Around 1 in 10 women in the United States has polycystic ovarian syndrome, yet it took Carolyn Witte more than 3 years to have a doctor diagnose her with the disease — and even then she had to do a lot of the research herself. The disease, which sometimes causes a hormonal imbalance and affects metabolism, can also lead to fertility problems, diabetes and mood disorders. After bouncing around between different doctors searching for clues, Witte finally pieced all of her symptoms together with the aid of a self-help forum where other women had described their medical journeys. “That exposed me to the challenges of this fragmented system and how that negatively affects women,” says Witte. And her experience is not unique — it’s estimated around 50-75% of women with the disease are unaware they have it. “What would healthcare look like, work like, feel like, if it was actually designed with women at the center of it?” she wondered. “If it treated women as whole people versus parts?”
Her answer to that question is Tia, a four-year-old startup that combines in-person and virtual care for women, which she cofounded with her best friend from college Felicity Yost. Witte, 31, and Yost, 31, are both Forbes 30 Under 30 alums. The New York-based company announced a $100 million Series B on Tuesday led by Lone Pine Capital. Existing investors including Threshold, Define Ventures and Torch Capital, among others, participated in the round, which values Tia at $600 million, according to a person familiar with the deal. The capital raised by the company is the latest signal that startups often sidelined as “women’s health” or “femtech” are gearing up to go mainstream against the backdrop of the broader digital health boom accelerated by the Covid-19 pandemic. Tia has raised $132 million to date.
One of the core principles that has led to Tia’s success may seem obvious: women are the most valuable customers in healthcare. Women make up 51% of the population. They are more likely to be engaged in their healthcare than men. They also tend to make 80% of the healthcare decisions for their family, according to a study in the Journal of Health Care For The Poor And Underserved. Patients may start coming to Tia for their annual well woman visit (which is covered by every insurance plan thanks to the Affordable Care Act) and then at least 50% will come back for another preventive service, like mental health or gynecology. “Women use healthcare more,” says Witte. “It’s not rocket science.”
Tia works on a membership model, where members pay around $150 a year to access the company’s clinics, the first of which opened in New York City in 2019. All of Tia’s doctors and nurses are employees, meaning members see the same care teams, who manage everything from annual wellness visits to behavioral health to acupuncture, and the clinic bills insurance. Patients have access to an app where they can chat with their care team, view their health record or schedule appointments. For the doctors and nurses, Tia has built out a workflow and clinical decision support app, which Witte likens to a medical version of Asana or G Suite. And the back-end software makes sure the entire care team is on the same page.
The company generates the majority of its revenue from in-person and online visits, making the membership fee only a tiny fraction, yet Witte says it’s a key component of the brand and the experience. Witte likes to say women “join” Tia, they don’t just “use” Tia. “We are a relationship-based healthcare company,” says Witte. “We are in the business of acquiring and retaining women throughout their life. ”
There are moments as an early stage investor “where you have these opportunities to invest in something that to you is so obvious, and yet, for some reason, the rest of the world doesn’t see this as obvious,” says Emily Melton, managing partner at Threshold who serves on Tia’s board. “When you find those opportunities you run to them, because that’s where you can get that asymmetric mismatch where you’re going to get the biggest outcomes and the biggest opportunity to drive really meaningful change.” For her, that opportunity is women’s health. And Tia is going to be proof positive that “this isn’t a niche market,” she says. “No one questions why Glossier can be worth billions of dollars — of course, women buy lots of makeup. Women also buy lots of healthcare, but there just isn’t an Estee Lauder parallel. And so we have to create that.”
“We can’t just be this information front door and then refer women into the healthcare system that they hate. That’s failing them. We need to actually become the healthcare system and actually change the way care is delivered.”
Witte and Yost didn’t set out to be in the business of delivering healthcare. After meeting as undergrads at Cornell, Witte went to work in marketing and branding at Google, while Yost went to a hedge fund and later moved to product management at a data startup. After Witte’s PCOS health scare, she quit her job and decided to create a Google-like search tool for women’s health that would empower users to make better choices and not have to travel down the rabbit hole of online forums, where misinformation has the potential to run rampant. From that experience, the duo saw there was massive demand, but that serving up the information wasn’t really enough. “We can’t just be this information front door and then refer women into the healthcare system that they hate. That’s failing them,” says Witte. “We need to actually become the healthcare system and actually change the way care is delivered.”
Tia closed a $24 million Series A the day the Covid-19 lockdown began in New York City. The company already had 3,000 members but all of its revenue was from in-person services. Policy changes soon followed that allowed for doctors to bill for providing virtual care, which meant Tia was “able to essentially reinvent our business and start generating revenue online,” says Witte. At the same time, the company made a decision that the future wasn’t going to be virtual only, especially when it came to treating women. (After all, annual pap smears aren’t going online anytime soon.) Today Tia delivers 60% of care online (and some services like mental healthcare are 100% virtual). One of the ways the company is able to provide care at lower costs is its focus on mid-level providers—80% of services are provided by nurse practitioners. That combined with its software platform to automate care coordination and administrative tasks drives “allows us to reduce our cost of care on a per service basis by 40% compared to a traditional primary care practice,” says Witte.
Today, Tia has clinics in New York City, Los Angeles and Phoenix (opening in November) with plans to expand to San Francisco by the end of the year. The company’s also planning to open another 15 clinics in 2022. If its current rates hold, Tia expects to have more than 15,000 members by the end of the year with a goal of hitting 100,000 members by the end of 2023.
As the company grows, it’s also starting to partner with health systems through joint ventures so that women can receive specialty care, enabling services such as obstetrics to be provided in a hospital setting rather than a clinic. In March, Tia announced a deal with national nonprofit Catholic health system CommonSpirit to open a clinic in Arizona. Through the partnership Tia will refer patients to specialty care at the hospital and also gain access to CommonSpirit’s insurance contracts. But it also raised questions about access given the health system’s Catholic values. CommonSpirit does not perform elective abortions or in vitro fertilization but told Fast Company it would “always provide medically necessary care for any patient, including pregnant women” when the deal was announced earlier this year. Witte says even with the hospital partnerships Tia has “total control over the practice of medicine and the way we deliver care,” which means offering women choices.
“I think Tia should be everywhere,” says Lynne Chou O’Keefe, founder and managing partner at Define Ventures who was a seed investor in Tia and serves on the company’s board. “We really have those services holistically — both brick and mortar and virtually — across puberty to menopause. And so I think we can redefine what women’s healthcare means, and then subsequently, what that means for their family down the road.”