Women lead the healthcare economy and deserve a better healthcare experience. Finally, investors are taking more of an interest in women’s health companies and the solutions they bring to bear. But a question remains: “What the hell took them so long?”
“It’s both a blessing and a curse to be labeled a women’s health company sometimes,” said Jessica Bell van der Wal, cofounder and CEO of Frame Fertility, a digital platform for the early identification of fertility risk and women’s health navigation. But that labeling isn’t a deterrent from Bell van der Wal’s mission with her company, especially given her personal fertility experience and the impact that it continues to have on her life and others’ through Frame.
“I didn’t find out until it was too late that there were a lot of issues that would impact my ability to have children,” explained Bell van der Wal. “By the time I understood them, I was told it was too late, and that the only option for me was fertility treatment,” she said, noting the incredible time and money spent on the process, and both the mental and physical toll that fertility treatments took on her.
And while Bell van der Wal knows she is one of the lucky ones – her daughter will turn two this summer – her mission with Frame is to change women’s fertility journeys and shift care from reactive to proactive. And, like many others in the women’s health space, she is utilizing technology to make change possible.
Driving Investments In Women’s Health
In 2019, only 2.8% of VC funding was used to invest in women-led startups across the nation, a figure that dropped down to 2.3% by 2020. However, the sun shines a little brighter when looking at femtech healthcare company investment specifically. As Rock Health reported, US digital health startups serving women+ raised $1.3B through August 2021, nearly doubling all of 2020’s $774M funding. (While that accounts for 7% of the digital health funding pie, it is still down from the 11% high from 2019.)
Yet despite only getting a relatively small slice of the funding pie, women continue to be the primary healthcare utilizers, decision-makers, and managers for themselves and their families, even propping up parts of the healthcare industry in a near-ubiquitous fashion. And they want and deserve care models that work for them.
As Carolyn Witte, cofounder and CEO of women’s health company Tia, notes, “Women are the most influential healthcare consumer in our country, control most of the decisions, and actually make up a slight majority of the population, so it only makes sense that investors and providers take notice. The greater question is, what the hell took them so long?”
With this in mind, six women’s health company leaders weigh in on opportunities and challenges in the market today, their companies’ mission, and how they are working to improve women’s healthcare options, engagement, experience and outcomes.*
Q. What do you think is driving the uptick in attention and investment in women’s health in recent years?
Anna Lindow, cofounder and CEO, Brave Health: For far too long, women’s health as a whole has not been given the attention it deserves. As the industry matures, we are seeing a range of fantastic founders take the lead in addressing a wide range of conditions from menopause to postpartum depression. For example, we know biological and hormonal issues stemming from pregnancy can have serious implications on mental health. Up to one in seven women are diagnosed with postpartum depression, according to the American Psychological Association, yet many never receive treatment. We believe this is partially because there simply hasn’t been enough available care–and this issue, as is often the case, is the most pronounced for Medicaid beneficiaries. That’s why we are investing heavily in maternal mental health to combat disparities for Medicaid and underserved populations.
Jessica Bell van der Wal, cofounder and CEO, Frame Fertility: I think it’s a combination of things. First, I think the pandemic has brought a lot of things to the surface related to health equity and underserved populations, and women are one of those groups. Additionally, I think that there have been some recent successes in the space, such as Maven Clinic, that have gotten investors and the public energized about women’s health. These successes have also brought to the surface really alarming statistics that have gotten more and more people energized about the gap that exists in women’s health and how much we need to fill it, as well as how big the market is.
Hilary Coles, cofounder and SVP of Brand & Innovation, Hims & Hers: Women are often considered the “chief medical officers” of the household, making 80% of the healthcare decisions in their family. Because of that responsibility, women must be incredibly savvy and well-researched. But it’s clear that many of the options and solutions in the market today are not acceptable.
Carolyn Witte, cofounder and CEO, Tia: The US healthcare system has traditionally viewed women as a niche market, but I think we’re finally starting to see some stakeholders realize that the market is changing. Women are demanding more, and frankly they are entitled to it. Women are the most influential healthcare consumer in our country, control most of the decisions, and actually make up a slight majority of the population, so it only makes sense that investors and providers take notice. The greater question is, what the hell took them so long? Since our founding, Tia understood that women need their own medical home for healthcare that understands the specific physical, mental and psychosocial needs of women, and we are proud to be an example of the recent increase in investment.
Michelle Davey, cofounder and CEO, Wheel: Women are the predominant buyers of healthcare. Yet women’s health is in dire need of disruption, investment, and attention. I’m confident we’re just in the early innings — especially as powerhouse companies like Maven, Carrot Fertility, and Tia continue to grow and demonstrate their impact. But true innovation can’t happen in a silo. We need to continue to educate the industry on comprehensive care opportunities for women — and pave the way for more founders with innovative ideas. That’s a big reason why I’m a mentor and angel investor for women’s health founders. I can take the lessons I’ve learned along the way to help drive much needed change across the space.
Joe Connolly, CEO, Visana Health: Most people conflate “women’s health” with maternity and don’t understand the full spectrum of women’s health concerns. There’s been a complete lack of research, and there’s still a lot of stigmas around many women’s health conditions because they’re related to periods. A new cohort of entrepreneurs, executives, and investors are educating stakeholders across all aspects of the healthcare system about the breadth that “women’s health” encompasses, from conditions that only affect women to conditions that differently affect women. Analogous to the destigmitization of mental health conditions in the last five years, we’ll see women’s health conditions destigmatized over the next five years.
Q. Why did you start (or join) this company, and what do you hope to achieve?
Anna Lindow, cofounder and CEO, Brave Health: My interest in mental health stems from a desire to expand access to the services that helped me in adolescence. I received care that changed my life when I lost a parent in high school, so I understand the impact that care can have. And during my career in EdTech at General Assembly, I witnessed first-hand how enhancing tech skills created more independence and opportunities for students. So when the moment came for my cofounder, Jake Schwartz, and I to do something in the mental health space, we took it. In 2017, we launched Brave Health, a virtual-first start-up with a mission to make high-quality behavioral healthcare affordable, scalable and accessible for the underserved.
We want to disrupt a market—that desperately needs innovation—to bring critical mental health care to Medicaid patients in all 50 states. Today, one in four Americans are receiving benefits through Medicaid, and while there are fantastic care providers across the country, there simply isn’t enough capacity to go around, with wait times sometimes being months long. Brave Health was built to overcome these inherent obstacles, give individuals the tools to overcome perceived limitations, and foster the skills necessary for lasting behavioral change.
Joe Connolly, CEO Visana Health: I started Visana after watching my mother suffer from horrible menstrual pain for her entire life. She often had pain so bad she would puke, but despite that severity of pain, she struggled to get any semblance of care. Doctors dismissed her. They’d often say, “Take some ibuprofen and tough it out,” or, “everyone’s period hurts.” It took her 25 years to get a diagnosis: endometriosis and fibroids. She needlessly lost years of her life to her condition. We’re building the care model I wish my mother had access to, and our North Star is improving women’s health outcomes.
Jessica Bell van der Wal, cofounder and CEO, Frame Fertility: I didn’t set out to start my own company. I was at the intersection point of a transition from a professional standpoint and Covid had just hit and I happened to be six months pregnant. This got me thinking a lot about what I wanted to do next, and like a lot of people, I realized that I wanted to focus on something I cared a lot about. And one of the things that I really couldn’t get out of my head was the horrific fertility experience that I had. And as I started to survey the landscape and look at the other options in the space, I realized that everyone else was focused only on one element of the equation, which is when you are trying to conceive and/or have issues, how do we support you.
Philosophically, I want to help people avoid these issues, or really the fertility crisis, in the first place. I didn’t see anyone trying to prevent infertility; I saw everyone trying to address infertility and help you get through it. My goal is to help drive fertility health conversations early to avoid the downstream crisis for everyone. There are things that you can do in advance to help understand where you may be on the spectrum, and I want to provide support to ensure that people don’t feel out of control and lost as they go through the fertility journey, like I did.
Hilary Coles, cofounder and SVP of Brand & Innovation, Hims & Hers: I joined Hims & Hers’ cofounder and CEO Andrew Dudum to build this company because I grew up with access to education and affordable medication my whole life in Canada. I grew up taking care of my younger sisters while my mom worked. But, I recognized that the U.S. healthcare experience was much different, and I don’t know what we would have done without the access we had. I believe that everyone deserves that peace of mind – to know they have access to high-quality care without the massive tradeoffs between high costs and high quality that are so often present within the traditional US healthcare system.
When you don’t feel like yourself, whether physically or mentally, it’s extremely difficult to know what to do. Maybe a woman is facing sudden hair loss, or perhaps she’s having trouble getting out of bed in the morning. Regardless, in our healthcare system, it’s not often clear where to go first to find solutions. The US healthcare system does not make it easy, especially for women, so we aim to make it as easy as possible. Hers always has her back.
Carolyn Witte, cofounder and CEO, Tia: Together with my cofounder Felicity Yost, we realized that most women didn’t have a trusted medical home that is designed by and for women. Women are 30% more likely to be misdiagnosed than men; and female-specific conditions like endometriosis, fibroids often take 10 or more years for accurate identification and diagnosis. It’s no surprise, then, that the healthcare system has a “loyalty crisis” with its most powerful customer, with 50% of women reporting not trusting the healthcare system.
That’s why we built Tia; to be a one-stop-shop for integrated physical, reproductive, and mental healthcare with a strong focus on preventive health. We’ve created a comprehensive clinical model that supports the whole woman throughout her entire life – an approach that doesn’t segment a woman by life stage or body part and one that merges virtual care with in-person healthcare services.
Q. What are the biggest challenges to creating a business focused (at least primarily) on women’s health?
Carolyn Witte, cofounder and CEO, Tia: The biggest challenge is overcoming the myth that women are some niche market that can be treated in a one-size-fits-all model. At Tia, we believe in creating a relationship-driven care model that engages women early on and focuses heavily on preventive health. However, finding the right investment and health system partners is always a challenge, but it’s one that Tia has navigated successfully to date. We were fortunate enough to recently close a $100 million series B funding round, representing one of the largest of its kind for a company at this stage. We also plan to work with our health system partners to scale Tia to support 100,000 women by 2023.
Hilary Coles, cofounder and SVP of Brand & Innovation, Hims & Hers: Women’s healthcare has traditionally been under-resourced, and investment in research to improve treatments and care access haven’t received the same level of investment as men. Yet, at the same time, women’s biology and healthcare needs are incredibly complex, often creating a bad experience for women that leads to poorer health outcomes.
Additionally, women are frequently discounted when they report symptoms like pain levels compared to men, and they can start to experience these disparities as early as three-years-old. All of these issues and prevailing attitudes result in lacking trust in the traditional US healthcare system. I believe that’s why companies like Hers have grown so quickly, because we provide women with honest, personalized and unhindered access to comprehensive care.
Joe Connolly, CEO Visana Health: First, despite growing awareness in the entrepreneur and investor communities, there’s still a lack of awareness of the breadth and size of women’s health amongst health plans, employers, and health systems. You’ll often hear that women’s health conditions are too “niche,” despite the fact that there’s more women with these conditions than there are people with diabetes. We’re just now seeing this sentiment reverse and more investment in women’s health from purchasers.
Second, there’s a staggeringly small amount of research in women’s health. Women’s health has been underfunded for decades. This slows innovation, from therapeutics to care delivery to devices. We need more basic research and clinical research to help identify new breakthroughs that can improve women’s health outcomes.
Jessica Bell van der Wal, cofounder and CEO Frame Fertility: One of the biggest challenges of building a company that even touches women’s health is that, now that there are solutions like Maven Clinic, people and particularly investors will say, “Well, it may be doing all of these things, but do we need something else?” And that’s so interesting to me, because we can’t just say we checked the box on one women’s health solution and now we’re done. There’s no other part of healthcare that works the same way. And yet women’s health serves over 50% of the population, so it really can’t be a one and done solution.
I sense that people believe that women’s health, including fertility, is now saturated, but there are still significant challenges to overcome, and it’s important to have multiple solutions to drive innovation, partnership and better outcomes for patients. It’s both a blessing and a curse to be labeled a women’s health company sometimes.
Q. Many digital health solutions tend to serve commercially insured or Medicare populations. Is there anything you are doing specifically to try to reach underserved populations?
Jessica Bell van der Wal, cofounder and CEO Frame Fertility: Yes, our goal is to redefine family planning to be focused on what all people want for their families (not just what they don’t want and thus need contraception for!) We are building various components and flavors of our product that can be used in different settings (e.g., reactive urgent care, proactive well woman visit), and we are kicking off pilots to test lightweight versions in Medicaid settings now.
Hilary Coles, cofounder and SVP of Brand & Innovation, Hims & Hers: At Hims & Hers, we recognize that so many people can’t access healthcare because of high costs. While we don’t currently have relationships with insurers, accessing care on our platform – whether it’s for primary care, mental health, dermatology, sexual health or other healthcare services – is often less than the cost of a typical co-pay or co-insurance. That’s especially true for those on high-deductible plans, which a majority of Americans have.
Additionally, by offering telehealth-based healthcare services that don’t require people to physically visit a physician, more people can access care on their own terms. But, we also recognize that more people in underserved communities need access to telehealth. That’s why Hims & Hers is a founding member of the Telehealth Equity Coalition, which is driven to improve access to quality and affordable healthcare by increasing adoption of telehealth, especially among those communities who have been left out or left behind.
Carolyn Witte, cofounder and CEO, Tia: Core to Tia’s care model and approach to DEI and health equity more broadly is a steadfast belief that recognizing difference is essential to quality and cost reduction. While sex-specific difference is one key vector and way to segment the healthcare system of the future, we recognize, too, that women as a group are not a monolith; we need to not only recognize but affirm and tailor our care to other key elements that may distinguish one woman’s lived experience from another, by taking an intersectional approach to care, considering how race, ethnicity, sexual orientation and other aspects of our identities impact how we access and experience healthcare.
And we are proud of what we’ve achieved thus far: Today, more than 40% of Tia’s members identify as non-white and 7% use a pronoun other than she/her. We know that women of color, and especially Black women who have experienced decades of systemic racism often want to see a provider who “looks like them” and shares their lived experience in the world. More recently, we’ve expanded the ways we support our trans and non-binary patients with dedicated pronoun training for all of our clinicins + new services like HRT to support patients amidst transition.
Anna Lindow, cofounder and CEO, Brave Health: In spite of all the rapid growth of digital mental health companies, few are offering solutions to the ongoing challenges in Medicaid and mental health. When we started working with health plans in 2019, it surprised many that we had so much conviction around working in the Medicaid space. And we understood why; it can be a difficult market to break into—high regulatory barriers, long timelines—but the barriers to quality mental and behavioral care are often the most significant and can have the most nuance for the Medicaid population. But the need is so great that we felt strongly that there was a role for a national provider to operate alongside the work happening on the ground.
One of the biggest challenges in caring for Medicaid members is simply getting them into care in the first place. Once we receive a referral from either a primary care doc, or a case manager, we take on the responsibility of reaching out to the member and setting up a first appointment. We don’t wait for patients to come to us. This type of engagement isn’t a “nice to have”; it’s critical to quality measures like 7-day follow ups after hospitalization.
*Answers have been edited for length and clarity.