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Alter

Our Reflections on Female Health and Wellness Opportunities in Emerging Markets

At Alter, our thesis centers around investing in what we see as foundational technologies in emerging markets. That means investing in tools and solutions that give everyday consumers and small business owners in Latin America, South and Southeast Asia, the Middle East and Africa greater opportunities to learn via innovative education models, scale their businesses through access to capital, set up digital storefronts and process orders through automated, scalable logistics, and more. We believe accessible, affordable and high-quality healthcare is a fundamental component of emerging market development as well, and accordingly have started to develop an investment thesis around it.

From an overall market perspective, we believe now is the time to mobilize resources behind health and wellness technologies thanks to two core factors. First, technology adoption has increased significantly among healthcare stakeholders — from doctors to patients, pharmaceutical producers, pharmacies and more. Even policy makers, a group traditionally slower-moving with technological adoption, have begun to be more open to healthcare digitization. For example, the Indian government has created a domestic digital infrastructure system, the National Digital Health Mission, to centralize patient records and create a database of healthcare resources citizens can tap into. Finally, an increase in general health consciousness has led to an upswing in consumers’ willingness to pay for such solutions.

In this piece, we focus specifically on female health and wellness ventures, a segment we have just started to explore. To that end, this will not be a comprehensive analysis of the space or Alter’s perspective on its investment opportunities. Rather, we will share what we are noticing as the major decision points for entrepreneurs pursuing models in this area, and a few ventures in emerging markets we are looking at today. We also hope to use this as an invitation to engage with Founders, Investors and others as we seek to learn more.

First, let’s discuss why female health and wellness, often referred to as Femtech, stands independently as a sector. Historically, healthcare solutions were trialed and developed on and for men, with dosages simply scaled down for women without taking into account physiological, biochemical differences between the two sexes. As the medical community has recognized the flaws implicit in this approach and begun including women in trials and research, new healthcare products and solutions have started to be developed with female physiologies at the center.

Unicorns Maven and Tia have been exceptional pioneers in this space, demonstrating the clear value of healthcare services developed with and for women. Maven has achieved 20% lower C-section rates, 32% lower NICU admission rates, and 36% less in-person ER and doctor visits through its virtual care platform. Moreover, it has done so while significantly lowering costs, giving 2:1 clinical ROI and 4:1 business ROI.

screenshot of Maven’s online platform
Screenshot: Maven

Tia offers its members virtual and brick-and-mortar care. Providers are employed by Tia for “whole-person” check-ins that focus on root-cause diagnosis and lifestyle-based interventions with a specialist referral network, a vast improvement to traditional symptom-based treatment.

screenshot of Tia’s online platform
Screenshots: Tia

A less quantifiable, but very important element also created through these companies and ones like them has been trust-based communities where women can discuss and share healthcare questions, concerns and goals in understanding, and typically more supportive and transparent environments. Given the stigma around women’s bodies often present from adolescence and the negative health consequences this stigma can lead to, especially in emerging markets, the creation of these communities is incredibly powerful.

As we begin to speak with founders in this space, these are the 3 key business model questions and decision points we see them encountering:

  1. Comprehensive vs. Niche Service Offerings
  2. Doctors on Payroll vs. Contractor Engagements
  3. Offline vs. Hybrid Presence

1. Breadth of Services Offered — Comprehensive vs. Niche:

If we oversimplify for a moment, focusing deeply on a single health issue often leads to a more comprehensive solution and long-term customer retention, but requires a higher customer acquisition cost (CAC) to get there due to a more limited market size. On the other hand, a product offering a multitude of solutions can typically target a large market size for a lower CAC, but long-term retention is more difficult due to low switching costs.

To share a few examples of both models, let’s first look at ventures diving deeply into one issue. For expecting mothers, Babyscripts engages and remotely monitors them from pre- to post-partum, sharing educational content and even detecting possible risks. Modern Fertility aims to help women understand and make decisions about their fertility more knowledgeably, initially building its business around accessible and affordable at-home testing. Interestingly to our discussion, Modern Fertility has since expanded their product line to include pregnancy and ovulation tests, prenatal vitamins and more. On the other hand, Rory offers everything from an online evaluation to delivery of treatment and free ongoing care. Everlywell offers access to laboratory testing for wellness monitoring, educational webinars around topics such as women’s overall health, and daily supplements.

Ultimately, the “winning” solution will be that that can achieve a healthy, profitable CAC : LTV (lifetime value) ratio, and we are excited to continue to watch this segment transform.

Screenshot: everlywell

2. Expert Involvement — Care Providers on Payroll vs. Engaging Consultants

In looking at both payroll and consultancy models so far, we have found that doctors on payroll tend to provide more authentic recommendations and strategic feedback to their patients and the company when compared to providers operating as consultants. We attribute this to the organic, mutual benefits that exist between full-time employees invested into a company’s future compared to someone engaged more transactionally. Given that the underlying goal is to provide women a safe space for their healthcare needs, having doctors as permanent team members helps facilitate that long-term trust as well.

That said, we acknowledge the cost-benefit and ease of hiring contractors vs. full-time care providers, especially when it comes to scalability. This is certainly a component of the healthcare business model that we are still looking into, and are eager to learn more.

3. Digital-only vs. Hybrid (brick-and-mortar + digital):

Similar to the question around care providers’ employment relationships with their companies, the decision between operating a purely digital model or one that is hybrid with a brick-and-mortar presence is a significant one still in relative infancy.

Baseline, the cost of operating a purely digital business is meaningfully lower than also having a physical space, especially if it is one that customers have access to (vs. the “dark store/pharmacy” model). This certainly only increases as we discuss scale. That said, the level of consumer ties and switching cost to another option increases significantly when a deep level of trust is established, and we have found that easier to do when a business has a physical engagement space as well.

What other factors are significant for female health and wellness ventures?

Through our conversations with founders in this space and the lessons they have learned so far, we learned that it is essential to understand the status quo when it comes to female care before founders can begin to define and build a solution. More specifically, because people tend to be more reactive to their health rather than proactive in incorporating healthy habits whether or not there is an active health concern, the adoption of new wellness solutions takes time and a deep understanding of the market. It is not a one-size-fits-all space, particularly when adoption includes behavioral change.

Finally, a few emerging market, female health and wellness ventures so far:

In India, we would like to highlight Veera Health and Uvi Health. Their digital missions to give women access to high-quality, affordable care begin with a focus on Polycystic Ovary Syndrome (PCOS) treatment. Another strong example is Proactive For Her, a platform offering accessible, personalized and confidential healthcare solutions (across skin/hair care, menstrual health, sexual health, PCOS and more). Proactive for Her has also taken a hybrid approach with the launch of their flagship physical clinic in Bangalore earlier this year.

In Latin America, Plenna and Oya Care are strong examples. Based in Mexico, Plenna offers gynecological services, vaccines and lab testing, as well as in-person consultations and treatment. On the other hand, Oya Care in Brazil has built a digital-only model for its female health and wellness platform, providing gynecological and fertility testing and consultation.

As we hope we’ve shown, we’re just at the beginning of looking into the female health and wellness sector globally, and have much left to learn and observe. If you are operating or investing in this area, or simply interested in its development, we’d love to hear from you. Please reach out to us anytime — Sidd Dhankhar @ siddharth@alter.global and Yana Yasevich @ yana@alter.global.

Resources Mentioned:

  1. FemTech Analytics. “FemTech Investments Overview.” FemTech Analytics, https://www.femtech.health/femtech-investments-overview. Accessed 9 May 2022.
  2. Coombs, Bertha. “Investors see growth opportunity in Femtech devoted to women’s health.” CNBC, CNBC, 21 March 2022, http://cnbc.com/2022/03/21/investors-see-growth-opportunity-in-femtech-devoted-to-womens-health-.html. Accessed 17 May 2022.
  3. von Kameke, Leander. “• APAC: willingness for increased healthcare spending 2021.” Statista, 4 March 2022, https://www.statista.com/statistics/1294053/apac-willingness-increased-healthcare-spending/. Accessed 17 May 2022.
  4. Korenda, Leslie, et al. “Are consumers already living the future of health? Key trends in agency, virtual health, remote monitoring, and data-sharing.” Deloitte, Deloitte Insights, 13 August 2020, https://www2.deloitte.com/us/en/insights/industry/health-care/consumer-health-trends.html.
  5. Mistry, Lalit. “India’s healthcare sector transformation in the post-CO — KPMG India.” KPMG International, 1 February 2021, https://home.kpmg/in/en/home/insights/2021/02/india-healthcare-sector-transformation-in-the-post-covid-19-era.html. Accessed 17 May 2022.
  6. Shanthi, S. “Women’s Healthtech Startup Proactive For Her Raises $5.5 Million in Series A.” Entrepreneur, Entrepreneur India, 16 February 2022, https://www.entrepreneur.com/article/418885. Accessed 17 May 2022.

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Alter

Alter

We find and scale the best founders across emerging tech cities around the world.