Jannine Versi, Elektra Health, on smashing the menopause taboo

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Jannine Versi is the COO & Co-Founder of Elektra Health. Elektra Health is on a mission to smash the menopause taboo by empowering the 50M women with a full-stack digital solution. Elektra provides access to world-class, evidence-based virtual care, education and community. They have been featured in Forbes, Pitchbook, the Financial Times and Crunchbase, and have been recommended by both Katie Couric and Maria Shriver.

Prior to Elektra Health, Jannine held roles in marketing at Google, in the Obama White House and U.S. Department of Commerce, and at Cityblock Health, where she was VP of Clinical Programs and on the founding team. Jannine earned her BA in International Relations & History from the University of Pennsylvania and her MBA from Harvard Business School, and was a Fulbright Scholar in India.

In this episode, we discussed:

• What exactly perimenopause and menopause are, how women typically experience it over the course of 10 years, and the immense purchasing and decision-making power of this consumer
• Why the menopause space is highly-underfunded relative to the growing “femtech” category
• Chronic confusion around and lack of training for menopause care across OB-GYN providers, contributing to a lack of high-quality, evidence-based, content and care for menopausal women as they enter the second half of their lives: the very problem Elektra is trying to solve
• The high economic cost to payers and poor downstream outcomes of untreated menopause symptoms: $2,100+ PPPY, on par with uncontrolled hypertension
• Elektra’s early success in building a full-stack, digital solution including a telemedicine clinic with a distinctive NPS of 91, a cult-like following for its 1:1 and 1:many on-demand and live offerings, and expanding from DTC to B2B2C as forward-leaning enterprise partners seek to invest in female populations during this pivotal phase of life
• Three tokens of advice to female founders on battling imposter syndrome and staying grounded throughout the exuberant and tumultuous entrepreneurial journey

Start — 3:30: Jannine’s background

• Being #3 at Insomnia Cookies: Jannine’s first job in college (and first experience working with a startup) was at Insomnia Cookies her freshman year in college. A student union post advertised for a part-time baker to work 10pm-2am. She joined the senior student founders as employee #3 at their rental kitchen on Chestnut Street in Philadelphia. Over time, she moved beyond baking into managing the store, cutting her teeth recruiting and managing bike delivery folks, eventually expanding the business into new markets and even negotiating a deal with Tasti D-Lite. Here, Jannine fell in love with the pace and excitement of working at a startup.
• Public vs private sector: Jannine joined the Obama White House as a summer Fellow while at HBS, then stayed on for two more years as a political appointee. She was the Chief of Staff of a federal agency within the Department of Commerce, responsible for 15 direct reports, with half a billion dollar budget with a team of 2,200 professionals in 75 countries around the world. She worked on behalf of American businesses, helping them grow, export and attract foreign direct investment. Frankly, that’s a lot of responsibility for a recent MBA grad. Jannine’s take is that the sheer scope of public sector work forces you to learn how to be a manager and get things done in one of the most complicated environments possible.

3:30 — 24:00: Menopause: why the gateway to half a lifetime and a $600B market is not niche

• Menopause continues to be an underserved, underinvested market: 1.1 billion women (~1/7 of the world’s population) are expected to be postmenopausal by 2025. Pregnancy lasts nine months, but menopause can last anywhere from four to 30 plus years. The space is valued at about $600 billion of spending opportunity globally. Still, only 5% of femtech startups today address menopause, largely because of entrenched stigma around menopause.

“That menopause taboo affects the way that society perceives women as they age: as irrelevant, and as no longer sexual beings post-fertility. That’s nonsense. This stereotype continues to pervade medical education, care delivery, and how society perceives women in society broadly. Just take research literature for example: PubMed has 1M+ articles referencing pregnancy, while fewer than 10% of those mention menopause.”

• The power of the Gen X consumer: 50 million people in the U.S. are going through the menopausal transition today. Post-menopause, women spend the next third to half of their lives in a post-menopausal state. Elektra’s target audience is Gen X women (born mid 1960s-early 1980s) who are aged 40–55 today. They are the so-called sandwich generation with enormous healthcare purchasing power, controlling both their children’s spend and likely their parents’ (baby boomers) healthcare spend. They are savvy consumers and used to having sophisticated digital solutions at their disposal. Crunchbase did a deep dive into the “menotech” landscape in January 2021.

“[Gen X] may even use digital health solutions during pregnancy, perhaps for parenting, but then reach menopause, at which point there is no trusted brand offering high quality education and community. We’ve seen previously stigmatized topics go mainstream. Mental health is an enormous category. Erectile dysfunction is a very specific category that affects far, far fewer individuals than does menopause. So, we’re very confident that this is the time to be paying attention to solutions and innovation for 50% of the population.”

• Lack of provider training and education: Only 20% of OB/GYN providers are actually trained in menopause during residency, which is appalling as they are the vanguard of women’s health. The prevalence of menopause symptoms are staggering — we often think of hot flashes, but there are 34 different symptoms of menopause, ranging from brain fog, to painful sex, to dry and brittle skin, to hair changes, to anxiety and depression. 70% of women who seek these providers’ help for menopause symptoms and don’t receive appropriate care. The symptoms, married with the lack of education in both the patient and provider community, can be very disruptive to a person’s quality of life. One of Elektra’s medical advisors, Dr. Lila Nachtigall, is known worldwide for her clinical and academic expertise in estrogen therapy and menopause care. She’s a professor at NYU and the former President of the North American Menopause Society and together with Elektra, is focused on ensuring better provider training for menopause care. Her belief:

“It’s hard to counsel a woman around menopause because it’s complex and time-intensive and there isn’t just a single test you can do to pinpoint menopause as hormones are, by definition, fluctuating wildly. This space lacks diagnostics and the procedures in other parts of OB-GYN, and therefore in a FFS-world, isn’t remunerated well. If you’re a provider making a health system more money in procedural medicine, then you start to see where some of the systemic factors play a role in disincentivizing high-quality menopause counseling and care.”

• The tumultuous history of medically- and socially-accepted menopause treatment: Hormone replacement therapy, or HRT, is the use of supplementing hormones to balance out the declining hormone levels in a woman’s body, predominantly estrogen and progesterone, during menopause. In the 1990s, HRT was prescribed to roughly 45% of menopausal women (18M women). This number fell off a cliff after the Women’s Health Initiative (WHI) study, whose initial findings suggested a higher risk of breast cancer, heart disease and blood clots for women receiving HRT. It led many women and many providers to abandon HRT practically overnight.
• Reexamining the WHI study: The WHI study looked at two specific types of hormones, but generalized those findings to all types of HRT. The study subjects were, on average, older and less healthy than the women to whom HRT is typically prescribed. Reams of data and research show that for most women, most of the time, HRT is safe and effective. As with all drugs and medications, providers and women have to weigh individual risks and benefits. However, the shift away from HRT 20 years ago has caused lingering confusion for providers and patients. Today, the North American Menopause Society, the gold standard of medical research in menopause, explicitly states HRT is the first-line treatment for moderate and severe symptoms of menopause. There continues to be a dearth of data around menopause, though, so Jannine recommends payers with menopausal women in their population consider making that de-identified data available for researchers and entrepreneurs.

“Most women don’t know where to start. We hear time and again, ‘Why did no one tell me? I just need a roadmap. Where is the What to Expect When You’re Expecting, but for menopause?’ Elektra aims to provide exactly this: the full stack digital companion to a woman over the course of her menopause journey.”

24:00 — 34:30: Elektra’s mission to smash the menopause taboo

• Founding story: After a career in digital health (including at Cityblock Health), Jannine recognized the “femtech revolution” quickly taking hold and noted much of that innovation concentrated around the reproductive window, leaving a yawning gap for women in their 40s and 50s entering the second decade of their lives (Rock Health even reported on this in 2020). Jannine was introduced to her co-founder, Alessandra Henderson, through a friend and now investor, and soon joined Alessandra and Elektra’s founding physician, Dr. Anna Barbieri, on their mission to smash the menopause taboo from day 1.
• Naming the new venture: Jannine’s co-founder Alessandra was nearly named “Elektra” at birth. They think of the name as representative of a powerful alter ego, that resonates with a woman who is fearless, powerful and able to be everything she wants to be, as she looks to the menopausal transition and beyond.
• The high economic cost of hot flashes and other menopause symptoms: One of Elektra’s advisors, Dr. Phil Sarrel, has led seminal work on the economic burden of menopause. His 2014 paper showed that untreated menopause symptoms are associated with significantly higher healthcare utilization, work loss, and cost burden. Specifically, (1) women with untreated symptoms (specifically hot flashes) cost 4x their non-symptomatic peers, (2) symptomatic women incur incremental healthcare spend of $1,346 per person per year (PPPY), and (3) absenteeism from medical appointments for this population is estimated at an additional $770 PPPY. Having come from Cityblock and startups in behavioral health, we understand the importance of making the argument around outcomes improvement and cost savings, and here there is absolutely an untapped opportunity for payers.

“Looking at 500K lives, [Elektra’s advisor Dr. Sarrel] found that the impact of untreated menopause symptoms costs $2,100 per woman per year, just looking at hot flashes alone. This is on par with the typical per-member, per-year cost to payers of patients with uncontrolled hypertension. We’re seeing women with untreated symptoms resulting in a massive, 4x cost to the healthcare system compared with that of their non-symptomatic peers.”

• The downstream cost implications for untreated menopause symptoms: Intervening during the menopausal transition is really important to prevent increased risk of conditions that disproportionately affect women in their later decades. Jannine believes there’s a really interesting opportunity here to intervene as women shift from commercial to Medicare plans (alongside the shift from (peri)menopausal to postmenopausal) to improve quality of life, health outcomes, and reduce long-term healthcare costs. Those include:
• Dementia, because estrogen is neuroprotective. There’s a marked brain health decline as women go from perimenopausal to postmenopausal. Dementia affects women at twice the rate it does men.
• Heart disease, the leading cause of death for American women, which are associated with hot flashes. Some women experience hot flashes for 7–10+ years.
• Osteoporosis — 25% of women over the age of 50 die as a result of an osteoporotic hip fracture.
• Anxiety and depression — up to 40% of women report anxiety and depression during the menopausal transition.

“Some of these symptoms you wouldn’t wish on your worst enemy. It’s scary. It’s associated with aging. But we need to speak out and normalize this natural, universal, biological transition. It is the gateway to whomever you want to be in the next half of your life. We talk to women all the time who describe menopause as a real opportunity to reinvent themselves, to reframe their lives. Often it coincides with becoming empty nesters and rediscovering themselves, spending more time on what they love, and finding new passions. As a society, we’re finally starting to celebrate the 50 to 60 to 70 year old woman and beyond, whether that’s Michelle Obama, JLo, or Jane Fonda.”

• Destigmatizing a universal part of aging: Women are often shocked when they hit their 40s and feel like their symptoms hit them like a ton of bricks. They ask, ”Why didn’t anybody tell me?” So even at a young age, women should be learning about menopause, just like they learn about menstruation, pregnancy, family planning, and so on. Michelle Obama even devoted the third episode of her podcast, following the first featuring President Barack Obama and second to ongoing protests around racial injustice, to menopause. It was that important a topic for her to share with fellow women. Oprah devoted her October 2020 magazine issue to menopause. These are just a few examples of how this zeitgeist is shifting the narrative around menopause.

“We hear women who tell us they go to the emergency room multiple times because they think they’re having a heart attack, not realizing that heart palpitations are a menopause symptom. Women should address palpitations with a healthcare provider, but they shouldn’t learn that it’s a known menopause symptom after visiting the emergency room multiple times.”

• Today’s business model, and the continued promise of DTC menopause models: Today, women are taking matters into their own hands. They are the ones that are searching for solutions themselves. So, while there are plenty of verticalized solutions for consumer health selling into employers and payers, there’s also a well-worn path of building a beloved consumer brand and product that can then leverage enterprise channels effectively. While Elektra’s initial strategy is direct-to-consumer, they are confident they will move towards B2B2C models to scale to more women. Today, Elektra offers virtual care that is HSA- and FSA-eligible, with out of network reimbursement rates of 70%, reducing the cost of care to a specialty copay. (HTD has more on the spaces that have high DTC promise, well-aligned to Elektra’s hypothesis.)

“Women tend to do three things today to seek menopause care. First, they ask their doctor, but 70% of women leave their doctor dissatisfied with unanswered questions. Then, they search Dr. Google. They’ll likely find WebMD, or academic journals — which are impenetrable even to the most educated and savvy consumer — and then a bunch of off-putting content on the internet. Finally, they turn to their friends. Women’s health is inherently social. We find that when women find Elektra, see our brand, messaging, and mission, they bring their friends along. We’ve seen really sticky referral rates.”

• Offering menopause care as an employer benefit: Menopause is conservatively estimated as an $81B market in the U.S. It comprises healthcare and wellness spend. Not only are these women key household decision makers, but also, COVID-19 has made clear how essential it is to retain these women in the workforce. The DTC model makes sense today since perimenopausal women are the ones themselves searching for care and solutions today, but progressive employers are increasingly looking to support caregivers in the workplace. This is squarely the menopausal demographic. There are examples in other parts of the world, e.g., in the UK, where even though they are not responsible for the health care costs of their employees, they are already investing in solutions to help support menopausal women in the workforce. It’s written into labor policy, and it’s being taught in schools. In the U.S., Santander Bank (which has now earned massive credibility with Jannine) is one of the first employers to offer menopause benefits to their employees. This is fantastic, pioneering, and it will expand in this country.

“For employers who want to be on the right side of history and retain some of the highest performing folks in the labor force, it makes sense to invest in solutions to support this demographic. We’re seeing that employers are often still grappling with fertility benefits and parental leave. They’re starting to think about caregivers, and our demographic are exactly those caregivers in the sandwich generation.”

• Elektra is built around three pillars: Virtual care, evidence-based education, and supportive community. Elektra takes a holistic, integrative approach to menopause care and lifestyle changes, helping women answer the questions of: what are actionable steps that you can do to manage your symptoms? What are the treatment options, whether OTC or supplements — and which supplements are evidence-based? What is the range of prescription treatment options, hormonal or not? Part of what Elektra does is educate women around their options, think about their goals in an integrative holistic sense, and provide them with a roadmap to manage menopause and live well beyond.
• 1:1 and 1:many, live and async modalities: Elektra’s target audience — Gen X women — are incredibly busy, which means that Elektra needs to offer multiple ways to connect with their content — live and on-demand, individualized and in group settings. Elektra has built out a robust group salon forum where women gather weekly to hear from the medical experts and share stories/insights with each other. It has also built a telemedicine clinic, a weekly newsletter with thousands of subscribers, and a cult-like following for both online and offline content.

“One thing that we learned really quickly is that while women value hearing from medical experts, when that is married with the lived experience of other women, it unlocks a powerful and sticky experience. Women want to know: what does the science say? What should I be doing according to doctors who are trained in this space? And then actually, did this supplement work for you? Or, did you try HRT — and what did that look like? It’s essential to combine those two elements. The best way to do this is with curated community. One has to be really thoughtful about how to go about community, because it can be a race to the bottom. There are many Facebook groups out there, sometimes with 80K+ members, frequently with rampant, shocking, and scary misinformation. Instead, Elektra has found ways to curate opportunities for 1:many education and community with moderation to unlock that sticky community experience.”

• Success of the full-stack digital health solution so far: Elektra’s recently unveiled telemedicine clinic has an NPS of 91 (vs, single or negative digits for most healthcare incumbents, and 70s for notable consumer brands like Apple). Elektra already has a community of thousands of women highly engaged with their educational programming and regular virtual events. Elektra has a “Smash the Taboo” series, which is basically a regular menopause 101 educational series. They’ve seen high engagement and high referral rates both online and at group events. It’s really important to note that women bring their friends along. Women feel that getting smart with friends really resonates. Most of Elektra’s growth to-date has been purely organic, through group salons, sticky word-of-mouth referrals, channel partnerships like with Susan G. Komen of New York, and share of voice via press (like Katie Couric and Maria Shriver, both of whom have massive and loyal followings). In the future, Elektra will lean more into SEO channels since women are searching online — there is a dearth of credible, high-quality curated information. To this end, Elektra is launching a new website with rich, deeply referenced content. More activity on this front is coming soon.
• Future product roadmap: Elektra is also focusing on understanding a woman’s needs as they evolve from age 47, to age 52, to age 57 — which all have different implications for customer lifetime value (LTV). Where Elektra is most excited to advance their product is around what the data will show about predictive and preventative interventions that match women where they are. For example, Elektra would love to introduce a bone density exam to a woman who doesn’t know she should be having it early, which could help forestall that osteoporosis and potential hip fracture decades from now.

34:30 — End: Personal Leadership Growth

• On managing the naysayer voice in your head: Jannine won’t sugarcoat it — it is tough to be a female founder, raising capital, and building a startup in a pandemic. That too for a problem that is not novel, but for which the solution is relatively new. There are many traditionalists and incumbents to overcome. For Jannine, the imposter syndrome is very real. Her key to success? Manage it by building a solid support network. Jannine leans on her partner, family, friends, co-founders, therapist, and executive coach. Jannine suggests three tactics:

1. Find a co-founder — not just to complement your skill set, but to walk the lonely road with you. For folks starting out their entrepreneurial journey, Jannine recommends having a co-founder so that you can really emotionally support one another through an otherwise lonely journey. Yes, it’s great when there is also a marriage of skill sets, but more importantly Jannine believes you need to have a rock solid emotional support. Jannine has found that in Alessandra.
2. Invest in a therapist and/or coach. While this takes time and money, these tools have helped Jannine combat imposter syndrome throughout the rollercoaster of building a company. These have helped her keep her eyes on the prize.
3. Find a space where there is a true mission. Every day, Jannine speaks with women or sees email/outreach that reinforces that what the company is doing matters and is changing lives for the better. There is no better positive reinforcement when you’ve had a crappy day to see that message hit your inbox and be reminded of why you’re building something in the first place. These moments remind Jannine that building a company that serves a greater good is truly a privilege and honor.

The Elektra team today is a small but mighty team and over the coming months, the company will be expanding hiring significantly — stay tuned for job openings here!