The Coronavirus Economy: Tia’s CEO on running a women’s health clinic during a pandemic

May 28, 2020, 5:00 PM UTC

Subscribe to Fortune’s Outbreak newsletter for a daily roundup of stories on the coronavirus and its impact on global business.

Before cofounding Tia, a health care startup with gynecology, primary care, and wellness services, Carolyn Witte was working at Google’s Creative Lab, a design-thinking arm of the Silicon Valley giant. Based in New York City, Witte describes the group as the “translational bridge” between the tech side of the company and “real human-in-the-world needs.” It was there, she says, that she learned the power of user-centric design, storytelling, and the “special flavor of innovation inherent to interdisciplinary teams that would become the heart of Tia’s collaborative company culture.”

Aside from her own experiences as a patient, Witte admits she was very much a health care “outsider” but saw the opportunity to apply the playbook she had learned at the Creative Lab to a problem about which she felt personally and cared deeply. So she took the plunge: She quit her job at Google, moved to San Francisco, moved in with her best friend from college (and now cofounder), Felicity Yost, and started developing Tia from their dining room table in 2016. Six months later, Yost—who had her own share of subpar women’s health care experiences and a passion for using data to personalize health care—quit her job as a product manager at a data startup.

Fast-forward to the present, after already raising $2.5 million in previous seed rounds, Tia Clinic is now announcing a new round of fundraising and a new board member joining their all-female board of directors. And after shuttering its physical doors but developing its telehealth resources, the clinic plans to reopen for in-person appointments on June 1.

Fortune spoke with cofounder and CEO Carolyn Witte for a new series, The Coronavirus Economy, to ask about how the outbreak has affected her business and her thoughts on the future and to get a sense of how she has been handling this news, both emotionally and financially.

Carolyn Witte (right) started Tia Clinic with her best friend from college (and now cofounder), Felicity Yost.
Bridget Badore

The following interview has been lightly edited and condensed for clarity.

Fortune: What inspired the launch of Tia Clinic? What did it take to launch the business?

Witte: The initial idea for Tia came from my own experience struggling to navigate the health care system while going through a three-year-long polycystic ovary syndrome (PCOS) diagnosis process in my early twenties. I got fed up with a health care system that was fragmented and difficult to navigate, lacked personalization and made you feel like a number, and was overly focused on treating sickness instead of preventing it. Coming out of this experience, I asked myself: “If I can’t navigate this health care system, what woman can?” and started to envision what a whole new system might be like, designed for women’s needs at the heart of it.

Before getting into the world of clinical delivery, we built a chat-based Q&A app designed to give women personalized, evidence-based answers to health care questions like “I missed my birth control pill—what do I do?” We had a knack for building a highly intimate and trusted relationship with women, and within months, had more than 200,000 one-on-one conversations with women about all aspects of their health—not just reproductive health.

Most interestingly, we found women bringing the Tia app with them to the doctor’s office and messaging us in a care context. In the waiting room: “Hey, Tia, why do I have a deductible, can you explain?” In the exam room: “Which IUD should I get?” And post-appointment: “Tia, can you explain my test results?” Through these real-women conversations, we got a front-row seat to everything that was working and not working in health care today, validated that our poor experiences as patients were not the exception, but the norm, and quickly learned that to really change health care in the way that we wanted, we had to become the doctor. This is what led us to bet our business—literally and physically—on opening the first real-world Tia Clinic—a totally reimagined modern medical home for women that fused gynecology, primary care, and evidence-based wellness practices into a singular, integrative model.

While we did not start out as health care founders, over the past three years of building Tia, Felicity and I have become health care founders. But it’s been an uphill battle to get here: Our vision is both capital- and operationally intensive; it requires investment in real estate, doctors, and technology—and all at the same time. For this reason, we’ve been told many times through the highs and lows of this journey that we have “three strikes” working against us. One, we are first-time founders building a highly complex, capital-intensive business. Two, we are not doctors and have no prior experience working in health care. Three, we are women.

Despite these cards stacked against us, we persisted. Through every rejection, obstacle, and setback, we relied on our conviction, and above all else, the validation we got from real women in the world who wanted what we were building and didn’t “like” Tia, but loved it. Three years in, we no longer have just a starry-eyed vision but data to back up that the “Tia way” really, really works—and has the legs to scale. With a consistent patient Net Promoter Score (NPS) of 95 and a collaborative care model that reduces the cost of care by 40% per service, we’ve shown that Tia’s secret sauce is more than an Instagrammable waiting room. Rather, it is our fusion of technology, experience design, and best-in-class clinical research and practice that gives us a differentiated playbook for higher quality at lower costs and is what enabled us to secure this Series A financing, and with it, the opportunity to make the Tia Way, the new standard of care for women everywhere.

Witte sees Tia’s “fusion of technology, experience design, and best-in-class clinical research and practice that gives us a differentiated playbook for higher quality at lower costs.”
Kezi Ban—Blonde Artists/Courtesy Rockwell Group

How did COVID-19 initially affect your business? What instigated the move to close your doors? Was telemedicine an option for patients in the interim?

As a health care provider responsible for 3,000 female lives in New York City at the epicenter of the epidemic, the impact of COVID-19 was a stress-test on our business, our care model, and our values. Unlike a restaurant or a yoga studio, Tia is deemed an essential service, so we did not have to close, but we made the choice to temporarily close our physical doors for the betterment of patient safety, provider safety, and an NYC health care system with limited resources, e.g., personal protective equipment.

Instead, we focused our resources on expanding Tia’s Connected Care platform to include virtual care—specifically video visits—which had historically been stymied due to regulatory and insurance reimbursement constraints. With [the easing] in telehealth regulation, we seized the opportunity to roll out a robust virtual care product, which includes the ability for patients to use their health insurance for virtual services, setting us apart from the majority of direct-to-consumer telehealth companies that are cash-only or dependent on an employer-sponsored benefit. We introduced virtual COVID screenings, antibody testing, and 48 different gynecology and primary care appointment types, all via video. Lastly, in response to a 400% increase in behavioral health–related messages we saw on our platform, we accelerated the rollout of virtual behavioral health, which filled immediately and has remained 100% booked for the past four weeks.

Since COVID began, more than 40% of Tia’s patients have used Tia’s virtual care offering via chat or video, and our already standout NPS of 95 rose to 100 week-over-week during COVID—a testament to the role we’ve played for women in NYC as both care providers and their trusted source for information during the epidemic.

Now that you’re on the way to reopening, what should patients know when returning? What steps have you taken to ensure patients will be as safe and secure as possible when visiting the clinic?

On June 1, we are reopening the physical Tia Clinic and will be offering integrated in-clinic and virtual women’s health care. Just as closing our doors was a deliberate choice in service of patient safety, so is our decision to reopen them. Women’s health is an essential service. Delaying services that cannot be done on the Internet—such as a pelvic exam, an IUD insertion, or an endometrial biopsy—for 30 days is one thing, but delaying these types of essential services for a longer period of time puts women’s health at risk. Moreover, with lower rates of new infections in NYC and expanded access to PPE, we are now able to provide the essential health care services to our patients while mitigating the risks to our care team.

To maximize patient safety, we will continue to deliver the bulk of services virtually and only bring patients in for services that require in-person care. To prevent any exposure for our patients and staff, all COVID-related concerns are being handled virtually versus at the clinic. All patients coming into the clinic will answer a pre-visit health screening via text to assess any potential symptoms before they even show up. All check-in for appointments will be “touch-less” and done 100% virtually prior to showing up at the clinic.

We are maintaining strict social distancing by limiting the elevator to one person at a time, spacing out seating in our living room, and staggering appointments. Upon arrival, every patient will receive a mask, be given a temperature check, and be asked to wash their hands. We are keeping the Tia Clinic extra clean, by disinfecting all counter surfaces and medical equipment after each patient, throughout the day, and cleaning each evening with EPA-approved products.

Last but not least, we are screening all Tia staff members daily, testing them regularly for COVID-19, and providing personal protective gear for respiratory and contact precautions.

You just completed a new round of fundraising. How much did you raise, and what is the valuation of the company now? How difficult is that effort to undertake given the turbulent economic climate?

We raised a $24.275 million Series A fundraise, led by Threshold Ventures with participation from Define Ventures, ACME, Torch Capital, John Doerr, Homebrew, and Compound. I’m proud to say that it is the largest Series A financing led by a female CEO in 2020.

In addition to new capital, we are thrilled to have Threshold Ventures managing partner Emily Melton join our all-female board of directors alongside Lynne Chou O’Keefe, managing partner at Define Ventures.

In normal circumstances, raising a Series A of this size is extremely difficult—especially for women, who despite getting funded more frequently over the past few years, continue to raise far less capital than male founders [only 2.9% of total VC dollars in 2019 went to women], and sell more of their companies when they do it. And we closed our Series A on March 17 on the brink of a global health crisis and economic collapse, two days before shelter-in-place was instituted in New York City, and one day after we chose to temporarily shut the physical doors of the Tia Clinic.

While COVID-19 has had short-term implications for our business with the temporary close of our physical clinic, long-term, Tia’s business and service model will be stronger for it, and our investors saw that opportunity. We are the only virtually integrated women’s health care offering of its kind, giving us a unique opportunity to connect and scale our online and offline business and service models in innovative ways for the betterment of both women’s health outcomes and the cost of care.

With a big vision, massive market opportunity, and proven playbook from the past year of operating our first Tia Clinic in NYC, we were able to give investors the conviction to make a bet—despite turbulence in the market—on Tia being a leading force that can shape “the COVID correction” our health care system desperately needs.

How do you plan to utilize the new funds? What areas of service do you plan to expand? Are there any services that patients are requesting with more urgency?

With this financing, we are seizing this opportunity to bring virtually integrated Tia Care to new markets by expanding our virtual and brick-and-mortar footprint.

We plan to broaden our scope of practice to serve women throughout their reproductive lives, inclusive of prenatal, postpartum, and obstetrical care. Additionally, following the outsized demand for Tia’s behavioral health offering, we will be doubling down on expanding this program virtually and in-clinic in NYC and in future markets.

And we plan to partner with leading health systems, employers, and provider networks to scale our Connected Care platform, and open new physical and virtual Tia doors. These strategic partnerships will help us keep the cost of care affordable by working within the existing insurance system, enable us to better connect a women’s care journey across the outpatient and inpatient world, and give our patients access to the best specialists and hospitals when their care requires it.

There was some backlash last year in regards to concerns about the clinic’s data privacy policy as well as criticism that Tia Clinic rates were prohibitive on a socioeconomic basis, the latter of which could become exponentially worse as the unemployment rate continues to surge. What steps have you taken, if any, to address these issues?

Tia has always been and remains evermore committed to raising the quality bar of women’s health care within the confines of the existing system and payment models that dictate access and costs. We charge a modest membership fee of $15 per month, the lowest-price membership-based clinic on the market. This fee covers benefits that go beyond what insurance pays for, that many women want, including unlimited messaging with your Tia Care Team, and educational and community events including Support Circles for women with chronic conditions and trauma. And most important, we work with insurance companies to ensure women can use their health insurance for all services at Tia from gynecology to primary care to acupuncture, and soon behavioral health, in-clinic and virtually.

Recognizing that a membership fee of any kind can be cost prohibitive, we introduced a membership fee waiver program earlier this year to waive membership fees for low-income women or those facing financial hardships. We have not yet seen, but expect applications for waived membership fees to increase in light of the current economic climate and will be doubling down on supporting this waived membership fee program in NYC and in all markets that we expand to later this year.

More than waiving membership fees, however, we believe the most impactful way we can increase access is by helping women get health insurance, which is the key to unlocking access to covered benefits at the Tia Clinic and at any women’s health care provider. Before COVID, one in five millennial women was uninsured; we expect this figure to increase rapidly in light of massive job losses, and with it, insurance coverage. To help solve this, Tia’s care coordination team has invested extensively in helping our patients navigate this new insurance landscape, creating insurance guides and calling your insurance company on your behalf to fight claims and charges.

On the data privacy side, we aim to give patients control when it comes to their health and data, across our free consumer-facing apps and HIPAA-compliant patient and provider apps. Most notably, we’ve built in additional layers of control and transparency to support our Cycle-Connected Care feature, which can connect (if a patient so chooses) self-reported cycle, health, and wellness data from our Tia Tracking App with their Tia Care Team.

We explicitly give Tia Clinic patients the choice to securely connect their data to care to be viewed by their Tia Provider on their Tia Visit in order to further personalize the diagnosis and treatment process. With one tap, patients can now turn on or off data-sharing with their Tia Care Team, if they so choose.

On a personal note, how have you been faring amid all this?

I’ve spent the majority of quarantine hiding out with my cofounder, Felicity, which reminds us of the early days of building Tia from our shared dining room table. I am grateful for this one-of-a-kind personal and professional partnership though this unprecedented roller coaster, the late-night whiteboarding, and decompression cooking sessions.

Through times like these, we are especially grateful for the “tunnel vision” that Tia gives us—the responsibility and opportunity to commit tirelessly to something bigger than ourselves that we hope can play some small part in the COVID correction.