The best partners can bring very different perspectives and processes versus reinforce the same ones.
After Carolyn Witte graduated from college and began moving around the US for work, she soon received a lesson about the state of healthcare when it came to millennial women like her: it was broken.
Witte, part of the massive population cohort born between 1981 and 1996 that now constitutes America’s largest generation, was forced to spend years finding a consistent OB-GYN to treat a medical condition. Along the way, she learned firsthand what happens when you don’t own your own health data and wind up shuttling between different doctors who don’t talk to each other. Eventually, she was finally diagnosed with a common condition called polycystic ovarian syndrome, but the frustration from that experience shined a spotlight on a very big idea that Witte and her best friend from Cornell University, Felicity Yost, seized upon to find a different way to deliver healthcare to women.
That was the goal behind Tia, a next-generation women’s healthcare platform that Witte and Yost built to provide a personalized care delivery model in contrast to the industry’s conventional, one-size-fits-all approach.
Different populations are going to have different healthcare needs. Combine that with the fact that female healthcare consumers control more than 80% of the US healthcare dollars and the stars are aligning just as Tia closed its Series A financing round. “There’s a realization that we’re building a product and a company in the right industry, targeting the right customer around the right set of issues at the right time,” said Witte.
We caught up recently with both Witte and Yost, who found themselves sheltering in place in the same apartment — just like their old college days — to talk about healthcare, entrepreneurship, and what it was like to disregard the conventional wisdom about best friends becoming business partners.
Q: Is it surprising that the big healthcare providers have been slow to seize upon the potential of this market?
Witte: No. When you think about who controls the money and who makes the decisions in healthcare, it’s largely older men. So, it’s not surprising.
Q: What’s different about healthcare for millennial women?
Witte: First, I think it’s related to the fact that we’re digital natives and part of the convenience culture and all of that. We’re talking about a highly engaged, tech-savvy cohort that’s very open to adopting a new way of doing things. We’ve shown a willingness to adopt new healthcare technologies more than other generations in the population, as well as a willingness to pay for convenience and a better experience. And this is a demographic that oftentimes is moving to new places. I may be an extreme example, but I’ve moved cross-country five times in the last 10 years. Compare that with my mom, who had the same OB-GYN for 30 years. But that relationship is kind of gone for the vast majority of millennial women and so that’s what I would call a relationship void that this highly valuable demographic has with the healthcare system.
Q: What are some of the more problematic issues cropping up in the US healthcare system?
Yost: I think we now exist in a world where healthcare has become increasingly transactional and that speaks to what Carolyn’s talking about where you often don’t have a consistent provider any longer. You also see things like health data getting fragmented across a vast array of different health systems or providers, so you don’t have a consolidated health record. That’s pretty important to derive insights about someone’s health or how it might be changing or trending over time.
From an economics perspective, we consistently see payers and the insurance providers squeezing more and more out of preventative care type services, reimbursing less money and not meeting the inflation rate, which makes that economic model very challenging. And then there’s the consolidation over the last 10 years where lots of the Mom and Pop providers went away or were gobbled up by those big networks that were soulless. So that changed the traditional sense of what preventive care was for both the patient and the provider.
Q: You’re bringing to market a new concept. What’s it like pitching the idea when the people sitting across from you are mostly men?
Witte: There’s a mix of experiences. We have been lucky since the early days of Tia to have a lot of men backing the company. At the end of the day, when you’re raising venture capital, you need to prove that you can build a large successful business. We are personally very driven by the emotions behind Tia — it’s sort of a moral calling because we believe we are building a product that women fundamentally do deserve and need. But as part of that, you also have to figure out how to do that and build a big business at the same time.
But there’s this misperception that the person you’re pitching to has to be the end-customer. It takes someone to understand who Tia users are today and how the market might grow, how different women have different needs, and how we should think about that. The way those conversations panned out with some men was like, “Let me go ask my wife.” But if their wife had a great OB-GYN in Palo Alto, maybe she’d never experienced these pain points trying to navigate the healthcare system. So those conversations were sometimes kind of frustrating because they relied on an outside person who we didn’t know rather than doing what I would call more objective market research based on trends and consumer insights and things like that.
Q: What are common misconceptions you’ve needed to dispel?
Witte: It largely has to do with the education learning curve where some people think of women’s health as delivering babies and that’s it. Sort of like, “Well, what do women go to the doctor for? Do they have other needs as well?” It’s not exactly in that tone, but close. It got very frustrating for us as younger female founders focused on the non-pregnant chapters of a woman’s life, the longest chapters of her life. We realized that the traditional healthcare system — the hospitals, as well as the bulk of healthcare dollars — are fixated on a very specific, highly monetized chapter of a woman’s life. We needed to broaden their perspective so they could understand that women have a lot of needs outside of delivering babies that are important to consider in the context of overall female health. So that education curve was sometimes fun, but sometimes less fun, to bring people along.
Q: You two have been best friends since Cornell, right?
Yost: We met in an international affairs club at Cornell. We were kind of colleagues even before we were even really friends, working for a journal and then became close friends over the course of the four years at college.
Q: I read a paper that you published in the Cornell International Affairs Review about China. And you also studied French, international economics, and international relations. Did you want to become a policy wonk after graduation or were those just side interests?
Yost: I was originally interested in policy stuff. But we both eventually became disabused of the notion that working for the government was going to be a fun time.
Q: Carolyn, you also focused on politics. Neither of you have the typical background of people likely to go on to become tech entrepreneurs. Were there advantages in having a more liberal arts background as well as disadvantages as you pursued your paths as entrepreneurs?
Witte: I think what drew us together were those late nights writing nerdy theses about different parts of the world. We definitely were the nerdiest friends in our friend group by a long shot. But one of the things that can make for a successful entrepreneur is to have this sense of insatiable curiosity. And we’re both curious people with an obsession of “cobwebby” problems and trying to make sense of them and to understand things that are hard to understand. What our education taught us was how to break down complex problems and understand and articulate and explain problems — which is part of what goes into an entrepreneur’s job. The other part that we didn’t learn in school is how to develop solutions and solve those problems.
Q: In school or just after, did you ever think that one day you’d pair up in a partnership and start a business together?
Witte: Never. And when years later we finally did decide to do it, we were very nervous about telling our friends because everyone warns you not to start a company with your best friend.
Q: What were they saying?
Witte: That it was going to be complicated and what if we have a founder breakup and all those things. Everyone thought we were crazy.
Q: But it worked out.
Witte: What was interesting was that despite having spent so much time in school together, I used to think of myself as very similar to Felicity, which is hilarious if you’d ask anybody in our company about that statement. But I thought our brains were similar. We both love problem solving. We both like nerding out and we’re both passionate about women’s issues. Then as soon as you start working with someone, you realize what’s different about work versus school and you realize you don’t know this person at all, or how they work in a professional work context.
Q: Is it related to the different ways you approach managing?
Witte: It’s not just management style. It turns out that our approaches to solving problems are radically different. I finally learned that after many years of sitting in the library next to this person. It’s taken a long time for us to figure out how to play to our respective strengths and differences. I think the best partners can bring very different perspectives and processes versus reinforce the same ones. But I did not know that until we started working on Tia and realized how differently we thought about the same things.
Q: What has Tia demanded from you? Is being a founder as hard as you thought it would be?
Yost: It’s hard, so much harder than you might think.
Witte: I call it self-imposed masochism. I don’t think I’ve ever experienced anything like it. Very, very difficult.
Q: Were there things you weren’t prepared for? Or particular challenges that the role demanded that you had to learn on the job, if you will?
Yost: I’m a person who likes to plan and predict and know what’s going to happen. So, I had to learn to get comfortable with the fact that we could fail and that would be okay. That was a hard thing. In Tia’s early days, I would balance our budget every night. Every single cent that we spent every day, I was so worried. Then the other new thing for me was to create a structure out of nothing. We had to figure out how to do it together. And picking up on Carolyn’s point, we create structures in different ways and think about the value of structures differently. So that was a big transition.
Q: As you reflect on the last three and a half, four years, what’s the biggest learning that you’ve had about yourself?
Witte: I would never want to do this by myself. It’s a very lonely journey, even with a co-founder, it can be very lonely. And the speed at which you need to make decisions with imperfect information, the speed at which I — as a control freak — need to get comfortable with having no control, or very little control. Also, the speed at which you need to bounce back after rejection and failure and keep going is very intense. That’s why you need to grow as an entrepreneur.
Q: How has the pandemic impacted the way you guys manage the operation?
Witte: We spent the first 10 weeks of the pandemic together in quarantine. It was kind of like our early co-founder days. We were in San Francisco, after closing our series A round on March 17, which was a day after we had to close our first brick and mortar clinic in New York because of shelter-in-place regulations.
From a business perspective, a new investor perspective, and then a growing company perspective, we were learning how to handle all those things at the same time during an epidemic when we’re also responsible for 3,000 patients in New York City, and our staff. And you don’t have a crystal ball because there is no crystal ball. But you still need to make decisions and grow your company and learn what to do and what not to do.
Q: So, against the better judgment of people you know, your earlier friendship has been a plus for the business relationship?
Witte: I would say that this is a moment where you’re incredibly grateful for a partner who can be your mental partner as well as an emotional partner and your business partner. It helps when you need to untangle the internal dialogue swirl that’s in your head and turn that into something that allows you to make decisions, which you need to do every day.
Q: Felicity, you’ve talked on another occasion about how having a twin brother has shaped your worldview. Would you be able to share that story?
Yost: When you have a twin, you’re brought into the world thinking through a partnership lens. You always think about each other. I think that has characterized a lot of how I’ve come into the relationship with Carolyn and thought about always having a second half, if you will, or like a sidekick or, I don’t know, another lobe in another body. It’s a constant kind of collaboration and a journey of exploring and experiencing things that I’m thankful for.
Q: Carolyn, I know that your family also had a big influence. Can you talk about that a bit more?
Witte: I grew up in what I’d describe as a tribe of women who were very involved in women’s health and reproductive rights in particular. With my grandmother and my mother and my aunt, it was like a whole squad. My grandmother probably had the biggest impact. She’s 94 and she’s seen it all, so she has a certain amount of wisdom that comes with age and perspective about these sorts of waves and what happens and how to respond to them and put issues in the context of a broader movement.
She inspired me to care deeply about these issues from a young age, from a rights perspective. She got me to think about how you give women agency and the decisions that they make around their health and their life, which was, for my grandmother, tied to the voting, healthcare, economic, and marital rights. If I ever see her get mad or angry, it’s when we, as young millennial women, take those things for granted.
Q: If the White House is successful in getting the Supreme Court to strike down the Affordable Care Act (ACA), what would that mean for women’s healthcare?
Yost: Something that Carolyn and I recognized early on in our journey was the value of the ACA to promote women’s health. An annual exam that every woman is entitled to receive free of charge under her insurance plan per the ACA is very critical. And that access to preventative services is something where we’ve seen a huge uptake since the rollout of the ACA. If that goes away, the threat to women’s baseline health is scary to think about.
Q: And if President Donald Trump eliminates the ACA, millions of women may wind up losing coverage because of pre-existing health conditions as well.
Witte: There would be a significant domino effect if women stopped getting those services. If they’re not covered, that would have broad implications for their health.