’t changed much in 100 years; and how to keep a startup team motivated while chasing a long-term “moonshot.”
Plus, he shares his Upstart Moment: a bet-the-company pivot driven by an internal memo he wrote, “Free Is Not Enough.”
Below, you’ll find The Upshot, my personal takeaways from the interview.
Plus, we’re also sharing Nilsonne’s top company-building advice for startups, in a newsletter exclusive. Read on.
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The Upshot: Alex As Willing Guinea Pig
I will never have the claim to fame of our advisor to Upstarts, Natalie, who was the first woman, and third official member, to ever get a Neko scan in North America.
As an early test patient myself, I went in somewhat skeptical, and left mostly impressed. After a year-plus of punishing founder hours and stress, I’ve tried to be more intentional about my health in recent months – or at least more self-aware – meaning I’ve spent hours catching up on doctor visits, skin exams, blood draws and the like.
My baseline experience: doctors and their staff still seem to mean well. They can be empathetic and even funny; for me at least, they can get the job done as professionals.
But the experience itself is more of a mess. Waiting rooms are unhappy places, shared with occasionally very angry people. And staff are incentivized to move so fast, working through so many patients, that there isn’t much context.
My general practitioner, whose office is just a few blocks from Neko’s NYC clinic, is an even-keeled veteran. I have no plans to stop seeing him. At the same time, it doesn’t feel great to have to remind him of my name and quick context at the start of every visit, while he pulls up my file on a years-old computer system. I have to remind the staff about medicine dosages, and log into a clumsy website to see test results whenever I think they might be ready. It’s a similar story at my podiatrist, whose website is broken and can only bill over the phone, and at my dermatologist, where an exam lasts all of about five minutes (if that).
The contrast with Neko is stark. A staffer greets you with an iPad; you enrobe in a private sauna-like changing room. A nurse walks you through the process and encourages you to take the seemingly requisite selfie. It feels more like you’re in a space-age spa than an examination room.
The most jarring part for me: when a human doctor came in to manually inspect moles and give a once-over. What felt modern and high-tech suddenly feels much more traditional and… fleshy.
“Our general philosophy is we would rather check one time too many than too few, to have multiple layers of controls,” Nilsonne explains on the show. If Neko finds something concerning, it can refer you to another on-call doctor, or help you set up a follow-up appointment with a specialist.
“Most healthcare is like, the machine has to solve this one very specific thing, and it’s all very narrow,” Nilsonne adds. “We think about the whole picture of your health.”
When I tell my GP that I’ve gotten a Neko scan and offer to show him the full results – easily read on a dedicated app, and at a level of detail I’ve never seen from other tests before – he scoffs that such services are incentivized to scare you about your health, and push you toward expensive remediation. And I get where he’s coming from, but it doesn’t match my own experience.
For 92% of Neko members, their scan doesn’t show anything seriously concerning, but provides them with baselines to monitor, and a wider understanding of their body, than they’re getting from a generic annual physical. So it doesn’t surprise me that most members book their next appointment while still in the room, a savvy business move by Neko to encourage, but one that seems justified.
We talk a lot on the show about accessibility, and how Nilsonne wants to make high-quality doctor visits more affordable for a wider base of people. At $499 in the U.S. and a bit cheaper in the U.K. and Sweden, that feels credible, at least for now. If Neko starts to offer premium tiers, or more experiences to upsell members on even more layers of health understanding or preventive care, I reserve the right to seek out a second opinion.
Startup Building Tips From Neko’s CEO
Nilsonne has told the story of Ek reaching out over Twitter DM before, but the way he frames it on the podcast is a valuable reminder for business builders.
As the founder of a climate tech startup that had “crash landed,” he was in between companies, essentially licking his wounds, at the time that Ek pinged him.
“When you’re on the up with a company, everyone is your best friend. Every angel investor and their uncle is like, ‘Dude, I always knew that you were the most talented person ever. We’re gonna support you, you know, ‘til the end of time.’
And then when things don’t go well, it’s like, block, block, block, block, block. Like, literally no one wants to return your call.”
But Nilsonne’s failed startup had two big immediate impacts on Neko: it taught him first-hand that you can’t rely on a market’s established players to be motivated partners (check out the chapter about his memo, ‘Free Is Not Enough’) – and the enthusiasm he’d shown talking about the company, Watty, at a conference had impressed Ek, who remembered Nilsonne, a stranger otherwise, as the type of founder who might be able to take on a new moonshot.
That leads to Nilsonne’s best advice for startups: get back on the horse.
Ek gave him that pitch with Neko: with a big opportunity already looming, what was he doing recovering for an extended period of time, or feeling sorry for himself?
When I ask Nilsonne about where he would use a do-over, or ‘reload from last save’ option, he talks about Neko’s pivot following that memo, and the cultural shock it meant for the company. Initially, Neko didn’t plan to build and operate its own clinics. Once it committed to doing so, members of the existing team were shocked at how much Neko was suddenly focusing on consumer product concerns, like colors and shades, lighting effects, and visit experiences.
“There was a lot of friction,” Nilsonne says. “This was a cultural reset that took at least a year to really demonstrate that it mattered, or that it made sense.”
With a do-over, Nilsonne would have leaned into those clinics from the start – making it clear what Neko would stand for and how multi-faceted it would need to be, and hiring relevant experts sooner.
The advice for startups is two-fold: control your product experience, and do the hard thing fast.