A New Standard of Care for Women
Women are the power users and the power brokers of healthcare.
With more frequent and complex health needs, women spend significantly more on their care at every stage of life compared to men — especially in their reproductive years, when they spend almost 2x as much as men of the same age. And as the de facto “Chief Medical Officers” of their families — who make the bulk of healthcare decisions for their partners, children, and parents — women control an estimated 80% of all U.S. healthcare dollars.
Yet our healthcare system is failing women. The majority of women report experiencing gender discrimination from their providers, and feeling that their concerns are taken less seriously because they’re women — even to the point of “medical gaslighting.” Numbers prove this isn’t “all in their head.” Women are 30% more likely to be misdiagnosed than men. Female-specific conditions like endometriosis and fibroids often take 10 or more years for accurate identification. A shocking 60% of maternal deaths in this country are preventable. It’s no surprise, then, that the healthcare system has a “loyalty crisis” with its most powerful customer, with over half of women reporting not trusting the U.S. healthcare system.
In 2017, I invested in a 2-person startup looking to reimagine women’s health. That company has now evolved and grown to hundreds of employees, seven clinics in New York, California, and Arizona, 100,000 healthcare visits last year alone, and has raised over $132M in venture funding.
The company is Tia and in this episode, I talk to the CEO & Co-founder, Carolyn Witte.
About Tia
Founded in 2017 by Carolyn Witte and Felicity Yost, Tia is the modern medical home for women. The company is trailblazing a new paradigm for women’s healthcare that treats women as whole people vs. parts or life stages. Blending in-person and virtual care services, Tia’s “Whole Woman, Whole Life” care model fuses gynecology, primary care, mental health and evidence-based wellness services to treat women comprehensively. By making women’s health higher quality and lower cost, Tia makes women healthier, providers happier, and the business of care delivery stronger — setting a new standard of care for women everywhere.
About Carolyn Witte
Carolyn Witte views it as her mission in life to fight healthcare inequalities women face. After experiencing her own set of health struggles and seeing how the healthcare system is not built for women, Carolyn started Tia to reimagine women’s healthcare from the ground up. Together with her co-founder Felicity Yost, Carolyn built Tia, the modern medical home for women. The company is trailblazing a new paradigm for women’s healthcare, treating women as whole people versus body parts or life stages. Tia’s “Whole Woman, Whole Life” care model fuses gynecology, primary care, mental health and evidence-based wellness services to treat women comprehensively. Since launching in 2017, Tia has grown to serve thousands of women aged 18-80 with blended in-person and virtual care in New York City, Los Angeles, Phoenix and San Francisco. By making women’s health higher quality and lower cost, Tia makes women healthier, providers happier, and the business of care delivery stronger — setting a new standard of care for women everywhere.
Carolyn has received many high-profile awards, including Entrepreneur Female Founder 100, Forbes 30 under 30, Inc. Female Founder 100 and Business Insider’s Healthcare 30 under 40. Tia announced a $100 million Series B fundraise in September 2021, representing one of the largest investments ever for a healthcare company focused on women.
Topics covered:
Moving from body-party care to whole-person care in women’s health
The “triple threat” facing women today
The role of primary care providers in abortion care
Going from digital to brick-and-mortar
What she sees as major opportunities and gaps in the women’s health
Listen
Transcript
Halle: This is the Heart of Healthcare podcast, and I'm your host, Halle Tecco. In 2017, I invested in a two-person startup looking to reimagine women's health. That company has now grown and evolved to hundreds of employees, seven clinics in New York, California, and Arizona. A hundred thousand healthcare visits last year alone, and over 132 million in venture funding.
The company is called tia, and today I'm talking to the c e o and co-founder Carolyn Witte. Carolyn views it as her mission in life to fight healthcare inequalities women face. Carolyn, welcome to the show.
Carolyn: So great to be here, Hallie. Thanks for having.
Halle: So for those of our listeners that aren't familiar, can you give us a brief intro to Tia?
Carolyn: Sure. So at the crux of it what TIA is, is a new standard of care for women. Our vision is to fundamentally redesign healthcare with women at the center and shift how the healthcare system defines treats and conceives of women's health from body part based care to whole person. From care that's focused on narrow reproductive life events to care that supports women's whole life from post puberty through menopause and beyond.
From care that's overly focused on treating sickness to care that's focused on prevention and wellness. And lastly, to care that's fragmented and siloed to care that's integrated and seamless so that healthcare just works for women and by extension women, families, and communities more.
Halle: and you guys started off very tech-centric. You had an app where women could message with questions about birth control and sexual health, but you've gone on to become an. Actual I R L clinic. And while the rest of healthcare is kind of digitizing everything, you went the other way and you're really investing in that in-person experience.
Carolyn: sure. So Tia's a story of many stairsteps or iterations. as you mentioned that, you know, the, the original idea for Tia that you, the. You invested in way back when was not a care delivery company and definitely not one with brick, bricks and mortar, but a digital front door product.
Think a personalized WebMD for women's health. The idea was can we be the answer to Google or WebMD and give women personalized science back answers to their healthcare questions so that women can make better healthcare? And that product was really, really successful. We learned a ton of things in those early days.
First that we were really, really good at acquiring acquiring patients, or at the time we call them musers and bringing women in the door. We had a brand that was very clearly, clearly designed by and for women that aoke trust and got women to come to us as their pseudo front door to the healthcare system, we learned that women don't just want Health information or healthcare for that matters that's really limited to their sexual reproductive health.
This is where we started, but we quickly found that a question about birth control or egg freezing would lead to a question about someone's mental health or diabetes or nutrition or something that wasn't limited to a woman's reproductive organ, so to speak, and that informed the care. The whole person care model that Tia is so focused on.
And then the last thing, perhaps the most interesting thing of all was we found that women didn't just want information. They wanted information and care from Tia. They wanted TIA to be their doctor so to speak. I mean, learn this because women would bring our app with them to the doctor's office and message us in the, in the real world.
So in the waiting room, it was, Hey, Tia, wa of a deductible. Can you explain my copay? In the exam room it was, Hey, Tia, which I u d should I get? And post appointment it was, Hey Tia, can you ex explain my pap test results? And it was those moments that kind of got the light bulb to go off for me and realized that we had the thing that no one else had.
We had this trusted relationship with. And we could use that to actually have even more impact by changing the way care is actually delivered to women and becoming the doctor. And that's what led us to where we are now. a full stock care delivery company with both virtual and brick and mortar components.
That's d all about delivering comprehensive whole person care to women, a woman.
Halle: and it goes without saying. These clinics that your team has built are gorgeous, they're comfortable, they're not pretentious, they're not scary, they're not cold. They're really warm and. They feel like your living room, like your dream living room everything down to the the robe that she's wearing and the socks that you provide, what has been the response?
I mean, you did that because you're, you, you have a great design stents, and I'm sure there was just part of like, dreaming about making this beautiful clinic, but how has that actually changed the experience for your patient?
Carolyn: Yeah. So there's two parts of this. One is I'll start with the fun part. I have a design and brand background. The idea of redesigning a doctor's office for women and saying, okay, the typical doctor's office or hospital was clearly not designed for me. Like, who invented these stirs? What about the temperature?
Like, all those details. And the idea of designing a physical space with women at the center was a kind of a fun design project. one I personally really, really have enjoyed and invest deeply in. The second part of it though much more I would say on a serious note, was our clinical model is really about prevention.
And we're about saying, you know, we, our goal is quite simple. We wanna make women healthier, right? And. core to that thesis is actually getting women to use healthcare particularly before something is wrong. And so where those two concepts connected is saying, what if, how can we make the quote doctor's office a place that women want to go to and, you know, seek out not just for that once a year pap smear or in a medical crisis, but for preventative.
And that's where design is a really, really powerful tool and a differentiation, I think that Tia has invested deeply in, in saying, let's redesign the doctor's office to make it a medical home. That feels like your living room, as you pointed out, that is has many, many thoughtful details that is clearly a woman feels the second the doors open of our elevators and she walks into our living room and it.
We call it the shoulder drop moment where people just kind of take a big exhale and say, oh my God, this is the first time I've ever interacted with a healthcare system that feels like it was designed for me. That is something I think that our patients say day in, day out. And then the last part of it though I just wanna highlight where I think the real power of experience design comes into play is not the, you know, beautiful paint colors on our walls, or even the reimagined patient gown or the temperature controlled exam rooms.
But it's really the, the intangibles, the call it the bedside manner, the way that we've redesigned the experience of healthcare to make women feel, seen, heard, and cared for a. Traditional model, I should say, that all too often makes women feel gaslit. And this is the singular thing that we hear time and time again across every patient review, across a hundred thousand visits that we delivered last year across every virtual and in-person touchpoint of the patient journey.
It's wow, I felt seen and heard and affirmed and in the driver's seat when it comes to my health. Not belittled, not ignored, not. This is the real power of design that I'm most proud.
Halle: and what sort of services can you give us, like the breadth of the range of services that are happening within those walls?
Carolyn: Yes. So two things I wanna talk about. First is the services. Um, I mentioned this medical home concept. Um, the idea is that TIA is a one-stop shop for your whole health, physical, mental, reproductive health. And so brass tax, what that means is we are your primary care provider. Primary care plus for women is, is often.
Times how I talk about what we do. And through that lens, we are the answer to the, this primary care shortage facing one in two women in this country who don't have a primary care provider today. So that's the core. On top of primary care, we layering gynecology. so fusing your P C P and gynecologist into one integrated.
As well as mental health and wellness services like acupuncture. and so we put all those services together, integrate them into a one-stop shop model with a care team that works together in unison to manage your whole health and also deliver those services. Across chat, video and our in-person retail style clinic.
So, the other actually evolution of TIA that HAP has happened in the last couple years in the onset of Covid is this shift from being brick and mortar clinics to being really a hybrid online, offline care delivery company that's all about delivering right care, right place, right. . So today 70% of our services are actually delivered virtually the first time appointment for most patients occurs in our virtual virtual context.
But importantly we also deliver that critical hands-on body care and connect. That virtual experience with a real-world care experience in that beautiful, beautifully designed space that delights our patients and provides that deeper level of care that you can't get on the internet and then often continues back virtually through our video and chat platforms.
Halle: So we can't talk about women's health without talking about abortion. And you have pointed to the fact that only 1% of abortions are done in a primary care setting today, and you've been a vocal advocate for expanding this. What do you think is the potential impact of doing this, particularly when it comes to the supply gap facing women in restrictive and refuge?
Carolyn: So to talk about post Row America I think it's important to take a step back and really look at, you know, what's happened in the last couple years as TIA has been scaling our company. And the broader question that I've been asking myself is, what is the role of a primary care provider, Tia's model and re-imagining women's health and reproductive healthcare specifically?
And so, About, I guess to go backwards, to go forward. It was, it was about 18 months ago when the Dobbs case was going to the Supreme Court that I called a meeting with my board members and said, I'm really worried I think Roe v Wade's gonna be overturned. You know, we've been talking about this for a long time, but I'm not optimistic that this fundamental right that has under paneas model and the way that women across the country experience and interact with the healthcare system for 50 years is gonna continue.
And the world where TIA actually refers out of primary care to specialized abortion provider. In service of our pro-choice all options model's gonna fall flat. What are we gonna do if we have nowhere to refer? Right? And we saw really two different regulatory changes happening. One negative, obviously the threat to roe and one more positive, the changes that the F D a was making around prescribing and dispensing medication, abortion.
and we said, okay, let's not just sit here reactively and wait for a bad thing to happen and just be reactive. Let's actually be proactive and be part of the solution. And that's when we decided to prepare ahead of the Dobbs ruling to expand our scope of practice and start providing. medication abortion through our virtual care platform in a way that delivers high quality, safe, effective pregnancy termination care to women in the first trimester.
And why I believe that's been such an important thing for tia, but also the industry more broadly, is it's really about saying how do we reimagine what is considered core preventative healthcare? pregnancy termination, whether for miscarriage or abortion, is it all too a common part of a woman's healthcare journey and 90% of terminations actually happen in the first trimester.
And so we saw that as an opportunity for. To really insert tia's model and primary care more broadly as the solution to the, that abortion supply gap that you mentioned and say, let's actually step up and be part of the solution and innovate with a new model that can expand access.
Halle: And why aren't more primary care offices and hospitals doing the same?
Carolyn: So first I think there has been an initial cascade effect, I should say, since Tia kind of stood up in this way about a year ago and expanded our scope of practice, which was part of our goal saying, let's, our vision is to create a new standard of care for women. Prove that it works and create a model that others can follow too.
And we've done this both with the integration of medication abortion into a primary care context, but also with the integration of mental health and other types of services, not typically seen as bread and butter. Primary care. , but in terms of more broader adoption, which I think is so, so critical to solving this supply gap both for women in protected states as well as restricted states has to do a lot with the regulatory landscape being so, so gray.
Um, The way Tia delivers medication, abortion, we do it through our virtual care platform, which is legal in many states like California, new Yorker, in New York, but actually outlawed in other states that we operate like Arizona. And this legal gray area creates a lot of restrictions or fear I think more than anything else for providers to operate.
And I think creating more. Clarity around the regulatory environment will be really key to driving adoption of Scale of medication abortion within a primary care context. So that's one big piece of it. The second has to do, I think, really around broader sort of healthcare, sort of clinical organizations like ACOG and the sort of various groups of primary care and family practice physicians really making medication abortion and official standard of care in primary care.
Just like many other aspects of, of healthcare have become deemed typical scope of.
Halle: So not to continue to talk about things that are difficult, but the percentage of BC dollars invested in female founded startups dropped from 2.4% to 1.9% in 2022. What do you make of this?
Carolyn: So, The female ceo, female founder. Part of me is definitely demoralized by this sort of by this statistic and this downward trajectory when I started Tia and when you invested in me and Tia Halle. I often said that we, we had, I had multiple strikes against me. I was a female founder I was a first time founder and I was a women's healthcare founder.
Put those three things together, and it's a recipe for underfunding, let's say. Um, but on the flip side of it, I am proud to, to really be the antidote to some of those broader statistics in certain ways. As you mentioned, you raised a hundred million series B about 18 months ago, one of the largest single private financings going towards a women's c e o and women's health and history.
So that's a really big milestone that I think represents a positive trajectory. But it's also a drop in the bucket and we have a lot more work to do to invest in women's health.
So it's very clear that. Investment in female founders, investments in women's healthcare more broadly are far below where, where they should be, right. Um, we know that women's healthcare as a category holistically is underfunded compared to men's health in every other category, despite the fact that women control more than 80% of the US healthcare dollars.
And the pure economic reasons to invest in the category are very, very, That's said, I think there's a third third issue that is not talked about enough that is increasingly on my mind, which is the fact that the vast majority of dollars that are going towards female founders and in women's health are happening at the seed stage.
Right? They're happening seed stage, maybe Series A, but when it gets to the growth stage that's where I think a lot of companies that are founded and led by women struggle even. To access to big checks often from investors that have even fewer women investors around the table that make it that much harder to get the growth capital needed to really take a company founded by women with the product delivered to women to the next level.
And that's where I think in addition to total dollars going towards women, we need more focus and conversation around to really move the needle and enable companies like TIA to scale and get to the next.
Halle: Yeah, absolutely. It does. It, it only gets more challenging for founders as. Scale their businesses and there are fewer and fewer investors available at the later stage, especially those that are women and that kind of get firsthand the problem. You guys have a mix of women and men investors. Um, , you know, how, how do you find that male investors have traditionally received the business?
Carolyn: Yeah, I think there. There's two things at, at play there that sometimes get under my skin. But I've, I've learned to use them to my advantage in certain ways. One is, the vast majority of the time I'm pitching in, all or predominantly male room, and as I mentioned at the later stages, there's fewer and fewer women in those rooms that I'm walking into.
And so the question of, here's my personal healthcare story that led me to start Tia, you felt what it's like to walk into the doctor's office and feel like it's not designed for you. Those, those stories fall flat, right? And so that leads to the, well, let me go ask my wife or daughter. And on the one hand, I, I find that very frustrating where it's like, this is a, this is a business, right?
Are you gonna, are, do you ask your wife or your daughter to. A hundred million dollar financial investments and use their perspective to really drive your investment decisions in other businesses. It feels kind of crazy, right? On the flip side, I think it is, important to step outside of yourself and recognize I'm actually not the user and I need to find my, find a way to step into someone else's shoes and understand this problem on an emotional perspective or or what have you to understand if this is a valid offering and that can really solve a real problem.
I think the, the bigger thing though is there is this experie. Sort of relational gap that o obviously male investors have when it comes to women's healthcare solutions. But the, the biggest way to really drive investment in the category, I believe, is to get investors, men and women alike. To fundamentally shift how they think about women's health from niche to a massive business opportunity.
So I mentioned the 80% of the healthcare dollars stat that I think is the singular stat that has changed the trajectory of companies like TIA and others in the category and put us on the map. When I started fundraising, you know, seven years ago, people used to say to me, why are you building a care company that's cutting out 50% of the population?
Isn't that niche? and it's, you know, at which I eye roll and say, Hmm, is 50% of the FI population niche? I don't think so. but the flip of it now is actually more and more people, whether you're investor or tradit, traditional buyer of healthcare, a CFO of a hospital system, a health plan, and employer. everyone or increasingly more people understand that not only do women and reproductive age, women spend twice that twice as much money on their care as compared to men of the same age. We also are the chief medical officers of our families in control the healthcare dollars spent on behalf of our children, partners and fam and parents and families more broadly.
And so, putting aside post row America, putting aside the triple threat facing. women when it comes to their health. Right now, putting aside the moral imperative to invest in female founders in women's healthcare, there's simply an economic one, and investing in women and investing in women's health is smart business and smart investors, male or female, are increasingly recognizing that, and I hope that.
That 2.9% stat will eventually change as there are more success stories to point to with women's health really proving out to be a smart business opportunity and a win for investors too.
Halle: Yep. Funny story, when I had Maven obviously have another really big women's health company that has done well, I had Kate Ryder pitched my Columbia Business School class in 2015 or 2016. So really early on, and the way my class is structured is founder pitches and then the students write up investment memos saying if they'd invest or not.
and a lot of the students, most of the students said no. Why would, why would any employer buy into a benefit that only benef, that is only useful to at most half their employees? I sa same exact, you know, reasoning in their minds. And so I think this, traditionally, this thought in business that like, why would we cater, you know, to just half, half the population has led to this innovation.
Trend that you see in healthcare and in any consumer product, which is shrink it and pink it. so taking whatever has worked for men and just like making it a little bit smaller and painting it pink and thinking that that serves women. There are so many examples of this in so many ways where women are underserved because of it.
What do you think are still some of the major opportunities and gaps in this space where, We're still just so behind for women.
Carolyn: Oh, there is just so many to point to when it speaking to this trend, and I often just should say it back to you in my own language, I often Talk about it to my team as the healthcare system has been designed for men and largely white men. And treating women as small men with different parts.
Right. And if anything, if there has been focused on women's health, it's been specifically on the narrow reproductive Aspects of women's bodies and the women's journey, which are critically important, critically important chapters and experiences and part of our health. But the flip side as you've talked about, it's not the whole story, right?
We're whole people with complex needs. And so a couple examples I wanna to highlight here are really about the things that most people probably don't think of when they think of women's health. So a few examples. First is mental health. women experience and are diagnosed with anxiety and depression at two to three times the rate of.
Yet we, there are very, very few sex specific models out there when it comes to mental health. The vast majority of drugs and SSRIs prescribed to women in the mental health space, many of them weren't even tested really on women. We don't think about interactions between SSRIs, birth control, hormones, H R T, and other aspects of the women's care journey.
And we're basically treating women's mental health as men's mental health. And this fundamentally needs. Another area I I, I wanna highlight is cardiovascular disease. It's often a misnomer that, you know, people think breast cancer, ovarian cancer, these types of things are the number one killer of women.
It's heart health, it's cardiovascular disease. That's the number one killer of women in this country. And yet we don't even think of that as quote women's health. There are countless examples of this that I think really in reinforced. The crux of Tia's model being designed for whole people versus parts and really focus on giving women a prevent prevention focused medical home that can fill in these gaps in the healthcare system with the very first sex specific primary care model designed by and for women that cares about sex specific difference and thinks about that across the experience, experiential aspects, but also the clinical aspects.
Halle: And you guys recently commissioned a study of a thousand women asking what they want from their healthcare ranging from 18 to 65. I'm curious, can you tell us a few things that you found from the survey?
Carolyn: Yes. So I'll highlight a few things. First is that the end of Roe v. Wade has further eroded women's trust in the US healthcare system. And pushing reproductive health to the top of their priority list. So people want to know what their healthcare provider thinks, what they believe, and what they do when it comes to access to reproductive healthcare services.
They want to have more access, more improved access to medication. Abortion as a top priority, for example and better access to reproductive healthcare, more holistic. The second finding is really about gaslighting, which I mentioned a few minutes ago. an experience that is all too common for most women in this country who feel ignored, dismissed by traditional healthcare, by, by traditional healthcare, which leads to mistrust, delays in care and poor outcomes.
And this, these experiences of feeling gaslit. I wanna highlight. disproportionately felt by black women and women of color who report this gaslighting experience at higher rates. And so the solution to that, again, what women told us they want is healthcare solutions designed for them that make them feel heard and seen as whole people versus a body part or a symptom.
So those are two that are really top of mind for TIA and our big focuses on expanding our, our care model and the experience we've designed for women.
Halle: Yeah. I mean these are, other than the rovers, Wade and abortion care, kind of being treated as a wholeman is something that you've known for a very long time.
Carolyn: yeah, for sure. I think we're frequently , a lot of the stories and sort of pain points that I've experienced and you've experienced and you know, are are validating affirmed day in, day out. In terms of the patient stories we hear from women who use our services from these broader research studies we conduct across the country.
The thing that I think usually surprises me about them is not the insights to your point. These are, you know, we've known these for a long time, but actually how universal they are across aged brackets across race and you know, women from. , various backgrounds and different demographics from a race and ethnicity perspective and across even sometimes the political perspective too.
So we've run prior sort of national studies, for example, around this, where you, there's more, more that unites women what with respect to what women want when it comes to their health, then divides them. and I think that is an insight that is often. not really understood when it comes to the politicalization of women's health.
Halle: Yeah. So what's keeping you up at night lately?
Carolyn: Whew. What's keeping us, keeping me up? The biggest thing is, is, is really figuring out how to scale what we're doing. We've been on a long and an amazing journey, an iterative stairstep approach, as I mentioned, that has gotten to you to where we are today. This. Full stack, comprehensive online, offline care delivery model designed for women that women love.
And now we're in that stage of rinse and repeating and replicating this experience across New York City, la, San Francisco, and Phoenix, and hopefully new markets in the future too. And, Doing what we do at scale repeatedly while upholding and continuously improving quality is really, really hard and increasingly a focus of, of mine and my leadership's teams in terms of ensuring we can sustain that quality experience across every single interaction.
So that's the first thing. . The second thing that's really keeping me up at night is, is really the medium to long term state of healthcare for women and healthcare more broadly. Amidst a lots and lots of systemic and structural barriers that make it very hard to innovate in scale high quality solutions.
And the highest, the the highest order thing I'm talking or thinking a lot about is the payment. And the restrictions that primary care mental healthcare providers in particular face when it comes to all too low levels of reimbursement for critical healthcare services that are essential to health outcomes for women and men alike.
And so I'm spending a lot of time thinking about payment model innovation, what's actually needs to change structurally so that TIA can be the new standard of care for all women and not just some and one that has. You know, economic value attached to the outcomes that we drive to drive the systems level chain for the healthcare system more broadly.
Halle: And just to kind of close out for our conversation today, what advice do you have for others who wanna work in women's health right now, other than please come join us.
Carolyn: Yes, yes. So, I think one of the things I'm most motivated by, in many ways, proud of having been working on TIA and in the women's healthcare space. So the last. Seven years now is the rise of the category and the, the number of new healthcare companies being founded by women being built for women's needs is night and day from, from when I started and when you invested.
And put simply, we just need more people working on this problem. It's not crowded. There's not, it's not gonna be winner takes all. Like there's so many problems to solve. And what we need is more people. Um, with the grit, with the vision, the perseverance to fight through the various challenges, healthcare reimbursement, lack of r and d dollars, you know, bias and investment committees, all these things we've talked about to improve the healthcare system for women holistically.
And so, find a problem that you're obsessed about, obsessed with, that keeps you up at night, that you can't stop thinking. And start building and, and working on a problem to solve it. And that's the thing that I, I'm most motivated by and believe that a rising tide here lifts all boats. And that with more women and more companies built to serve women we can all benefit and improve healthcare for women holistically.
Halle: Yes. Amen to that. Well, Carolyn, thank you so much for your time today. Um, if anyone is interested, you can join TIA by going to their website. It's ask tia.com still.
Carolyn: ask tia.com.
Halle: and check it out. Well, thanks for being here.
Carolyn: thanks for having me.