Startup Brings Reproductive Medicine to Underserved Communities

When the Supreme Court overturned the constitutional right to abortion, Dobbs v. Jackson Women’s Health Organization Last summer, the founders of TwentyEight Health, a start-up that provides virtual health services to women and others who give birth, struggled to figure out how to launch a nonsurgical abortion service in the face of rapidly changing policies. I started exploring.

Bruno Van Tuycombe and Amy Huang co-founded TwentyEight Health in 2018 to increase access to reproductive and sexual health services in underserved communities. They were already using telemedicine platforms and home medicine delivery to provide birth control, prenatal vitamins, and treatment for sexually transmitted diseases. Providing medical abortion seemed the logical next step in their quest to support equitable access to health care.

“Because abortion restrictions have a major impact on low-income women and women of color, it’s become even more important to think seriously about how we can offer these services to our users,” said the company’s president. Huang, who also serves as chief product officer, said.

on the other hand, dobbs vs jackson The ruling is a setback for women’s reproductive rights and cements state authority over reproductive health care, including medical abortion, in states where abortion remains unrestricted.

In February, TwentyEight Health successfully launched medical abortion services in California and New York. “Our mission to improve reproductive and sexual health couldn’t be closer,” said Van Tuycombe, CEO of TwentyEight Health.

Twentyeight Health designs accessible health services for underserved communities, providing a dignified and welcoming experience in Spanish and English.

—Medical Advisor Dr. Eduardo Garcia

Among other startups using technology to address women’s health issues, TwentyEight Health was founded to provide reproductive and sexual health care to women and people of color in childbirth and on low incomes. It’s unique in that respect, Huang said. Slightly more than half of users are Medicaid enrollees. 58% identify as people of color. And nearly 60 percent of Twentyeight Health’s customers live in rural areas, she said. Twentyeight Health is available to patients in 34 states and Washington, DC.

The company’s services are available in California for women ages 13 to 49, and the company plans to launch related perinatal services in the state this year. The company focuses on the needs of individuals assigned to be female at birth. “If you are nonbinary or transgender and need contraception because your uterus is intact, we welcome you to use our services,” the company says on its website. The majority of Twentyeight Health’s direct care providers are women. 80% of her medical staff identify as people of color. And half of the staff speaks Spanish, Huang added.

“What Twentyeight Health has achieved is phenomenal,” said Melissa Buckley, CHCF’s Innovation Fund Director. “They built everything from the ground up for Medicaid and women of color.

Eduardo Garcia, M.D., a California obstetrician and gynecologist who advises frontline healthcare providers in startups, said he was proud to endorse the company’s “holistic approach to medicine.”

“Twentyeight Health designs health services to reach underserved communities and provides a dignified and welcoming experience in Spanish and English,” he said.

While CHCF recognizes that community clinics are the primary providers of health care services to low-income women and communities of color, the foundation seeks to expand alternative reproductive health options for women. decided to support The Innovation Fund invested her $250,000 in Twentyeight Health to increase access to healthcare services for rural Spanish-speaking women.

Women struggle to get care, even if enrolled in Medicaid

Twentyeight Health can be accessed online from your computer, tablet or smartphone. No app is required to access the website. For clients, the process begins with an asynchronous questionnaire containing information to determine Medicaid eligibility. You can then schedule an audio consultation, which is optional in California and some other states. A wide range of medications, including birth control pills, cold sore remedies, morning after pills, and abortion pills, can then be delivered to patients’ homes or nearby pharmacies. Patients can send messages to their healthcare providers at any time.

Medicaid programs typically cover your medications at no out-of-pocket cost, but you must pay an annual physician evaluation fee of $26 for each medication prescribed. Even those without insurance can get the medicine at a low cost. For example, a contraceptive pack can be purchased for as little as $18 per month. Twentyeight Health partners with nonprofits to provide free contraception to uninsured individuals with financial need. The company generates revenue through Medicaid billable services, annual fees, cash-paying users, and prescription fulfillment.

What was once limited to those who had access to a clinic or had insurance to see a doctor can now be experienced by anyone.

— Dr. Carla Robinson

Even in California, where abortion and contraception are enshrined in the state constitution, not all women have equal access to abortion services. There is an abortion desert in the countryside of the state. As of 2017, about 40% of California counties had no clinics offering abortions to women, according to a Guttmacher Institute study. The state also has 179 crisis pregnancy centers (PDF), where advocates criticize false medical claims about pregnancy and abortion to discourage people from getting abortions. I am warning you. In 2019, California had 20% more crisis pregnancy centers than abortion clinics.

Another study found that 12% of women with Medi-Cal who had abortions in 2011 and 2012 (half of them lived in rural areas) had to drive at least 80 miles for their treatment. Turns out it didn’t. The researchers reported that “28 counties, home to 10% of eligible women, did not have facilities that regularly offered abortions covered by Medi-Cal.”

“Some people may have insurance, but that doesn’t necessarily mean they can actually access covered medical services. Abortion drugs and online women’s health services are lifelines,” said Huang.

All you need is an internet connection

Communities of color have long experienced that non-Black doctors perpetuate systemic inequalities. This is another problem Twentyeight Health is tackling.

“Mistrust, that’s a big problem. It’s certainly a problem in a marginalized community that’s been exploited for years,” says Carla Robinson, M.D., board-certified family physician and care-certified at TwentyEight Health in Charlotte, North Carolina. . Patients in California and 27 other states were included.

The company’s healthcare providers, mostly women of color, have experience working with patients in underserved communities. Robinson said prospective patients can visit the company’s website to see “healthcare providers who are similar to and empathetic to them.” “I think it’s a long road.”

One of Robinson’s favorite features of TwentyEight Health is that patient race, ethnicity, and other demographic characteristics are not recorded in the records. She said this helps reduce provider bias.

“So to speak, we’re blind to certain demographics of our users, and this really helps remove any unconscious biases we may have for whatever reason,” Robinson said. .

Twentyeight Health also builds trust by partnering with nonprofits like Bay Area-based Access Reproduction Justice. The company says three-quarters of its referrals come from these partnerships. With a strong reputation for customer loyalty and satisfaction, Twentyeight Health believes its customers are paying off for their efforts.

Robinson said the company will take advantage of the convenience and benefits of telemedicine to avoid in-store medical care because many people cannot take time off from work, can’t afford the cost of childcare, or have a reliable medical institution. said it appeals to women and other people giving birth who have faced barriers to access. Transportation facilities.

“At the click of a button on your phone or computer, you now have the opportunity to experience what was previously limited to those with transportation and insurance to see a doctor. ‘ said Robinson. “As long as we have internet access, we can provide the reproductive services we need.”