Tuesday, December 6, 2022

Transcript: The Path Forward: Health Care with Kate Ryder, Maven Clinic Founder and CEO

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MS. SELLERS: Hello, and welcome to Washington Post Live. I’m Frances Stead Sellers, a senior writer here at The Washington Post. From fertility care to pediatric support and mental health counselor counseling, Maven Clinic is a telehealth platform that aims to provide families and their offspring with a wide range of services. I’m joined now by the founder and CEO, Kate Ryder.

Kate, a very warm welcome to Washington Post Live.

MR. RYDER: Hi. Thank you so much for having me.

MS. SELLERS: We’re very pleased and looking forward to a conversation. And before we start, a word to our audience. We would love to have you join the conversation by tweeting questions for Kate to @PostLive. That’s the Twitter hashtag @PostLive. Thanks for joining in.

So, Kate, let’s start with going back a decade or so to the beginning of Maven Clinic. What prompted you to support and begin this particular platform?

MS. RYDER: So, I started Maven eight years ago, and eight years ago, we were still in the very early days of talking about all of the kind of issues that we’re finally talking about today. So, whether it was postpartum depression or miscarriage or struggling with infertility, a lot of these conversations were still heavily stigmatized. And so I was starting my family journey about around that time and saw myself and a lot of my friends going through major gaps in care and how we were experiencing these family building journeys both with ourselves, our partners, and then ultimately as we became chief medical officers of our homes, with our–with managing our kids’ health as well.

And so I thought there was a lot of new and interesting technology at the time–telehealth included–and how amazing would it be to reinvent the care model, bring more holistic equitable care to women and families. And since then, we’ve expanded not just to women’s health, but to LGBTQ health, family health, children’s health and more broad-based reproductive health.

MS. SELLERS: Yeah, I was struck by that. You refer to partners, of course. You refer to LGBTQ. I think something like 40 percent of your membership is–identify as male. What kind of specific services do you provide for that group?

MS. RYDER: Well, you know, I think it’s always been our belief that it’s both partners. A woman may be pregnant, but particularly, you know, her partner should be included in that care journey. And then for same-sex couples, we support infertility journeys, egg freezing, surrogacy, adoption. And then in pediatrics, we actually see a lot of our male members using sleep coaches and pediatricians to really help manage the family’s household around their health.

MS. SELLERS: I’d love to ask about health equity, which has become such an issue–or it always has been an issue, but it’s certainly come to the forefront in recent years. As a telehealth platform, you’re potentially more accessible across the spectrum. And I have an audience question that’s come in from Nidhi in California. I will read it to you. Nidhi asks, “How do you address care to underserved and minority women?” Great question.

MS. RYDER: Sure. So, this is one of the things that we’re quite proud of and I think one of the absolute examples of the power of telehealth. So we have over 30 types of providers in our platform. Forty percent identify as BIPOC. Ten percent represent as LGBTQ. And so we’re able to match care based on someone’s lived experiences and how they prefer to be seen and heard and so they’re able to build that trust with a with a virtual care provider. So that’s one big area.

You know, only about 75 percent of White members say that they can meet with a doctor in person. Only 20 percent of Black and Hispanic patients are actually meeting with providers who share their ethnicity or their race, and that leads to worse outcomes. There’s a lot of studies that have shown that when Black patients see Black providers, they get better outcomes, particularly in maternal health, where the outcomes are that Black women die at three times the rate of White women in childbirth. It’s a really important issue. And so bringing this culturally competent care via telehealth is one of the ways in which we can begin to solve this. You know, we do it both at Maven, but as a broader healthcare system.

And I think the other the other area that’s really important, too, is Medicaid and working in Medicaid. You know, that’s where a lot of the, you know, minorities and underserved populations in maternal health. There’s a lot of very adverse outcomes there. And so we’ve just also made our first foray and launched our first populations in Medicaid this past year.

MS. SELLERS: Just to follow up a little bit on that, take me through the steps of you know, I come into your system, how do you do this matching of people who come in with doctors or providers who meet some of the–who have cultural characteristics that meet their own?

MS. RYDER: Sure. So, we have almost 2,000 providers in our network, and the telehealth is kind of overlaid with a care navigator or care advocate. And so once a patient comes into Maven, they meet with their care advocate. They can also meet with a care advocate of a specific race or that speaks a specific language. And then through their kind of questions they answer in onboarding as well as their conversation with their care advocate, they’re able to craft a care team that works for them. And so, you know, whether it’s race, it’s gender, it’s language, you know, patients are able to pick and choose.

And then I think what’s also pretty unique is 30 different types of providers just in women’s and family health is quite a lot. And so there’s also so many different holistic providers that can bring into these care teams, like pregnancy coaches or doulas or midwives, genetic counselors, adoption coaches. And so, you know, they’re really able to craft a care team that works for them.

MS. SELLERS: So, the declaration of a public health emergency really transformed telehealth for many people. You’re already in the business. What unique approach did you take at Maven to take advantage of the public health emergency and also to take advantage of the skills you already had from being in this area for such a long time?

MS. RYDER: Sure. So, I think we all remember those kind of crazy few months right when the pandemic hit in March 2020. You know, and being the largest telehealth provider in women’s and family health, we felt like we had a big–you know, we had a big service to do, and not only kind of for company growth, but we did do some emergency launches in those first few months. And what was–what was kind of amazing as I think back is we at Maven, as well as a small company, had just transitioned to remote work, and everybody was working around the clock. Sometimes–you know, I had two kids at that point, with kids kind of running around screaming in the background, as we’re all trying to manage this.

But we stood up some emergency contracts, one with the–with the state of Massachusetts and others–to really bring fertility, maternity, and pediatric telehealth to a lot of–a lot of patients who all of a sudden started to–you know, didn’t have access to care. If you remember at the time, there was a lot of fertility clinics shut down, and then for pregnant family or for pregnant women and their families, there was only one person often allowed in the hospital room, and there was just so much anxiety during that time.

But then what we saw, you know, as the pandemic wore on, is that telehealth became a mainstream kind of understanding among consumers. And so I think it was one of the things that we had always struggled with starting back in 2014-2015 as a lot of people didn’t even know what the word meant or what it did. And so we saw a massive uptick not only in kind of new customers, but within the customers that we had. Whether it was employees of, you know, big companies or members of health plans, they were–started to sign up for Maven in droves.

And so we saw, you know, not just kind of new sales go up as people recognized the importance of women’s and family health in the broader healthcare ecosystem, but they all–we also saw just a greater understanding and literacy from the consumer on what the possibilities of telehealth and virtual care were and how it could really help them.

MS. SELLERS: So, you became a unicorn company, I think, right in the middle of the–of the pandemic, maybe last August. What message do you have to investors in women’s health? What do you see the future holds?

MS. RYDER: Well, I think that when the show was starting, I was–I was seeing one of the original the initial stats that women make 80 percent of healthcare decisions. And I think that fundamentally, you know, women’s and family health has been so underserved for so long that as we look to transform and change the healthcare system for the better, this is one of the core constituencies and populations that have been left out, and so there’s just such an incredible impact that you can have systemically if you invest in family building, you invest in women’s health, you invest in this kind of, you know, beginning of somebody’s health care journey, and then really continue to serve them–you know, man or woman or child, you know, across a whole family care platform.

I think also what–we’re really in the very early innings. Today, we actually announced that we’ve recently launched a menopause product. That’s yet another area of women’s health that has been really underserved. I think what we’ve seen with Roe v. Wade being overturned, you know, access has been further restricted with a lot of LGBTQ rights as well. And some of what we’re seeing in the state legislatures access is, you know, being restricted and mental health and a lot of discriminatory practices are going up, which is–which really affects–you know, continues to affect one of the most important consumers of healthcare. So, I think we’re in the early innings, and I think hopefully what our valuation proved, as well as many other companies in our market and how much growth they’re experiencing, that this is–this is just a critical part of mainstream healthcare.

MS. SELLERS: We’ll get to menopause and the post-Dobbs atmosphere in a minute. But I want to ask you specifically about being a woman-led company. I think venture capitalists put only 2 percent of their investment into female-led companies. What advice do you have for other female founders, and why do you think this gap continues to exist?

MS. RYDER: Well, no pressure. But listen, I think that one of the big problems that we certainly saw early on is that venture capital rooms were full of mostly male partners. And so when you’re bringing unique issues that they may not understand as much about, then, you know, they may–they may be overlooked, like women’s health as an example, or children’s health.

And so one of the things that has helped us through the years, and I think continues to help diversify the capital and where it’s going, is there’s more female partners in venture capital. You know, our series A was led by a woman. Our series B was led by—co-led by two women. Our series D was co-led by a woman. And so we have–we actually have more women on our board than men. And that has helped us a ton.

I actually don’t know if Maven would be where we are today, if we didn’t have a lot of those female venture capital partners. And hopefully, you know, I think one of the great theses as well, if you look at a lot of women venture investors who are also trying to drive returns for their venture capital firm is that there’s a lot of underserved and a lot of, you know, parts of the female population, whether it’s retail companies or other products, because they have been overlooked by venture capital.

And so there’s a massive business opportunity. I think, when you also look in–there’s a lot of organizations now. Like Lean In, you know, published stats on company performance if they have more diverse teams. And so, you know, hopefully, there’s people taking notice. It’s still an uphill battle sometimes, but at least there’s more females around the table who are advocating for some of these products.

MS. SELLERS: So, let’s now get to reproductive health and the fallout from the Dobbs decision. You referred to it earlier on. What was your reaction as a company leader, and what did you begin to hear from patients?

MS. RYDER: Well, with the Roe decision, we knew–I mean, a lot of the people in the women’s health community knew it was coming right when SBA was passed in Texas last fall. And then obviously, there was the leak from the Supreme Court. What we did is we worked across a few of our product lines to really ramp up what companies and health plans could offer members to bring better access to care. So, one of the products, Maven Wallet supports travel reimbursement across states. Another product, which is our pregnancy options counseling product, which is part of our core maternity track, helps, you know, women understand when they get pregnant what their options are, whether they want to give a child up for adoption, whether it makes sense to terminate a pregnancy, and in compliance now, of course, with the state laws that they live in, or whether they want to continue with the pregnancy.

And so this is all, you know, core prenatal care, and I think there’s a lot of nuance and complexity in a lot of decisions. Our chief medical officer, you know, speaks a lot about the complexity of obstetric decisions when it comes to choosing the best options for patients. And you know–and so I think with Maven, you know, a lot of the telehealth and the care advocacy, that’s a lot of instant access to care and instant access to second opinions and understanding about what people’s options are. I mean, it’s a time of a lot of confusion. But from patients, not even who are pregnant right now, but, you know, taking a larger step back and thinking about their family building journey, if they live in these more restrictive states, there’s a lot more anxiety around what they should do, you know, should their options be restricted.

MS. SELLERS: So, a number of these state laws complicate fertility care, the potential for multiple fetuses or other issues like that. Did you see this in terms of a business as something that would cramp your offerings to people or as an opportunity?

MS. RYDER: You know, we didn’t know, quite frankly, because I think that in the beginning we didn’t–you didn’t see a lot of people stepping up to talk about it right after SBA was passed. Only our Texas clients or some companies in Texas, which were more vocal. You know–and I think a lot of people were trying to figure out what to do. There’s still a lot going on in the world, that a lot of benefits teams are dealing with and trying to understand and guide their teams on. And so there was a lot of wait and see. And we didn’t know, given how politicized this issue is, whether and how diverse a lot of the companies are that we serve. You know, a lot of companies don’t want to wade into politics. But I think that when the decision was passed down–it was a Friday–what we saw was all of a sudden, a tremendous influx of companies of health plans of all sizes, from all different states trying to figure out how to better support their employees in the aftermath of Roe, how to open up access, because at the end of the day, I mean, you know, this is a healthcare issue.

It’s also an equity issue, and a lot of companies struggle to have inequitable benefits across states for something that is so core to an employee’s life, which is building their family, whether it’s, you know, through IVF and what that means for you know, the embryos in some of the states where personhood laws are now in the state legislatures or whether, you know, those are the states with heavily restricted access to abortion care. So anyways, so we continue to see a ton of companies, you know, whether they’re doing something immediately, within 30 days, whether they’re–you know, over the next six months, they’re planning to, now every company is that–you know, almost every company is really looking at doing something. And again, it’s not just the right thing to do, but 80 percent of employees are saying that they only want to work for companies with equitable benefits that support DEI. So, it is–it is also a major talent issue if you–if you don’t have these inclusive benefits.

MS. SELLERS: So because you’re a telehealth company working across state lines, are you seeing women reach out for potential abortion counseling and even for abortifacient drugs at this point?

MS. RYDER: Yeah, of course. I mean, I think it’s–again, it’s almost one out of four women get an abortion before they’re 45. So, it is a core part of women’s healthcare. And so now I think what is–what we’re seeing is, is people just don’t know what they should be doing, and what’s legal, what’s not. You know, and so Maven of course, you know, is in compliance with all of the laws. We’re also helping keep patients up to date, on the latest things that they’re able to do. You know, what we also see, we do work with a lot of providers, too. And I think what also is concerning is what this is also doing to the providers.

And so a lot of providers in states with restrictive access, even when a woman’s having a miscarriage–and about one out of five women get miscarriages–could be as high as one out of four–but they don’t know what to do and what the laws are saying around helping support women during that moment. And so in a lot of these states where we’re already seeing in the U.S. 50 percent of U.S. counties do not have an OB/GYN, which lead to these maternity care deserts, a lot of them are in states with the restricted access. And so if these providers are thinking about leaving the states, that’s going to lead to even greater shortages of care and providers in women’s health for so many women who need the care. So, it’s both sides, both the patients as well as the providers.

MS. SELLERS: This is fascinating, Kate. Have you seen a spike of investments following the Dobbs decision?

MS. RYDER: Well, it’s coming at a time when the macro economy is challenged, and the markets themselves are crunched. And so I think that in general, you’re not seeing a lot of investments period. But certainly, you know, we have seen more people reaching out to us, and you know, again, not the macro environments are very challenged. The amount of VC funding has gone dramatically down. But I think women’s health continues to be an area that is top of mind for VCs, both because of the massive opportunity in front of it but of how underserved, and with Roe even more underserved so many patients are.

MS. SELLERS: And what broader impact do you think this decision may have on maternal health and maternal mortality in the United States, which is certainly a controversial and troubling issue?

MS. RYDER: Well, stats keep getting worse. So, before COVID, we saw the U.S. having the worst rate of maternal mortality in the developed world. Over the last two years, even before the Roe decision, during COVID, we saw maternal mortality go up by about 20 percent. Now, with this ruling, a lot of–you know, the University of Colorado, for instance, published a study about a month ago predicting that, you know, rates of maternal mortality will now go up 20 percent further in states where there is restricted access. And so I think if you also look at the data in a lot of the states with these trigger laws, rates of maternal mortality are 2x higher than states with better access to care. So, it is not looking positive at all. And unfortunately, I mean, the data is going to tell a story, but there’s going to be a whole lost generation and–for years, I’m sure of people who are really losing because of–because of all of these laws.

MS. SELLERS: Kate, you mentioned earlier–and of course, we saw the press release that your company put out about menopause–what are you doing to bring menopause, which of course affects every woman as they move out of childbearing ages–what are you doing to support that process in the workplace?

MS. RYDER: Well, you know, menopause is another underserved area of women’s health. And so we–we’ve had–we’ve been helping women with–through menopause or perimenopause, you know, since we launched in 2015, because we had access to all of this telehealth and to OBs and midwives and whatnot. And you know, we’ve asked, because we have this family care platform for employers and health plans, over the years if menopause would be of interest. And I mean, it always was, but it just wasn’t the top priority. But then what happened in the last year is the UK actually came out with a working group on how menopause affects women in the workforce. They wanted to kind of lead the world in talking about this issue, which has been stigmatized for a while. And I think that–you know, a lot of their findings were that, obviously, this is a huge issue. It’s not served at all. And so a lot of, you know, our multinational companies started hearing from their employees abroad, as well as then increasingly in the U.S. about this being a major issue that no one’s talking about enough, that affects women’s productivity at work.

And so, so this year, we just started to see a huge amount of interest. And so we have a client advisory board, and we asked them, you know, back at the beginning of the year, okay, is now the year, is this something you would be interested in. And it was kind of a unanimous yes by some of the largest employers in the country, which was really exciting. And so–and so we quickly took a lot of the core elements of our platform–our telehealth, which has those access to OBs that do serve, you know, women going through menopause.

A lot of–we produced a library of content so that people could really understand symptoms and what was normal, what was not. You know, we have virtual classes around going through perimenopause. We have, you know, care navigation to help people who are going through more extreme experiences, get that care in person that they need. And we brought all of that together pretty quickly. And we now have just in a very short amount of time about a million lives under contract with our–with our menopause product.

MS. SELLERS: And what’s been most striking or surprising about the kinds of questions women bring to this discussion?

MS. RYDER: Well, I think it’s the–I mean, it’s like a lot of women’s health. It’s the lack of education on what’s about to happen. I mean, I’m not going to lie. Like, I’m not going through menopause, and it was eye opening. I learned so much going through this product. And no one ever teaches you about it or tells you about it. And so what to do if, you know, when the symptoms start coming and how to manage them.

Same thing, kind of even going back to preconception care, no one tells you how to–you know, what it’s like to be pregnant or going through that preconception journey.

And so, again, I think there’s a lot that that we’ve brought now to really shed light on the fact that every woman who’s going to go through menopause is going to probably have different symptoms, it’s going to start at different times based on your history, but that there’s a ton of care out there and a ton of great providers who can help you through it so it doesn’t have to be debilitating, whether you need hormone therapy, whether you can kind of manage the symptoms naturally, but at least kind of normalizes it, and really helps people kind of manage their day to day as they go through it.

MS. SELLERS: So this lack of knowledge and lack of ability to find information is of course linked to research. And I think a McKinsey report said that just 1 percent of health research and innovation was dedicated to female-specific health research that’s outside of oncology. What’s going to change that tide?

MS. RYDER: Well, I think that a few things. Number one, you know, as more and more companies kind of come into women’s health and as some of the big–the big health plans and health systems have a bigger focus on it–which by the way, they should. Like childbirth is the number one reason for hospitalization in the United States. This is a massive industry. That, you know, as more of those leaders inside of industry as well kind of team up with digital health companies, you know, we can–we can produce a lot more data. And I think that the–when you–when you do not have research dollars going into these studies and you don’t have technology platforms that are able to help collect a lot of this data, it’s pretty hard to produce studies and do original research.

And so with Maven, you know, we’ve been–we have some interesting and exciting studies coming out, based on a lot of the data around the patient populations we’ve been managing, everything from digital phenotypes of types of users to, you know, how telehealth can improve maternity outcomes and fertility outcomes, to, you know, we see even our chief medical officer and his team just were at–was at ACOG, which is the American Academy of Obstetrician Gynecologist conference this year showing that even Black members use Maven at higher rates than White members, which is really encouraging because there’s so much mistrust, you know, among that community, as well with the system. And so if we’re able to bring, you know, that trust and care and match Black patients and Black providers, you know, that that also is just really encouraging. So, I think it’s–you know, there’s been a data problem. There’s been a funding problem. But hopefully, you know, platforms like Maven can start to close that gap.

MS. SELLERS: And talking about collecting data, we’ve seen that long COVID–and I want to take us back to the pandemic just briefly–disproportionately affects women of childbearing age. Is that something you’ve also been collecting data on?

MS. RYDER: You know, that’s one of the many things we haven’t done any studies on it, but it’s certainly–we’ll add to the list. It’s certainly something that is definitely disproportionately affecting women. I think a lot of different things disproportionately affect women, whether it’s, you know, mental health and depression. So, we have a long list of things that we want to go deeper on, in, you know, across our studies and our clinical research,

MS. SELLERS: Actually, jump into a couple of those for me. What are your future goals? You’ve got this very successful platform now. Tell us where it’s going.

MS. RYDER: Well, I feel like technology can be a great leveler, and so a lot of these gaps that you’ve been highlighting, asking about, you know, first of all, through the virtual care, bringing that access to care equitably, to all corners–not just to the U.S. but of the globe–and to show up in a way that is trusting in a way that people want. You know, depending on where you live, what your race is, what your socioeconomic background is, what your–you know, what how you identify sexually and from–as a gender–whatever you need from the healthcare system that maybe a local healthcare system and bricks and mortar care can’t give you, that, you know, Maven and telehealth can provide it. And so, you know, as we go into Medicaid, which is nearly 50 percent of the births in this country, it’s more challenging and complex to, you know, address some of the social determinants, needs in that population. And we are, you know, working on are continuing to evolve our product to meet those needs.

And so I hope that Maven, you know, is credibly showing up both from an experience standpoint as well as an outcome standpoint across the diverse populations that we serve. Whether it’s a woman working at Google in San Francisco, a gay man in New York, you know, a lower income woman in Alabama, you know, a couple in India trying to conceive, these are all of our users, and so continuing to personalize the care through the services as well as the technology.

MS. SELLERS: Kate, I want to squeeze in one last question. I can’t resist. The pandemic particularly showed us how–and it certainly predated the pandemic, too–primary care has been ill served by infrequent bricks and mortar visits, things, particularly chronic illnesses like diabetes, hypertension, all these other things. Do you see yourself as a model to help–to help solve this huge primary care problem across the country?

MS. RYDER: Absolutely. I think that what we talk about here at Mavin is that often family building and women’s health is an onramp to primary care. And so one of the things we see in our population–and I’m guilty of this myself–is that almost 50 percent of our moms don’t have PCPs. We’re too busy. We have OB/GYNs. We have pediatricians. We do not have PCPs. The system doesn’t make it easy. And so that is a huge issue. A lot of Gen Z and millennials as well. And so I think that oftentimes, what we see is when you start to build a family, whether you’re a woman, whether you’re a man, this is–this is the onramp to the healthcare system. And so how do we help kind of connect all of those dots back to primary care? So, I think there’s a huge opportunity.

MS. SELLERS: Kate, unfortunately, that’s all we have time for. Thank you so much for joining us and teaching us about the onramp to the primary care system.

MS. RYDER: Thank you so much for having me.

MS. SELLERS: Thank you, everybody else. As you know, if you’d like to see more programming from Washington Post Live, go to WashingtonPostLive.com, where you can sign up for our future programs. Thanks for joining us today. I’m Frances Stead Sellers.



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