Reinventing Healthcare For All — One Condition at a Time

Steven Gutentag and Demetri Karagas, Co-Founders of Thirty Madison

Why can’t everyone — no matter their income, job, and residence — access affordable, convenient, specialized healthcare for chronic conditions?

This is the question that drives us.

We founded Thirty Madison in 2017 to build a better and more accessible approach to treating chronic health conditions for all. Through our three brands (and counting) — Keeps for hair loss, Cove for migraine, and Evens for acid reflux and heartburn — we are bringing real relief to hundreds-of-thousands of patients.

By reinventing the care model, we are creating solutions to industry-wide problems. We are humbled by the support we’ve received from key stakeholder groups in healthcare, including some industry leaders who participated in our recent Series B fundraise.

But this was not always the case. To get to where we are today, we had to be resolute in our vision and relentless in our effort to turn skeptics into believers, even partners.

We began by asking:

Why is our healthcare system such an inaccessible mess that favors those with means and time?

That it’s so difficult for most people to get successful ongoing care for chronic conditions is wrong and unfair. Tragically, the COVID-19 pandemic — and the disproportionate deaths of Black, Hispanic, and Native American people — is showing us just how dangerous our healthcare system is when people can’t access care for chronic conditions that leave them immunocompromised.

Having previously founded and sold a company together, we naturally turn to each other when we see problems in need of solutions. Upon digging, we discovered how absurdly complex and convoluted the healthcare industry has grown, to the point that structural inefficiencies actually disincentives affordable, accessible care.

Too many patients rely on emergency medicine for stopgap measures and ad hoc treatments. Some defer care entirely. Too many patients are left connecting the dots of their own healthcare, trying to ensure doctors, insurance, and pharmacists are all on the same page. Most critically, too many people without good insurance, financial flexibility, or industry access simply do not get the care they need. The social and economic impacts only exacerbate from there.

The takeaway? To get successful and expert care for chronic conditions and optimize one’s health, you must have good insurance, time, and money.

What first began as a personal frustration over hair loss grew into a shared passion over an inequitable system in need of fixing — fast. In order for anyone, no matter one’s economic or geographic circumstances, to access expert care for chronic conditions, the model needed reinvention.

Through our research, we saw start-ups moving in-person visits to the virtual. And concierge medicine offering a higher level of generalized care to those who can afford it. We saw a crop of companies providing digital care for acute and/or lifestyle issues, such as family planning.

But we didn’t see anyone solving the structural problems that preclude all people from receiving affordable, ongoing specialty care for chronic conditions. This led to more questions.

If scarce in-person appointments for chronic conditions prohibit access, why can’t affordable, quality care be virtual and asynchronous?

Why must you take time from work or family and negotiate the doctor’s schedule to get care? Why must you live near a specialist to benefit from her expertise? Why do you have to have a Cadillac health plan — which usually requires a white-collar job — to get affordable care? How does standing in line at a pharmacy improve health outcomes?

Most healthcare is synchronous and happens in real time, meaning patients have in-person visits and go to the pharmacy for medications. The more we probed this status quo, the more we wondered why care can’t unfold over time — and online — to remove structural inefficiencies. If expanding access to the best specialty care was our goal, the model would have to be digital and asynchronous so that doctors could scale care and reach far more patients than possible with an in-person model.

With this idea, we approached leading hair loss experts — who at first resisted. “There’s no way doctors could treat hair loss online,” many said. “It’s way too complicated.” But we persisted. We believed patients would embrace telehealth if it promised improved care at lower costs and on their schedule. In time, we brought once-skeptical doctors to our side to help us launch Keeps.

Leveraging their expert knowledge and experience, our specialist doctor-partners create diagnostic and treatment protocols. Doctors within our network then apply their clinical judgment to our expert protocols to individualize treatment plans. Medications ship directly to patients. Patients, who have the same doctor throughout ongoing treatment and care, report progress through uploaded photos. They can message their doctor at any time, and doctors reply promptly with Thirty Madison’s signature compassion. In our first year alone, we shipped treatment to over 100,000 customers.

With proof-of-concept in hand, we set out to recreate our success with another chronic condition — migraine. We approached leading migraine specialists. Again, they resisted. “Hair loss is easy to treat online. But there’s no way doctors could treat migraine online,” many said. “It’s way too complicated.” Again, we persisted.

In launching Cove, we learned that while different conditions require differentiated care models, Keeps was no fluke. We adapted our model for Cove and again affirmed its viability. Of patients who’ve been with Cove for six months or more, 80% report a reduction in urgent care and/or ER visits, 70% saw a reduction in migraine severity, and 56% report a reduction in migraine frequency.

Reduced patient costs is also central to our mission. Through innovative partnerships with healthcare companies, we now offer direct-to-consumer access to a range of medications at dramatically lowered costs. More patients, across all of our brands, benefit from accessing these once inaccessible medications.

Yet, if we stopped short of upgrading the human experience, we would stop short of truly reinventing healthcare. This brought us to our next question.

Why can’t expert care for chronic conditions be enjoyable (yes, enjoyable)?

More and more, patients come to Thirty Madison because they know they will receive expert care and be treated with respect, heard, and given ongoing attention. Our customer service team always looks for opportunities to bring empathy and humanity to every patient touch point. As an example, we’ve reduced costs for patients who’ve suffered financial hardship from the economic fallout of COVID-19 so that they can continue their treatment with us. Doctors take time to develop relationships with every patient, supporting each as much or as little as needed throughout the whole journey of treating their condition.

Patients repeatedly tell us they are not just satisfied with their care — they also enjoy it. Yes, healthcare can be enjoyable. Making it so is part of the Thirty Madison promise.

Next, we asked:

Why can’t Thirty Madison be the best place to treat all manner of chronic conditions?

At every turn, medical professionals have initially resisted our reinvented care model. At every turn, we have turned skeptics into supporters and partners.

Thirty Madison’s care model brings solutions to problems experienced by all stakeholder groups, while never losing sight of the ultimate goal — better health outcomes for more patients through an enjoyable experience that puts them first.

Our success has earned us credibility, such that when it was time for a series B fundraise, Polaris Partners, with Managing Partner Amy Schulman at the helm (and, soon, on our board), became our lead. With Polaris’ stellar reputation in healthcare, we raised $47 million, amounting to $70 million in total funds raised to date. Industry leader Johnson & Johnson Innovation also participated in the Series B, along with existing investors Maveron and Northzone.

Nearly 60% of Americans suffer from at least one chronic condition. Today we treat three chronic conditions, each impacting tens of millions of Americans, and we are just getting started. We know Thirty Madison’s novel approach to care delivery can serve far more patients than traditional healthcare can serve, and we won’t stop improving until we are the best at it.

We have found innovative ways to remove structural barriers that, in turn, solve systemic problems and unlock access and affordability. We are improving health outcomes for hundreds-of-thousands of patients. We are putting humanity back into healthcare, every step of the way. With industry giants lending that much more credibility to our cause, we are reinventing healthcare for all — one condition at a time.