A notable paradigm shift is underway in the U.S. healthcare economy. Runaway costs, greater access to technology and online information and the increasing adoption of consumer-driven healthcare (that is, high deductible plans that require payment through an individual’s tax-free account rather than a fixed annual health insurance benefit) are driving patients to take a greater role in managing and paying for their own health. In contrast to the passive model of insurance that pervaded the industry for decades, Americans, now in more control over their healthcare budgets, are increasingly looking to become better informed and more active in health and wellness decision-making.
For women, who frequently play the role of “chief medical officer” within their families – spouses, children and, increasingly, aging parents – the trend toward a consumer-centric environment is significant. A recent study found that regardless of marital status or children, 94% of women make their own healthcare decisions, and 59% make healthcare choices on behalf of others.1 Clearly, women are driving the majority of healthcare decisions in the U.S., with responsibilities over doctor and insurance provider selection, treatment choices and the health agendas for themselves and their households.
Historically, despite this critical decision-making role and the fact that they make up the majority of the healthcare workforce, women have been left out of the boardroom and policymaking discussions. Even with some recent improvement, women currently hold just 21% of executive positions at Fortune 500 healthcare companies – and there are no women CEOs. Hospitals rank slightly higher, with women comprising 30% of their leadership teams.2 Ironically, as the CMOs of their families, women are often better positioned to understand the U.S. healthcare system’s pain points and to design solutions to directly address them.
The tide appears to be turning. With more decision-making responsibility and power over their healthcare purchases than ever before, women are seizing the opportunity to take matters into their own hands. Female entrepreneurship is on the rise across the country; more women-led businesses are founded in the healthcare sector than any other industry. Of the healthcare companies that raised funding in 2016, 24% had female CEOs, a significant jump from as recently as 2011, when the number was 9.7%.3 This is good news for individuals and companies alike. When women engage with the healthcare industry through leadership roles and positions of influence, the odds increase that more patients will be represented and served most effectively.
Following, we feature three women who are harnessing health-related challenges they have encountered in their own experiences to develop innovative solutions across the fertility, mental health and aging and longevity sectors.
What prompted your initial interest in the fertility sector? Tell us about your work at Progyny and what you are looking to do now as an investor.
As a serial entrepreneur, I enjoy solving problems. And as a previous patient, I had a million questions, and the answers were not readily available. There was disparity in terms of pricing and success rates, and I felt completely powerless and vulnerable. I founded Fertility Authority, and then Progyny, to create more transparency, increase accessibility and empower patients. As an investor, I’m always looking for innovative solutions to transform women’s healthcare – we have entirely too much inefficiency and variability in an industry that’s actually highly predictive.
At Progyny, we were focused on solving several needs for large, self-insured employers and their respective employees: lowering multiple births (twins and triplets), increasing recruitment and retention of women and establishing a robust family-building solution for same-sex couples. Multiple births (predominantly twins) create an unnecessary burden on the mom and the healthcare industry. When we first started offering the Progyny benefit, twinning was almost one of every three births related to in-vitro fertilization, or IVF, and we have been able to reduce that to single digits. Adding an egg freezing benefit that allows women more flexibility with their own reproductive health is something that the employees of several large, self-insured employers had been requesting for years. And, being able to build one of the first family-friendly benefits for the LGBTQ community, who had previously been denied through their insurance plan, was rewarding for our entire team.
The majority of CEOs and investors in the fertility sector are male, as are the doctors managing the IVF process. What challenges exist in serving the female population?
From our research, we know that 80% of fertility patients looking to undergo treatment have no doctor in mind, and, when given a choice, the vast majority will choose a female doctor. However, the challenge historically has been an insufficient number of female reproductive endocrinologists, and even when the doctors are female, they have not had equity positions in the practice to influence growth and patient care. That is finally changing; the number of women completing the reproductive endocrinology specialty now outnumber their male counterparts, and I anticipate that they will have a bigger role in strategic direction as more take an ownership position in their practices. I believe that this will ultimately result in more compassionate care for patients as well as more competitive pricing.
The fertility sector is an expanding business, with annual revenues in the U.S. growing 5% annually due to demographic trends, such as couples waiting longer to have children and improved legal rights for same-sex couples. Where do you see the biggest opportunity to create economic value while also serving patients more effectively?
In addition to the macroeconomic growth trends, we are seeing an increase in accessibility from employers adding more robust reproductive health benefits for services such as social egg freezing, IVF and surrogacy. The opportunity to create real economic value looks like it would for any other antiquated business: bring in state-of-the-art technology and combine that with operational expertise and extraordinary customer service. I believe that having a national brand would help transient patients have an affinity to a brand that speaks to them. There is consolidation happening in the fertility industry at a rapid clip, with investors buying multiple practices to create businesses of scale, but I fear that acquiring legacy practices that insist on keeping their local brand name and are on disparate technology platforms could lead to big challenges down the road.
What signs of progress or change have you witnessed in your nine years working in the sector? Where is the industry going?
Patients shop for service now and compare pricing – they have many more options. Unfortunately, the fertility IVF process remains unnecessarily complicated, and comparative analysis is challenging. The industry is still effectively in a nascent stage, but increased utilization will continue as prices begin falling. We must embrace technology and make the process easier on the patient. Everything starts and stops with the patient – by putting the patient first, everything falls into place.
As a female business leader in healthcare, what advice would you give to entrepreneurial women who have identified gaps in the healthcare system and are seeking to develop solutions?
It is definitely easier to raise capital than it has been historically. Nothing replaces hard work, humility, integrity and the ability to execute well. What is incredibly rewarding is that now, I am often no longer the only woman in the room. In more and more cases, women are outnumbering men in clinical settings and boardrooms, particularly when we’re talking about the future of women’s healthcare.
In what ways are women most affected by mental health issues, either personally or as a caretaker within their families?
While mental health conditions affect both men and women, women tend to suffer twice as much as men from conditions such as major depressive disorder and generalized anxiety disorder. Eating disorders are 10 times more prevalent in women than men. Women comprise 80% to 90% of the population who suffers from fibromyalgia, which is characterized by widespread pain and stiffness of soft tissues accompanied by fatigue, sleep, memory and mood issues. Hormonal challenges can also create significant physical and emotional changes that cause mental health conditions and other somatic symptoms – for example, chronic headaches, gastrointestinal issues and insomnia. Experiencing mood or anxiety symptoms in the peripartum period, caring for one’s children, parents and/or loved ones can also add layers of stress that cause a range of health issues.
In the 15 years that you have practiced psychiatry, what have been the biggest challenges in treating mental health conditions? What gaps in the U.S. healthcare system make it more difficult to facilitate an effective recovery?
Pressing challenges in treating mental health conditions include lack of access or willingness to undergo treatment, funding cuts on both the federal and state level and lack of integration with other evidence-based treatments that would ensure more holistic recovery and accountability. One of the contributing issues is poor insurance reimbursement for care, which has pushed many psychiatrists into a fee-for-service model that many Americans cannot afford. Accordingly, emergency departments and inpatient psychiatric units have become slammed and act as “revolving doors,” where patients will be admitted for a few days for acute stabilization and then discharged with limited follow-up and comprehensive services.
Furthermore, detoxification off of alcohol or drugs and/or acute stabilization of depression, bipolar disorder or other behavioral disorders, without complementary treatment, is ineffective on its own. It is the lack of integration across the care continuum that makes it so difficult to maintain recovery. Just as one would transfer a patient to rehabilitation after a hip replacement, ongoing support is needed to aid those struggling with mental health and addiction issues.
Research shows that 56% of American adults with a mental illness do not receive treatment due to lack of access to care.4 In addition, stigma prevents people from seeking the help they need.5 At HopeWay, we are working with community partners to educate the community and reduce the stigma associated with mental illnesses. We believe that it is crucial to start talking about mental health issues as brain diseases. These illnesses affect one in four families, and the community needs similar support to what is given to people living with cancer, diabetes or any other chronic medical issue.
BBH Partner Charlie Izard and his wife Kathy are one of the initial founding families of HopeWay.
You recently moved across the country to become HopeWay’s CEO and chief medical officer. What compelled you to take on this role?
I relocated from Southern California to lead HopeWay in opening the first accredited nonprofit adult residential and day treatment program in the Carolinas. The founders’ focus on holistic care grounded in science along with top-notch patient care combined with a person-centered approach to treatment was attractive. HopeWay gives people access to residential and day treatment programs to complement acute crisis stabilization and traditional outpatient services through comprehensive psychiatric, medical and clinical care with the addition of innovative therapies such as art, horticultural, music and pet therapy. We also offer health and wellness coaching, nutritional guidance, yoga, mindfulness and spiritual support.
I believe strongly that HopeWay’s integrative model and focus on the individual and family unit is the best way to ensure long-term recovery. The opportunity to make hope tangible by inspiring mental wellness for all – while helping grow the program to be a premier national leader in mental healthcare – was incredibly appealing. I am excited and passionate about our future as an organization.
How is the medical community’s view on treatment evolving? In addition to looking at conditions more holistically, what other developments are facilitating better outcomes?
The medical community has recently evolved its focus toward more integrated care, individualized treatment and awareness of genetic contribution to inheritable diseases – a much-needed step in the right direction. Pharmacogenomics, the study of how a person’s genes affect his or her body’s response to medications, tests changes or variants in genes that may determine whether a medication could be an effective treatment for the individual. Additionally, measurement-based care uses patient-reported rating scales in conjunction with evidence-based clinical practice guidelines to provide an objective assessment of patient progress over time, which helps to guide a more precise plan of care. Lastly, I have seen an increased awareness of family education and support as a crucial link to integrated care and wellness, which is an important development for maximizing outcomes for the patient and the family.
How did personal experiences prompt your commitment to help families tackle the legal, financial and caregiving challenges that may come when supporting aging parents?
I was leading a busy consulting practice with a dozen retired executives when I became legally responsible for both of my parents. I was in my 30s, and my children were 6 and 3 years old. A few years before, I had relocated my family to Boston – temporarily, I thought – so my children would have time with their grandparents before the end of their lives. My father had been diagnosed with cancer, and my mother was living with heart disease and dementia. Although I commuted monthly to New York, and my husband traveled extensively, I am part of a large family that includes physicians. I remember thinking, “With all this support, how hard will this be?”
I was so naïve. Healthcare delivery was – and remains – fragmented. Specialists often do not coordinate care, older patients may struggle with both physical and cognitive challenges, medication is overprescribed, costs escalate, and families are left trying to navigate a system that overwhelms with its complexity. Even with the family network we had, I found it difficult to coordinate care and find affordable community resources that would support keeping my parents at home. Beyond the medical concerns, there were legal, financial, housing and familial challenges, as my role transitioned from being one of my parents’ five children to being their care partner and healthcare advocate.
This experience, coming in my 30s and not late 40s, which is more common for most women, heightened my awareness of the challenges of navigating the last decades of life. I set out to better understand how to age well, drawing on my background as a scientist and pharmaceutical executive and joining boards to learn more about brain health, women’s health, integrated medicine, nutrition and palliative care. I created and delivered educational programming for executives, clinicians and financial advisors and, because so many people asked for assistance, I founded Circle of Life Partners, a consultancy that guides mid-career professionals in how to support aging parents successfully and plan for their own longevity. A few years ago, the entrepreneurial world found me, and I spend a portion of my time advising and mentoring innovative leaders, especially women, who see the opportunities to impact the health and well-being of older Americans and their families.
Talk more about the damage on women’s health that can come from the stress of juggling family, aging parents and jobs.
Heart disease is the leading killer of women. The top cause of heart disease is not smoking, but chronic stress, and who is more stressed than a mid-career woman with a demanding job, teenage children and aging parents and stepparents? The physical consequences of stress are well-documented and include a predisposition to autoimmune disease and diabetes; stress also affects brain health. Further, there are financial implications of caring for aging parents that can cause additional levels of stress; a recent survey about caregiving in the U.S. found that 51% of people, men and women alike, reported that caring for an older relative has negatively affected their career; 10% actually quit their jobs or retire early.
It always surprises people to learn that 60% of the family eldercare is done by women, and 40% is done by men. With smaller families and siblings living geographically distant from each other and their parents, the challenge of supporting an older relative becomes more complex. It is difficult to care for your aging father when he slips on the stairs if you reside in New York and he lives alone in Florida. The eldercare system in the U.S. was designed for a 20th century lifestyle when more women stayed at home and extended families lived geographically close to each other. That is not our current reality.
In your view, what are some of the most effective ways to relieve this burden on women? What steps do you encourage women to take to regain control of the aging journey for themselves and their families?
Women must find time daily for self-care. We know, scientifically, what contributes to longevity – not just your parents’ longevity, but yours, too. About 30% of how we age is tied to our genetics, but 70% is tied to five factors: diet, exercise, sleep, social interaction and stress management. The Mediterranean diet will prevent heart disease; aerobic exercise – walking, hiking and dancing, for example – will strengthen body and mind and lead to a more restful sleep. Finding time to laugh, to meditate and to play with friends is an essential part of keeping healthy. It is not easy to make yourself a priority, and some days it will be impossible to do so, but women need to give themselves permission to take time for self-care.
For women, it is critical to plan financially for a long life. In your 20s, set up retirement accounts, get smart on finances and pick a supportive company if you desire to have children. In your 30s, especially if you have a family, acquire disability insurance and create a will and powers of attorney, using that process to discuss legal planning with your parents. Continue to enjoy family traditions. In your 40s or early 50s, your parents may begin to experience medical crises. That is when you will need to focus more on their needs.
It is helpful to think of aging and childrearing as the mirror opposite of each other. Infants transition from full dependency on others toward complete independence by the age of 25 or so. During the last 25 years of life, our parents will transition from independence toward dependency, needing assistance with driving, bill paying, or perhaps, even getting dressed for the day. As women, whether we have had children or not, we know the kind of ecosystem needed to care for another human being. And when you reach this stage in life, when your parents need assistance, just remember that you are not alone. Millions of older women have been through this experience; just ask for guidance.
The challenges of aging are not new, even as people continue to live longer. What exciting innovations are you seeing in healthcare delivery, and how are women affecting your sector?
The longevity industry is an enormous $7 trillion marketplace, with opportunities for innovation going far beyond caregiving. The most interesting development I have seen over the past 15 years is that women are finally at the table. Female entrepreneurs, like Gina Bartasi, are launching products and services that leverage their areas of expertise and merging them with modern technology to provide real solutions, while clinical leaders, like Dr. Kuroski-Mazzei, are bringing innovative approaches to mental health care and traditional medical practices. I talk with dozens of startups each month; there are so many interesting and engaging ideas coming to market. It bodes well for our future.
Over the past 30 years, Brown Brothers Harriman (BBH) has committed to supporting healthcare companies in achieving their mission of developing and commercializing new products and services. We have been privileged to work with more than 100 companies as a long-term corporate advisor or source of equity and debt capital, committing over $1 billion of capital to support the growth of these companies, which focus on a range of areas, including medical technology, diagnostics, pharmaceuticals and healthcare services. One theme that has particularly resonated across our industry work has been improving quality of care while reducing cost. As an example, over the past five years, our equity capital supported the growth of Best Doctors, which offers a second opinion physician network to patients and their families who are suffering from a critical illness. In addition to our own employees at BBH, this employee benefit is widely utilized across the Fortune 1000 in the U.S. The ability to access key opinion leaders at a time of need has proven both to bring comfort as well as improved diagnostic and clinical results.
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1 O’Connor Vos, Lynn. “She’s the Chief Medical Officer.” greyhealth group. May 1, 2015.
2 Tecco, Halle. “Women in Healthcare 2017: How does our industry stack up?” Rock Health. 2017.
4 “The State of Mental Health in America.” Mental Health America. December 2017.
5 Greenstein, Laura. “9 Ways to Fight Mental Health Stigma.” National Alliance on Mental Illness. October 11, 2017.