Dr. Somi Javaid, HerMD, on expanding access to female sexual health

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In this episode, we chatted with Dr. Somi Javaid, Founder & Chief Medical Officer of HerMD. Dr. Somi Javaid is a board-certified OBGYN and pioneer in the women’s sexual healthcare space. She founded HerMD, a female-forward, insurance-based women’s healthcare center to help educate, advocate for, and empower women to take control of their health care. Recently, HerMD raised $10 Million in their Series A fundraise to bring their unique healthcare model to women across the U.S. JAZZ Ventures led the Series A round.

We discussed:

• Watching her mother struggle to receive the care she needed and experiencing personal job dissatisfaction and burnout led Dr. Somi Javaid to found HerMD, a clinic specializing in menopause and female sexual health, designed to empower both patients and clinicians to create a positive care experience.
• The importance of promoting access to innovative therapies treating menopause and female sexual health disorders through insurance reimbursement, opening physical locations in “flyover” states, and championing education and patient advocacy.
• The rise of female healthcare-focused startups is likely to persist in conjunction with more VC funding, with opportunities for consolidation and collaboration across brands.

Start to 8:13: A personal motivation for championing women’s health

• A personal encounter with gaps in healthcare for women: While Dr. Javaid was completing her pre-med studies at Northwestern, she witnessed her mother struggle to find the right care for her cardiovascular issues. Dr. Javaid’s mother was often dismissed when she reported experiencing chest pains and a family history of cardiovascular disease. Despite exhibiting abnormal EKGs, doctors refused to believe she could have cardiovascular disease given her relatively young age and healthy weight. In fact, she was told “your kids are stressing you too much,” to “cut back on caffeine,” and “she’s a woman — their EKGs look different.”
• On becoming an advocate for women’s health: Dr. Javaid founded HerMD because she saw a gap in the status quo in providing quality healthcare for women. Even though her mother eventually received the surgery she needed through emergency care, the care delivery was hectic and robbed the family of the preparation time they otherwise would have had if the doctors had accounted for mother’s symptoms during the initial appointment and scheduled the procedure ahead of time. After undergoing this difficult care experience for her mother, Dr. Javaid was determined to become an advocate for women’s health.
• On practicing “doorknob medicine” and the decision to start HerMD: As a practitioner, Dr. Javaid experimented with a variety of clinical settings including working at a hospital, an academic medical institution, and a large private practice. However, these practices were missing at least one of the dimensions that was important to Dr. Javaid: job satisfaction, work / life balance, and addressing the taboo topics including sexual health that patients sought guidance for. Given her high patient load, Dr. Javaid was forced to practice what she terms “doorknob medicine.” Her hand was always on the door because she was constantly being rushed to see other patients. As she looked for new jobs that would bring better continuity of care for patients, Dr. Javaid embraced advice her father gave her to build her own path if other doors are closed. As a result, Dr. Javaid purchased a building and opened HerMD, focused on addressing menopause and women’s sexual health.

“My father gave me a piece of advice that I’ll never forget. He said, ‘If you can’t find a door that’s open, build your own door.’ And that’s what I did. I bought a building and opened a practice. And that’s where it started.”

8:13 to 12:41: Overcoming training gaps and low reimbursement models

• On supplementing menopause and sexual health training: Medical education provides limited guidance on how to help patients manage menopause and sexual health beyond treating infections or pregnancy-related issues. However, many patients struggle with other menopause and sexual health issues such as orgasm, arousal, and sexual pain. Given the gap in medical training, many practices also lack the expertise to advise patients on these topics. To supplement her training, Dr. Javaid got involved with national societies such as the North American Menopause Society and the International Society for the Study of Women’s Sexual Health to learn about leading research and technology used to treat menopause and sexual health conditions.
• On gender disparities in sexual health: Most people, including women, have heard of erectile dysfunction (ED), which is a form of male sexual dysfunction. In the U.S., there are currently 26 different medications addressing men’s sexual health but only 2 options for women’s sexual dysfunction. Providers also often lack the training and knowledge to educate patients on the full spectrum of viable treatments. Given the high patient load that is typical in many traditional provider settings, both patients and doctors struggle with receiving and imparting the highest level of care for menopause and female sexual health.
• On reimbursement options for women’s health: Reimbursement through insurers is fairly low, which makes it economically challenging for providers to give patients the time and attention they need. A standard visit can take an hour, and providers must account for costs such as the nurse, medical assistant, software, and fixed costs such as rent and other overhead costs. Given these challenges, many menopause and female sexual health specialists adopt concierge or direct-to-consumer cash models. However, Dr. Javaid recognized providing a service external to insurance creates an economic barrier for many women who cannot afford to pay for services outside of insurance.

12:41 to 40:33: HerMD’s mission to expand access to female sexual health education and treatments

• On HerMD offerings: HerMD is a gynecology clinic offering annual check-ups, contraceptive visits, and abnormal bleeding checks. HerMD specializes in menopause and female sexual healthcare. HerMD provides ultrasound, surgery, imaging, and phlebotomy as well as specialized services such as radiofrequency and CO2 procedures that target sexual pain and incontinence. Beyond clinical services, HerMD also provides access to a medical spa run by aesthetic providers that includes CoolSculpting, lasers, fillers, Botox, and other aesthetic services. HerMD works with insurers but also offers options for patients to pay out of pocket for services not covered under insurance.
• On adopting a hybrid model of care delivery: HerMD’s care delivery model includes brick and mortar locations supplemented with telehealth offerings. Dr. Javaid chose to adopt this model of care because while telehealth provides more accessibility for some patients, it alone is also insufficient to treat conditions such as abnormal bleeding, fibroids, and cysts that require in-person examination and, in some cases, operations. HerMD also ensures patients receive a uniform experience through standardizing the training and care HerMD physicians provide.
• On scaling across state lines: Over 40 states had waiver programs and temporarily authorized clinicians to practice across state lines without applying for new licensing and accreditation. These waivers were instituted during COVID to help providers meet the growing need for medical services across the U.S. Programs like this and compact licenses where states recognize providers licensed in other states have allowed HerMD clinics to see patients from 34 states. However, HerMD still has to apply to be included in insurance programs in each state they want to operate in. This process has slowed down HerMD’s expansion into states outside of their current physical locations in Ohio and Kentucky.
• On other regulatory progress achieved through COVID: During the pandemic, insurers implemented pay parity for telemedicine services. Previously, telemedicine visits were reimbursed at a fraction of the cost of in-person visits. Given the surge in demand of telehealth visits during COVID, insurers instituted pay parity between virtual and in-person visits. This is a trend Dr. Javaid expects to persist.
• On the decision to include supplementary services (weight loss, aesthetics) in the offering: Weight loss came up in conversations with patients about 80% of the time, and weight management is a natural topic that comes up with female patients when discussing their health goals. In addition, obesity is a pervasive health issue in the U.S., leading to comorbidities including diabetes, hypertension, cardiovascular disease, and even reduced libido. As patients seek options to address weight loss, HerMD has been able to offer a range of FDA-approved weight management medications and a medical spa that empowers women to look their best and feel confident.
• On the competitive landscape and HerMD’s differentiation: Tia, a female healthcare startup with brick-and-mortar locations, is HerMD’s most direct competitor. There are also other female-focused healthcare startups that also provide telehealth services. Compared with its competitors, HerMD is the only company that treats menopause and female sexual health conditions with evidence-based care options within a primarily insurance-based reimbursement model that does not require additional out-of-pocket memberships. HerMD is also physician-founded, another point of differentiation with other comparable startups.
• Addressing physician burnout at HerMD: Even though HerMD enables clinicians to spend more time with patients and boost both physician and patient satisfaction, the practice faced burnout challenges during COVID. HerMD also faced financial challenges as insurers delayed payments despite the clinic accruing additional costs such as purchasing PPE to protect staff. In spite of these challenges, HerMD cultivates a culture of community and openness amongst staff. The team hosted Zoom socials, retreats, and lunch-and-learns to get to know each other. Clinicians can also flag when they need more breaks in their schedule or time off. These measures are intended to enable better provider retention, a key risk area as ~47% of current healthcare workers are projected to drop out of the healthcare industry by 2025 due to burnout.
• On measuring patient efficacy: HerMD tracks patient outcomes both through patient surveys and by measuring clinical outcomes. HerMD recently conducted a retrospective chart review of patients who struggle with hypoactive sexual desire disorder and compared the clinical outcomes from HerMD patients with rates of success of treatments that had been published previously. This review revealed HerMD patients exhibited higher clinical outcomes. HerMD continues to conduct assessments like this in addition to gauging metrics like patient and provider satisfaction to ensure the best care experience for all.
• On leveraging data to build payer buy-in: One of the challenges for providers such as HerMD in employing novel technologies to treat patients is inertia from payers to reimburse these procedures. Treatments labeled as “experimental” often are not reimbursed at parity with FDA-approved procedures even if these treatments received regulatory approval in other countries. Given this, Dr. Javaid is focused on conducting studies that demonstrate the clinical efficacy of cutting-edge treatments such as CO2 therapy to eventually gain payer buy-in for reimbursement, once larger studies validate these findings.
• On promoting access through physical locations and health education: Beyond taking as many forms of insurance as economically feasible to limit out-of-pocket payments, HerMD is also addressing access in their choice of where to open physical clinics. HerMD is opening locations in “flyover cities / states,” which are areas that are less densely populated and have fewer resources available to women. By opening locations in areas that are less serviced, HerMD seeks to reduce additional financial barriers to access such as transportation. Currently, HerMD has locations in Ohio and Kentucky, with upcoming openings in Nashville, Tennessee, Carmel Indiana, Charlotte, North Carolina, and New Jersey. In addition, HerMD hosts summits for patients and providers to educate all stakeholders on the options available for treating various female sexual health disorders. Providing education on female sexual health disorders and treatments empowers patient advocacy, reducing the knowledge barrier for patients to access care.
• On the HerMD patient: Currently, the median age of patients at HerMD is 43 years young. Dr. Javaid is noticing a trend of younger patients in their 20s and 30s visiting HerMD clinics seeking guidance for sexual health issues and to use the medical spa. These patients are more comfortable discussing issues of sexual health despite the stigma that is often associated with female sexual health.

40:33 to End: The rise of the female healthcare industry

• On partnering with others to elevate female sexual health broadly: HerMD partners with nonprofits and brands that support similar missions of bringing greater awareness to female sexual health disorders and support for women. One example of this is HerMD’s collaboration with the White Dress Project, a nonprofit that supports women with fibroids, which are muscular tumors that grow in the uterus. Dr. Javaid also sits on medical advisory boards and acts as a speaker for pharma companies that are offering treatments for various female sexual health disorders and menopause. HerMD will also be launching an e-commerce site to enable patients to purchase recommended products for treating pre-menopause, menopause, and various female sexual health conditions.
• On securing VC funding as an older, female, minority founder: When Dr. Javaid initially set out to pitch to VCs, she was told that she had a 0.37% chance of succeeding. She was “too old, from the Midwest, and a minority woman.” However, Dr. Javaid emphasized her 20+ years of seeing patients as a point of differentiation in providing insight into the female healthcare segment. This perspective into what patients and providers are looking for resonated with several VCs and enabled HerMD to close out their Series A funding round fairly quickly.
• On the future of female healthcare companies: Dr. Javaid predicts interest in female healthcare-focused companies will continue to persist. VCs are more willing to listen to and invest in companies targeting female sexual health disorders. This is evidenced in the significant funding female health-focused companies such as Maven Clinic and Tia have raised.
• On the near-term development of the female healthcare industry: Many new companies have started entering the female healthcare market, resulting in fragmentation. Dr. Javaid surmises the companies that lack an understanding of the science behind viable treatments and the patient experience will not survive. However, there are opportunities to partner with other companies that provide complementary services. In this way, Dr. Javaid also collaborates with brands to cross-promote HerMD services and the products and services of other female healthcare-focused companies.

“Surround yourself with like-minded people. Surround yourself with people who have gifts where you have gaps. Do not let the detractors take away real estate in your head. And don’t take no for an answer.”