Alison Greenberg of Ruth Health: 5 Things We Must Do To Improve the US Healthcare System

An Interview With Luke Kervin

When focusing on pregnancy and postpartum, I think a lot of the challenges we see with maternal mortality, morbidity and preeclampsia could be solved with more frequent monitoring and more frequent access to providers.

As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Alison Greenberg.

Alison Greenberg is CEO and Co-Founder at Ruth Health, a perinatal telehealth hub and comprehensive care platform built for women by women. Prior to co-founding Ruth Health, she worked as an independent consultant in branding with companies such as — CVS Health, Summit Health/City MD, Stryker, Verizon, McDonald’s, and more. Alison previously co-founded aflow, a conversational AI studio and is also the co-inventor of the Dioptra, a patent-pending gynecological and obstetric medical device. Alison received her Bachelor of Arts in Anthropology from Yale University. In 2019, she founded the New York City chapter of Women in Voice, a professional alliance of 3,000+ women/allies in voice tech and conversational AI with chapters in Seattle, San Francisco, London, and Madrid. She is also on the NY Programming Board of StartOut, a non-profit driving economic empowerment of LGBTQ+ entrepreneurs.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?

I often say I was born into this career path, but I think there were also a lot of interesting detours along the way to get here. My mom is an Ob/Gyn, and I grew up working in her practice in the Philadelphia area. I filed charts and yelled at insurance companies to submit reimbursements, all while acquiring an unusually good lexicon for women’s health and an overall understanding of how healthcare works. Fast forward to a career in brand and health care strategy to then starting my first company in conversational AI. Although AI fell right in with my love for using technology to solve problems, building chatbots and voice experiences was not what I felt to be truly engaging in solving meaningful human problems.

It was at that time that I met my co-founder, Audrey. Both working in the same space, we agreed that the next step in our career was to further something that did in fact feel more meaningful, something that would contribute more to the human experience. And we both realized that that space was women’s health. So that led us initially to rethink a medical device that women hate (and that obviously men designed) called the speculum. After winning two FDA-funded grants and successfully designing a Silicon attachment to the device, we realized the problem was much bigger than that.

After doing some research, we identified pregnancy as the highest-volume-care moment in a woman’s life. Yet, unfortunately, it had been the seat of a lot of inequity, as exemplified by the statistic that places the US as the highest mortality nation for pregnancies in the developed world. So, from all this, we said, “You know what? We will build something that fills some of those gaps in care. How do we make maternal health care more accessible and affordable?” And that is what we did with Ruth Health.

Can you share the most interesting story that happened to you since you began your career?

I think it was building a healthcare company during a pandemic. We didn’t set out to build Ruth Health as a telehealth company. But given the need to give people Covid safe services, we made that pivot to scale care and make sure that we could reach the most lives most quickly. This was around the time when telehealth was becoming a household term. It was not something we talked about before 2020. So, although we didn’t set out to build Ruth Health to provide things like remote support for pelvic care, c-section recovery or lactation support, it’s been fascinating to see how much of this care we could offload from the clinic and hospital setting and bring it to people’s homes.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

One of the funniest mistakes I’ve made (and that I will never make again) was very early on when we were bringing on beta users for our pelvic training and recovery sessions. We printed out postcards and I actually went on the New York City subway with these on hand. I was trying to hand them to anyone I saw with with a brand new baby or who looked pregnant. And there was a woman who looked to be about 8 or 9 months into it. And I was like, “Great. I’ve seen somebody.” So, I handed out a postcard and said, “Hi, I run this maternal telehealth company, and we’d love to help you out if you need any support.” And to that, she replied, “I am not pregnant.” So, yes, it was embarrassing for me. I felt horrible, but I learned never to assume somebody was pregnant.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

There is a quote: “Plant trees under whose shade you will never sit.” I always felt like that was an important way to guide work that is of service, whether charitable or volunteer work. Or even if you are supporting somebody as a mentor or giving advice. And I don’t think my co-founder Audrey and I would be here without people planting those trees and supporting us. There were a lot of folks who gave us great advice. Some helped us with our application to Y-combinator as well as hone our business model.

And this is also entirely true of the business we’ve built. I’m not a mother myself, but I am an aunt and raised by an OBGYN and somebody who has plenty of friends and family who have been through this experience. So, although I’m someone who doesn’t have children, I feel called to use my privileges to make the world a little bit easier and safer for those who do.

How would you define an “excellent healthcare provider”?

I think the most important thing about an excellent healthcare provider is a combination of listening and reflection. Reflective listening is something you want in a friend as much as you want in someone who is helping you in your health journey. So, I think great providers listen and don’t just speak. But, in addition to that, they also reflect using their training, using their experience, and a lot of times, just great intuition. And that’s really what we look for in providers. Our lactation consultants and pelvic trainers are people who really do execute on collaborative care. But you can’t do that without listening to the person because no two pregnancies are the same and no two experiences are the same. And that I think is the difference between an appointment and true care.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

There are so many of them. I love listening to the Huberman Lab Podcast for the latest in health and exercise science. Although it’s not specific to pregnancy, I think it’s just a great source on the latest in our research and understanding of these. I also love listening to How I Built This, as well as Masters of Scale. I love hearing how other founders built their businesses and I think we can draw a lot of lessons from across disciplines in this area.

And in terms of books, I found Bumpin’ by Leslie Schrock incredibly eye-opening. She really does help take down so many myths around pregnancy and make us think about our methodology for righting some of the wrongs in and around the partum and the postpartum periods. And there is also Cold Start Problem — which was recommended to me by Jon Dishostsky, one of our partners over at Giant Ventures. It was a really great way of looking at how some of the biggest businesses we know today got started.

Are you working on any exciting new projects now? How do you think that will help people?

We are excited about launching a custom care portal for our patients. I think it addresses a lot of the existing issues with other dashboards in healthcare. They either provide way too much information or nowhere near enough. And they don’t necessarily have resources baked into them, but that is what we are building. It’s a dashboard that gives you everything you need, nothing you don’t, and integrates written content, video content, and checklists. It hopefully helps our patients get prepared while also allowing them access to their information. We want our patients to have access to data transparency and understand the plan their provider has built out for them.

Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

My first reaction is to compare the American healthcare system with ones that function much better in Northern and Southern Europe and even in parts of the Middle East. I think the biggest challenge is that the US healthcare system is a business before it is a public service. The business of healthcare is highly profitable when you want it to be, but it’s not always focused on outcomes or true patient care.

So, although we are starting to enter a world where care is value-based and prioritized, I think our healthcare here in America is still not there yet. It’s a system of billing for things that are not necessarily needed. It’s a system of prescribing when that is not necessarily the right answer, which leads to a lot of excess, and there are just many issues with a lack of customization. So, if I could sum it up, it is a need for deeper listening.

I think the problem is that when providing healthcare at scale, it’s nearly impossible to listen. So that is what we think about with our business. We ask: “How can we continue to provide one-on-one care and provide asynchronous care as well as evergreen content?” And I think there will always have to be a balance. But it’s hard to listen to everybody in a massive system. I think that is one of the reasons why mistakes are made and health care can cost a lot more than it should. It’s because we have a system that is more about the masses, when true health is about serving individual needs.

As a “healthcare insider,” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

When focusing on pregnancy and postpartum, I think a lot of the challenges we see with maternal mortality, morbidity and preeclampsia could be solved with more frequent monitoring and more frequent access to providers. Thus, here is what I would recommend:

Make doula care accessible to anyone via Medicaid. We know that doulas can lower the risk of preeclampsia, preterm birth and a low five Apgar score. Doulas are a wonderful support provider that you can have alongside your Ob/Gyn while giving birth. And we see them as a great way to lower some of the maternal outcomes currently being seen in America. So that would be my change: make Medicaid subsidization for doulas available across the country.

Make pelvic floor therapy the standard of care in every perinatal care plan. It’s one of the services that we offer at Ruth Health but used very infrequently in the US and across the board. On the other hand, look at countries like France where it is the standard of care: every person receives subsidized access to pelvic physical therapy. What makes this service important? It’s not just about how it can address pain and incontinence. It’s also about preserving intimacy between partners. Ultimately it is about dignity and women not normalizing pain and embarrassment and the frustration that comes with pelvic disorders.

Provide closer monitoring of postpartum bodies. A visit before the 6-week check-up postpartum is just as important as more frequent care before birth. Postpartum bodies need care just as prenatal ones do.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

I think for all of that to roll out, we would need a single-payer system and that’s going to be a move by leaders in government that we are not expecting to see in, at least in our lifetime. But one move individuals could take would be reaching out to lawmakers at the local, state and federal level and making demands about improvements to maternal health.

But, sometimes, when our government and our health care system don’t step up, corporations actually can. And so, we’ve seen a huge growth in employee benefit programs that provide maternal health benefits. That can help fill. We’ve even had a company based in Idaho and California that’s majority male that offers free access to Ruth Health to their employees at no cost. These companies realize that the wellbeing of your employee is interlinked with the health of their spouse or partner and their whole family. So, a greater corporate conversation around more robust employee benefits and maternal care benefits would be an incredible step in the right direction.

As for communities and leaders, I think it’s all about education around the issues. A lot of people are shocked to hear where the U.S. stacks up when it comes to maternal outcomes. We need to talk about it. We need to talk about why it happens. Then, I think more leaders need to be open to piloting programs around the use of doulas and around mid-wife-driven care (which has been shown to have great impact). Finally, we need to talk about closing health equity gaps. We need to consider how mothers of color and women of color are disproportionately affected by these worse outcomes.

The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?

One of the tragedies of Covid was that during the 2020–21 years over 80% of preventative women’s health care visits were missed. Among those were things like a mammogram. These were seen as nice to have when hospitals were totally overburdened with people on ventilators. And that’s just sort of the pandemic calculus that pervaded care at the time, but I think what happened in the wake of it was a rise in diagnosis of breast and cervical cancer, a rise in pelvic issues. And we saw more people not really set up for healthy pregnancies when they were ready to take that step. And so now it’s really a pivotal time for the American public to get back on their preventative care and to make up for the time we lost over the last couple of years.

How do you think we can address the problem of physician shortages?

Although there are shortages across the board, I think we need to be more thoughtful about what pool of providers we want to focus on expanding. I think the shortages we are seeing for Ob/Gyns across the board signal that we could be adopting a more midwife-driven system in pregnancy care. Which is not necessarily a bad thing. We know from the healthcare systems in England and the NHS that although Ob/Gyns are often extremely well trained and sometimes great for all sorts of jobs around birth, midwives are very specifically trained to handle birth. And we know that the outcomes are pretty strong based on how the NHS works. So, thinking about a midwife as kind of your first line of defense in birth and then bringing Ob/Gyns as necessary for more complicated cases is a more powerful way to expand the pool of providers against support pregnancy.

How do you think we can address the issue of physician diversity?

This is why it’s so important for physicians and other healthcare providers of color to be spotlighted and be celebrated. I’ve always believed in this idea that if you can’t see it, you can’t be it, and so those already out in the field can sort of pave the way for more folks like them to join the ranks in health care.

But I think it’s very hard. We know women of color make less money. We also know that female physicians of color make less than their male counterparts. We know that female patients of color are discredited and often not heard in a hospital setting. So, a lot of it is discouraging. We need more pay equity audits across hospitals and healthcare systems. At the same time, I think more physicians of color can really help us with the disproportionate negative outcomes that exist for women of color.

How do you think we can address the issue of physician and nurse burnout?

This is the scariest happening in the healthcare system today. That there are so many physicians and nurses that have burnt out since the start of the pandemic. Many of them have left. But there is a little bit of a silver lining in all of this which is that some of them are pivoting into a career in telehealth. And I don’t think that is right for everyone. I think we still need full ranks of in-person providers. But the clinicians who do need room to breathe and want a more flexible work environment can still make an impact virtually by going into telehealth. And so, my hope is that some of the folks who have experienced burnout can make a pivot into a different world where they are providing care virtually. And that’s definitely been the case for some of the folks we work with in terms of patient consultants and pelvic trainers. We want them to be able to show up for their families and overcome the strain of the past few years while still engaging with patients.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I would like to contribute to the movements that exist to close the gender wage gap. But it’s not only just a gendered wage gap. It’s a gap that’s also widened for women of color. It’s just been too long that women are earning 80 cents on the dollar for the case of a white woman. Black women make less than that and Hispanic women even less than that. I believe that while women earn less, they will never truly be equal.

For us, pregnancy and birth are actually good places where you can start making a difference. A more supported postpartum woman might be a woman who is more comfortable going back to work, realizing her economic potential, and contributing to her family. And that is the reason why I’m so passionate about this.

How can our readers further follow your work online?

https://twitter.com/ALiS0NLAURA

https://www.linkedin.com/in/greenbergalison/

Thank you so much for these insights! This was very inspirational, and we wish you continued success in your great work.