Women’s Health in Focus 

In this podcast episode, we discuss women’s health and healthcare with chief medical officer Dr. Janet Choi and chief development officer Julie Stadlbauer from Progyny, a fertility, family building, and women’s health benefits provider.

From the history of exclusion in medical research, to the fragmented system and myriad point solutions now available, women’s healthcare requires expertise and navigation, the experts say. And it’s an opportunity for employers to better serve this crucial population.

Read the Transcript

Disclaimer: Podcast transcriptions are computer generated, please excuse errors. For the most accurate version of the conversation, please refer to audio.

Julie Stadlbauer: I have never in my career seen the immediate impact of a solution being launched. Every time we launch, people cry and it’s because they have hope again. Because on average it takes people up to $70,000 to leverage fertility treatment in order to have a child. And that is just not feasible for a lot of people.

Sandy Laycox: Welcome to the Leader’s Edge podcast. I’m Sandy Laycox, Editor in Chief of Leader’s Edge. In this podcast sponsored by Progyny, I talk with Progyny’s chief medical doctor, Janet Choi and Chief Development Officer Julie Stadlbauer.

First, Julie shares who Progyny is and what it means to be a fertility, family building and women’s health benefits provider. Then we hear from Dr. Choi, who joined Progyny after seeing its benefits to her own patients.

Julie Stadlbauer: So we launched in 2016 really to address the shortcomings that exist frankly this day and in fertility and family building. Where we really pulled together the optimization of benefits design, curated specialty networks of providers, reproductive endocrinologists, reproductive urologists and embryologists, and then wrapped around it some patient support that both complements members needs for navigation of complex benefits, but also the need to have clinical education and support proactively. And so we launched that very successfully. We’ve grown to over 6.7 million lives with over 530 clients in 45 different industries today.

And we’ve taken that model and really looked at where are the other areas where women’s health is really fragmented, and how can we leverage the eight plus years of expertise that we have built around wrapping around that clinical and educational support and curating and managing specialized networks of both virtual and in person providers to help reduce the fragmentation that uniquely exists in women’s health.

Dr. Janet Choi: You know, before I got to join Progyny full time as our chief medical officer last year, I was on the medical advisory board and also Progyny provider as part of our network. I was in clinical practice chiefly focused on reproductive endocrine for over two and a half decades. And it was really there, witnessing my patients experience that I really kind of learned firsthand the Progyny difference and how much of a life changing impact it really has literally night and day.

So high level fertility is incredibly fraught, especially if you’ve been suffering years of infertility and seeing all your friends and colleagues having children and you’re being left behind. Or having loss after loss. And then if you layer on top of that all the financial stressors, even when you have some sort of modicum of insurance coverage, without any kind of educational support outside of your, you know, cursory short Doctor’s visits. It can be incredibly overwhelming, and something has to give. And in many cases, I. You know, I can’t tell you how many times I would have these conversations with patients who had a little bit of coverage, but they were worried about running out, and so their eye was not only on, how quickly can you get me pregnant, but how quickly can I get out of your office and hopefully not go broke?

And so, they would be making decisions that weren’t always necessarily the best medical decisions for their situations. And then along comes Progyny. And that’s when I actually was like, oh, this is actually a carrier that I think I can work with. Because we had patients who were incredibly well supported both by their patient care advocates. Each member here is assigned their own care advocate, typically a former nurse, former embryologist, former psychologist, or LCSW here serving to help the patients navigate their journeys. And they also really understood and felt confident that anything that they needed on their path to actually having a child was going to be covered by their Progyny benefits.

So that really helped clear the air and made it much easier for me to practice as a doctor and help guide them to the best decisions and actually the best outcomes, too. It really didn’t take much convincing for me when I was approached by Progyny to say, hey, would you consider joining us full time as a CMO? And again, the impact that we’re having, as Julie said, on the millions of people that are our members is really quite stunning.

Julie Stadlbauer: I have never in my career seen the immediate impact of a solution being launched. Every time we launch, people cry, and it’s because they have hope again, because on average, it takes people up to $70,000 to leverage fertility treatment in order to have a child. And that is just not feasible for a lot of people, and they shouldn’t be in a situation where that is a barrier. And so we are able to make this something that shouldn’t be an affordability issue in terms of being able to get pregnant or being able to build your family if it’s in other pathways like the LGBTQ community or other folks. So this has been what I call my career nirvana, because it’s rare that you get to work at an organization where you immediately, very impactfully see that reaction.

Sandy Laycox: Our conversation then turns to women’s healthcare and how it has suffered in a fragmented system that historically had not even included women’s health in research. We discussed the effect on women’s health and how that comes into play for employers.

Julie Stadlbauer: As we think about women’s health overall There are significant gaps in the way that health benefits are delivered, and specialists are available to women in the healthcare system that are unique to women. So, you know, one of the big gaps we solve for with fertility. But when you think about endometriosis, for example, did you know it takes on average for 50% of the women in the United States about 10 years to get to a diagnosis of endometriosis? That stunned me. And it’s so disappointing for something that’s relatively common. And when you think about what that means in terms of the healthcare costs that employers are dealing with and brokers are negotiating, that leads to higher number of specialist visits that are unnecessary.

It leads to a higher percentage of ER visits due to pelvic pain and, you know, not to mention the productivity impact for people trying to navigate something that they can’t even get to a diagnosis. And so therefore treatment is very difficult. And so when you think about the healthcare system and you think about what we’re doing, leveraging all of the experience we have, it’s really, how do we identify those other areas of women’s health all the way through midlife and menopause to really create the ability for women to access care, have clinical, educational support and navigational and benefits support there, and connecting them to curated networks of providers that aren’t necessarily readily available or they don’t even know to engage.

So when you think about PCPs or you think about menopause specialists that have certification, or you even think about endometriosis specialists, they don’t typically participate in the health plan. And so we have a real ability to help drive down cost for employers by creating the ability for members to be supported, understand where they can engage in the healthcare system, get to the optimized level of support, whether that’s virtual or in person, and have that follow up so they don’t kind of drop out if they’re not experiencing better symptoms because of therapy or what. Have you anything you’d add, Dr. Choi, about where we are with women’s health?

Dr. Janet Choi: Yeah, no, I think it’s actually exciting that now where there’s more, I think, drive and interest in furthering research in women’s healthcare in medicine as it pertains to women. I think some of us are familiar with some of the historical facts, like in 1977, the FDA excluded women from clinical research. I think it was kind of in a paternalistic way to protect women in case they were pregnant, so they wouldn’t go through these drug trials where we didn’t know what the impact was on pregnancy. Thalidomide was unfortunately one of those unfortunate medications that fortunately, I don’t think the FDA approved in the US but caused a slew of losses and birth anomalies before everyone realized that it wasn’t ideal to be using this drug.

And so for a long time because of that ban, the loss of that or the downside was that women were not enrolled in some of these crucial medical trials, drug trials. And I think we’re starting to where there has been this growing understanding that, you know, there are certain conditions that only affect women. Julie alluded to endometriosis. Another one that comes up is polycystic ovarian syndrome, a slew of autoimmune diseases that more frequently affect the female population over the males. And, you know, yes, in 93, the NIH actually kind of required inclusion women research, but it was sort of a slow slog, I think, up until the past, I’d say few years, decade, when I think more people are becoming much more outspoken about the need to drive more dollars into women focused research.

I really appreciate the fact that the White House actually signed an initiative last year to further research, particularly on women’s healthcare. And when you take that into consideration and the backdrop of all the conditions that are affecting women, I think it’s exciting that we are kind of working to make positive change, trying to, in the case of infertility, make sure that we connect both men and women and those who don’t identify as either right, with the right well trained, experienced reproductive endocrinologists who are properly certified. Same with the reproductive urologists for those who are suffering, you know, sperm issues. This is actually, I think, quite interesting when I speak to my reproductive urology colleagues. So, these are individuals who’ve gone through not just college, med school, but seven years of urologic residency training.

They get board certified, and then you do another one or two or three years of reproductive urology training to focus on the areas of male’s fertility and hormone health. And so what the urologist will say is oftentimes men, just like a lot of busy women, will sometimes not go to the doctor until they find they’re having an acute problem, in this case infertility, and they have an abnormal sperm count. And actually, that abnormal sperm count could be a biomarker and a signal that there’s something else going on with their health. And so, it’s kind of a backwards way to actually connect males with primary care to deal with their endocrine issues like diabetes or cardiovascular disease through their subspecialist. There are all these different gaps, sometimes in the past, not always covered like fertility.

And sometimes, you know, there is a kind of a bare minimum foundation of primary care support. But people aren’t always connecting with the right providers. Which is why oftentimes, as in the case of endometriosis, women will often er, shop, doctor shop, pharmacy shop for years before they get to the right diagnosis. And so what we’re trying to do, especially as we look at other areas of women’s healthcare beyond the fertility family building sphere, like with our menopause program, is make sure that our members are getting connected to the properly trained, experienced, practicing current evidence based guidelines at the top of their game so that those members who need medical support are getting the right treatments in a very efficient manner.

Julie Stadlbauer: As I think about kind of what the brokers and consultants are dealing with today, it’s point solutions, fatigue, we often hear that. But it’s very difficult to do what we’ve done which is integrate into the health benefits of the health plans. And so I think, you know, as we look at the broader areas, we want to be the destination for women in pivotal moments of their care so that they can connect with us for any kind of, you know, any symptoms or issues that they’re having. Just really complex navigation requirements for people that aren’t familiar with the healthcare system. And, and that’s what’s missing and that’s what we aim to do in women’s health.

And we are best positioned to do that given how we’ve been able to very successfully improve clinical outcomes with fertility and family building, manage our network through exchange of clinical data, sitting down with physicians, sharing that data back with employers and really be able to reduce costs of treatment and overall risk downstream for NICU expenses and multiple births.

Sandy Laycox: We then talk further about the challenge of navigating the many point solutions available today in health benefits. And Dr. Choi drills down into the highly curated expertise of the Progyny.

Julie Stadlbauer: Network brokers have an increasingly challenging job. As I think about how many point solutions and all the different categories, I think what’s really important because I think also people are seeing some of the more digital only solutions. There’s question I hear in the market about well, what value have they actually delivered? And so I think when you’re looking at, particularly in this environment of higher healthcare cost increases that people are, I’m hearing everything from 7 to 10%. Obviously you’re going to have some real solutions that can address those medical costs, higher trends than we’ve seen in as long as I can remember.

And so I think it’s really important to sort through what is a mile wide inch deep, you know, what is the real impact of what the solution can provide and can the solution really have an impact in a broader way than just one area? And so when I think about what we do, it’s really. Or comparing us to anybody else. Are there specialty networks that have been curated that people can access where there’s an exchange of data and you can really make an impact? And how is that being managed? Because you hear a lot of partner networks, but it’s a little bit of vaporware. I would say it’s not really an integrated relationship with the treating provider, which is key to being able to follow up and even report on your own clinical outcomes. I would say dedicated member support that’s really specialized.

Digital is important. But a lot of people in these kinds of journeys, I think about menopause, you think about the challenges with infertility or fertility benefits, needs or navigation, it’s very personal and a lot of times they don’t have anyone they can talk with. So really making sure that you have that quarterback that is a complement of both educating people on the benefits ecosystem and what they can access with connecting them to those providers and make sure they don’t fall through the gaps is really important and then pushing on reporting. So, you know, making sure that if you see a solutions reporting that you know what it means for us, it is our entire book of business reporting that we compare against and for employers, we give them their own data.

Julie Stadlbauer: For many others, it’s a snapshot of a very small percentage of their population because they’re not getting that data to report. So if you’re not getting the data, then how are you really even managing the problem? And so I think really kind of diving into that is really important.

Dr. Janet Choi: I think also, you know, the understanding that is, I think the reason why, one of the reasons, many reasons why I think Progyny has done so well is that, you know, our team took the time and the effort over a series of years, not just kind of a slap dash, check the list kind of let’s offer this just so we can say we do in terms of how we very thoughtfully curated, developed our, for instance, fertility network of providers, made sure that they understood and people actually want, providers actually want to join our network because they’re treated well and also because they know that the patients who come through their Office doors are going to be incredibly well supported.

And that also, as Julie said, is, you know, through that contracting work and relationship building, it allows us to have this ongoing dialogue with our providers so we can get actual clinical outcomes data. And what I find very exciting is looking at our utilization management program that we have in place that was developed by our medical advisory board, so by reproductive like minded specialists who actually practice fertility medicine, not some, you know, non specialty provider. And so I think that also kind of helps sort of underscore the importance of really putting a lot of thought, a lot of effort time into developing this very cohesive benefit offering. Right.

So curated network of providers, ongoing dialogue, data sharing, clinical outcomes reporting, member support, not just with an app, but each member doesn’t have to tell their story over and over again because they’re assigned from the moment they onboard with us, their own human patient care advocate. And so it’s very easy and comfortable for that member to kind of call back in and say, hi, I have a follow up question. I spoke to you last week.

Sandy Laycox: Finally we discuss the opportunities for brokers to bring well vetted options to employers and what success that Progyny has looked like so far.

Julie Stadlbauer: Yes, it’s interesting. I had, I’ve had a variety of different really interesting conversations with brokers lately where you know, even if you just ask the question, so they, I hear my clients are all interested in women’s health. Well, what do they mean by that? Well, I’m not really sure. And, and so I think, you know, because you’ve got all these, you know, mile wide, like it’s all digital and all of this solutions, there’s really an opportunity for brokers to have leadership and in helping their clients understand what an effective women’s health strategy will be. And so the way that we’ve curated this specialty care network with wraparound clinical coaching and the exchange of data really becomes not only that cost saving opportunity which I know is really important, but also addresses other elements of why clients want a women’s health strategy.

Julie Stadlbauer: They’re, they’re looking at retention of women in the workplace. They’re looking attraction. I mean we’ve had, we have some very large health system clients that we greatly improved the attraction of and retention of women in their workforce. And that is hugely valuable for them when you think about those specialties. So I think that’s the reason primarily that people are looking at women’s health solutions. But if you’re going to put one in, you have to put one in. That actually makes an impact for women. And that’s really in addressing you know, all of the different challenges that women have in navigating the healthcare system, trying to get diagnosis all the way through, how they can get coaching support for navigating parenting because they’re you know, a parent but also in the workplace. And so I think that’s really important.

And the other benefits and why women’s health has, has this, you know, I love that it has a spotlight on it but I think there’s really a differentiation opportunity for the broker community to really draw a line in the sand on. This is what an impactful women sell strategy means. And this is what I’m going to put my client in for my clients so as not to like look two, three years down the road. And I’m questioning what this solution has done for me other than charge me case rates for digital engagement.

Dr. Janet Choi: I mean what I find exciting as a gynecologist is it’s looking at the patient experience from multiple levels. One, we talked about the benefit and the administration of the benefit with minimal stress on the member’s part while also being mindful of our clients’ expenditures. And I think we do a great job of that balancing the two. And then also from a clinical care perspective you have the patient care advocate to provide the advocacy, the really important listening ear, the kind of acknowledgment, sort of seeing and understanding the, A lot of members will say, you know, this is the first time I actually felt heard. I spoke to my gynecologist, you know, six months ago and kind of gave up because I wasn’t sleeping well and gained weight. And they just said I, you know, it’ll pass perimenopause. Right.

And so you know what, I’ve audited some of these calls. Like the members will say I’m just so happy that you know, you’re actually listening to my symptoms and you’re helping me connect with a menopause provider who doesn’t think this is all in my head. So it’s the patient care advocate and then layered with whether it’s a primary care partner solution in person or virtual, really excited about that opportunity as well as sort of, you know, this should all be technically primary care but because doctors albino’s have become so subspecialized they, there’s the area of like polycystic ovarian syndrome support or endometriosis support or pelvic physical therapy support whether you’re immediately postpartum and having pelvic floor issues or if you’re a male with certain health issues and having issues with dysfunction and need some pelvic PT support there.

We actually are able to link our members up with the appropriate primary and or specialty providership in many scenarios. So I think it’s like it goes very deep and as we kind of go very thoughtfully, I wouldn’t say super wide, but super expansive and comprehensive. And we took our time about it for a really good reason.

Julie Stadlbauer: When I think about health plans, I’m really excited about the success that we’ve had of late with health plans. And you know, I know that others have partnerships with health plans and were invited to the dance on all of that, but the requirement was really, they just wanted a digital bolt on and really it’s the health plans, underlying management, case management, all of that. So we did not, would not agree to that because it undermines the value that we deliver. Others very easy to agree to that because that’s what they are. It’s digital bolt on. So for us, we’re now having success with the health plans. So we’re launching multiple health plan announcements, most recently launching CIGNA as a health plan partner.

And I think that’s really important distinction because that means that the plans are delegating fully, network credentialing to us, utilization management to us, and the full management of that member and provider relationship. And they’re recognizing the value of what our solution can deliver. And so I think it’s huge statement to what we’ve been able to accomplish and build that we are starting to see great success in our health plan growth because it’s very different than the other women’s health solutions that are easy button health plan solutions which I think a lot of brokers and consultants are starting to understand.

Dr. Janet Choi: What I find really exciting is Progyny started off as a fertility family building solution that was unlike anything that was out there in the market or in the field. And really I didn’t have to rewrite because there wasn’t really a clear script like created the script on how to really administer and offer superlative fertility and family building. Not just benefits, but just patient support, patient experience. And what I find so exciting now is as we expand our aperture to encompass more areas of women’s health, it’s not just talking about the wellbeing of one’s family, but the wellbeing of the women that we serve.

Sandy Laycox: That was Dr. Janet Choi, Chief Medical Officer and Julie Stadlbauer, Chief Development Officer for Progyny.

I hope you enjoyed our conversation about women’s health.

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