Deena Shakir, Partner, Lux Capital
Carolyn Witte, CEO, Tia Health
Moderator: Emma Hinchliffe, Senior Writer, FORTUNE 


Brainstorm Tech 2022: Digital Health Startups In A Post-Roe World 

Conferences

Digital Health Startups In A Post-Roe World 

Hi Dina and Caroline. Thank you so much for joining us. Um, so obviously the end of row is affecting everything in so many ways for you Caroline. How is the end of nationwide abortion rights, affecting your business? That to us? Sure. Um, well, first off, thanks for having me here and thanks to fortune uh, for putting this important topic on the main stage. I think there's never been more uh, is an important time to talk about the moral and economic imperative to invest in women's health businesses like TIA and others in the space who are innovating, uh putting forth innovative solutions that expand access to comprehensive women's healthcare solutions inclusive of but not limited to abortion. For those of you that don't know what TIA does. We are hybrid virtual and in person care delivery. Uh, company designed for women. Uh, we provide integrated physical mental and reproductive health care services, inclusive of medication, abortion, uh, for women's whole health for their whole lives from puberty through menopause. Um, and so for those reasons as um, a venture backed company who is responsible for tens of thousands of lives in California new york and Arizona patients and providers. We've been uh, both devastated but also not surprised in being prepared for what we've long anticipated to be post road America and that's involved for us. That's been, has meant reimagining how to deliver reproductive health care services in this new landscape, figuring out how to deliver medication, abortion, which we believe is a cornerstone of the future in terms of how we're going to expand access to women, both in protected and restricted states through our virtual care platform uh and figuring out how to empower all women to have access to all of their choices in a new model for women's health care. Uh that shifts the conversation a bit I think from the courts uh to the exam rooms where we believe abortion should be an integral part of a new standard of primary care for women in America. Thank you so much Caroline. Uh Dina, how are your portfolio companies being affected especially in the fertility space? Yeah, so first of all, thank you again for having us. Um at luck, we've invested in companies like maven clinic, you heard from kate just about an hour ago as well as a life health, which is a company that's using ai to advance the efficiency, the efficacy and the equity infertility care. And one thing that's not discussed as much is the impact of this reversal, not only on abortion care, which in itself is a massive issue, but also on issues in women's health and family health that are orthogonal to abortion, fertility being a big part of that. There is already undue stress on the limited supply of clinics that are providing care uh and that is only going to be increased as embryos are at risk and families are unable to receive the care that they need. Um This is the case also for contraceptive care, which is another big area of focus and so all of our companies, whether they're in states where this has been, you know, officially, uh, you know, overturned by a trigger law or in states that are perfect that are protected are seeing the impact immediately with more to come. Yeah. Tina, how are investors responding? Are they cooling off on women's health as a category? And how are you feeling? Are you still bullish on it despite this roadblock? Not at all. In fact, I have been so heartened by the outpouring of interest and support in this space, both from investors who have already, uh, put a lot of money into women's health and others that see this capital deployment as a mechanism for action. I think there are, you know, tremendous examples in history where regulatory, uh, you know, constraints have impelled creativity and innovation. Um, and I'm really optimistic about the work that some of our companies are doing, that companies like t are doing, uh, and uh, and and others that may not have focused on women's health that are actually taking this on as part of their day to day work Caroline. You mentioned, you know, your passion for treating abortion care as part of primary care and really caring for the whole person. You know, what lessons do you think that that viewpoint has for employers in the audience who are now maybe because of this decision and other factors being forced to really think about their employees as whole people. It's a great question and I think really requires taking a step back and thinking about how abortion and reproductive health care has historically been delivered in this country. Why um to put a controller and view forward row may have failed women, not just from a policy perspective, but from a healthcare perspective and what a new model should look like as you look forward. So today, only 1% of abortions are done in a primary care setting. Only one yet 90% of abortions are medication abortion eligible, meaning they occur within the first trimester where medication abortion can be safely administered by any primary care provider, whether virtual or in person, an Mp. Or an M. D. To be able to give a patient access to safely terminate a pregnancy either in a clinic or in the context of her own home. Yet only 1% of abortions are occurring in a primary care setting today. So why does that matter for women? And why does that matter for providers and employers and why do we Tia believe it's critical that we change that. So, I mentioned this issue of um Abortals of course. Now being restricted not only of course to women who live in restricted states. Uh, so abortion is now no longer a right, but a privilege to those who live in 20 states who have chosen to protect that or for patients who have means to access those states. What this has created is not just an issue for women in those states though, but for women in California new york, no matter where you live. For the reasons I think Dina mentioned this isn't just abortion, this is Miss Care, this is a topic pregnancies, this is uh embryos. There's so many health care issues that necessitate access to abortion services and we believe integrating them into primary care is the way to do. So there's a massive supply gap facing women in America and providers in America. If every uh primary care provider in California stepped up and started providing medication abortion as part of their standard of care. Just as another healthcare service alongside treating strep throat and pink eye and uh you know mental health and pap smears and birth control and all sorts of uh commonplace medical services that primary care providers Do day in and day out. We could cover the supply gap facing the 34 million women in America no longer have access to abortion services. And this is why we believe the future lies in abortion becoming a new part of primary care. And for employers to ensure that all their female employees. have access to an integrated solution that is inclusive of abortion but addresses women's whole health as whole people not parts or positive pregnancy test. Yeah, thank you so much. Um just to remind you for the audience that will be coming to you for questions soon. So raise your hand if you have one anytime soon, we'll be back. Um Tina. I know you have some thoughts on all the calls that have been out there for people to delete their period tracking apps. You know, what do you think is back? And what do you think is fiction? Yeah. So this has been um sort of the the aftershock if you will of understanding the reversal is uh fear. There was a tweet that I think went viral on that was calling for women to delete their their period tracking apps. There's still a lot that remains to be um understood here. And I'm certainly not giving any legal advice but we do need to be aware of the privacy implications here. And I think there's you know, discussion that's happening in D. C. Right now on this topic and there's a lot of fear. But at the end of the day they're from a legal perspective like there's it's all still up in the air. I don't think we necessarily need to be, you know, deleting all of our period apps. I think we need to understand um from a provider perspective what is covered by Hipaa and what is not provided. Um But also from a legal perspective what actually can be penalized and what can be and as Carolyn mentioned, it's not just about uh you know, pregnancies and miscarriages but uh primary care in general. There are many issues related. You know within women's health that are not specifically around the reproductive care cycle that are also at risk here given this reversal just to layer in there. I think the the the challenging part though is it's that much more important that women are body literate and and deeply understanding things like their cycles or miss periods and things like this at the time when access to services like abortion is going to be increasingly more restricted. And so I think the legal, the legal situation is gray and hazy and it's on us to to give patients clarity by giving them access to comprehensive health care services that include navigating an increasingly complex legal environment state by state. Uh, so that they can make informed choices day in day out when there is a increasingly ticking time bomb uh, that exists as a reality for women when it comes to making daily decisions in the context of their health. Yeah. You know, for the tech companies in the audience, um, what can they do to protect people who are seeking abortion care? You know, what are their vulnerabilities when it comes to user data on things like location data, Whether you're a company that directly deals with um women's healthcare information like a period tracking up or something totally different. Yeah. So, you know, I think there are already companies that have come out with statements around how they're making sure that, you know, they have a sanctuary for for data and how they will protect and there needs to be more of that. Um, employers in general are also stepping up and have been stepping up since the news came out uh, to support their employees and it's not just the women employees. I mean this is an issue that affects all of us as human beings. There are men who will be affected by this. Um, and especially in the midst of the great resignation that we're seeing right now, it is more incumbent than ever for employers to provide the care that families need abortion is about abortion care is about health care at the end of the day, it's not an issue that should be relegated to a specialty provider or to a specialty cause um, yeah, do you have any questions in the audience and if you could just introduce yourself by name and company again with forge. Um, I'm just curious how is this might be more for Caroline like cross border um medical, medical, um abortion. How is that impacting your business or what influence because I feel like that's like a nexus that has yet to be. Hey, yes, thank you for raising this. Um, it's a really important question because the, you know, first and foremost, I want to acknowledge that there is no silver bullet solution to this problem. Um, we believe it's going to require a lot of innovation both from healthcare providers like TIA as well as employers stepping up as well as insurance companies stepping up to actually increase coverage uh for medication, abortion and other services, nonprofits policymakers. It's gonna take a lot of efforts with respect to uh medication abortion, which is a critical, it's a tool in our toolkit that we know that can cover the vast majority of abortions in this country if we're able to figure out how to safely and legally help women access to them, figuring out how women travel across state lines to get these services is one component. Um I need to figure out how to protect the patients and the providers delivering this care. And so I want to call it, California has been a real leader here in terms of passing protective legislation, both for patients who may be traveling from a restricted state, uh saying they can't be essentially brought back to their state or criminalized. Um but also the providers in that state, and as someone who employs hundreds of healthcare providers, I can tell you uh, that this is a daily experience. My providers come to us and say, what can we do? Can I counsel my patients? What are my rights? Am I gonna be criminalized? And until we can give our patients and providers clarity about what they're able to do, they're in the business of giving, delivering um equitable, high quality health care and helping women make decisions for themselves, but they need to understand what their legal rights are. You cannot is not medication abortion to clarify that currently. Um telehealth regulation prevents providers from prescribing any drug across state lines. Um this is true for uh an ss ri and it's true for medication abortion as well. There was a temporary temporary regulation laxed. Um I think certain laws with respect across state lines describing evolving so much and including um you know, regulations that are outside of states as well. But Dina, I'd love to talk to you about how this is affecting digital health beyond women's health. You know, other spillover effects of this decision into other categories of digital health. You know, I think what we're seeing is certainly some companies that may not have focused on digital health or may not have focused on women's health more broadly. And digital health taking this on one of our companies, for example, Carbon Health is now providing care in this space. But the other point I wanted to make that I'd be remiss not to include is around the impact on underserved communities and especially communities of color. Uh well before this ruling came out, we know that we're in the midst of a black maternal health crisis gemma just released a report a few weeks ago on the impact on latin X communities again, pre pre reversal. We were already seeing an increase in maternal mortality rates and of course this is going to have an even more outside impact again on those communities, almost half the babies in this country are born under Medicaid. So although we've talked a lot about the impact, you know, on employees and so on, there is a large percentage of the population that will not have access to that. And so I'm heartened to see companies that are stepping up to the plate, like maven who are, you know, launching in Medicaid communities for the families that need it most Well, thank you so much, Carolyn, thank you so much for sharing your views on this important topic.