Friends,

The problem of inequity in women’s health is a hugely disturbing one, particularly in American healthcare. For example – the disparity in maternal-fetal mortality & outcomes among Black women compared to White women in our country is an egregious example of a long-standing unsolved inequity. To put it plainly, it’s a shocking disparity and one that has to be addressed and eliminated.  

In this dialogue we are introduced to another shocking inequity in women’s health. The issue is menopause, and I have to admit that I was unaware of the enormity of this unaddressed issue, and its debilitating impact on literally tens of millions of women each year. As always, our main focus here will not be on the problem, but more so on a solution that a courageous group of leaders have deployed to create a new and more humanistic approach to healthcare in our country.  

Joanna Strober is the CEO of Midi Health.  Prior to Midi, Joanna founded Kurbo Health, a digital therapeutic for childhood obesity that she grew to serve tens of thousands of adolescents worldwide and sold to Weight Watchers in 2018. Prior to following her passion for digital health, Joanna spent fifteen years making investments in venture capital and private equity. Joanna is also the co-author of Getting to 50/50, a best selling book written to help parents thrive in the workforce after having children. Joanna received her BA in Political Science from University of Pennsylvania and holds a JD from University of California, Los Angeles where she was UCLA Law Review editor.

In this episode, we’ll discover:

• How Joanna Strober personally discovered one of the great hidden inequities in American healthcare – an issue that is impacting nearly 60 million women.
• How painful and debilitating menopausal symptoms can be, and how these symptoms can be mis-disagnosed and mis-treated by well-intentioned providers.
• The impact menopause has on the professional lives of tens of millions of women in our country, and its negative impact on corporate America.
• The evidence-based, expert-supported, consumer-oriented & hyper-focused model of care that Joanna & her colleagues have created to address the problem of menopause in America.
• How Midi Health can be a synergistic and collaborative partner with providers and healthcare systems.

A number of summary learnings are well worth reviewing:

1. Nearly 60 million women in the USA are in the menopausal age range.
2. The symptoms are incredibly debilitating and are often missed and misdiagnosed by providers, leading to costly testing as well as inappropriate treatments. It’s not hard to see how these symptoms could be confused for other issues, as they include: migrainous headaches, sleep disturbances, anxiety and depression, heart palpitations, brain fog, memory problems, and a lack of energy.  As Joanna states, when these symptoms arise in a women between the ages of 40 to 65, menopause should be on the top of the list of possible causes rather than at the bottom.
3. Women struggle to find appropriate care because the bottom line is that primary care physicians, neurologists, cardiologists, sleep medicine doctors and even gynecologists don’t get significant, if any, formal training in menopause.
4. In addition to the personally debilitating symptoms, menopause also impacts women’s professional lives. Here are some stats Joanna shared with us: 
   1. Nearly 60% of women have to take time off from work due to menopause.
   2. Nearly 20% have to take off more than 4 weeks.
   3. In one survey, 60% of women said they did not apply for a promotion or raise because of their menopause symptoms. 25% said they had considered quitting their jobs, and 10% actually quit their jobs as a result of their menopausal symptoms
      

What struck me during this interview was the truly exceptional clinical program that Joanna and her colleagues have built at Midi Health. It is one of the most elegant and sophisticated clinical/operational models of care that I have come across. It’s also supremely consumer oriented. The model is virtual which makes it accessible and convenient. Below is a high-level overview.

The major interface women have is with a nurse practitioner who is certified by NAMS – the National Association of Menopause Specialists. In addition to being highly trained and vetted, these nurse practitioners are also following continuously updated, evidence-based protocols that the renowned experts at Midi Health have painstakingly created. If you take a look at their website, you’ll get a sense of the depth of the experts and expertise that Midi has brought to bear.  

In addition to the NAMS certification and updated protocols, these nurse practitioners receive on-going training by the core team of experts. During the actual patients visits, the nurse practitioners also have real-time, on-demand access to the panel of experts. So they can literally obtain an expert consultation during the virtual visit.  And, this is not just general menopausal experts; but it’s specific sub-specialized expertise such as for breast cancer or osteoporosis or mental health or for naturopathic treatment alternatives.  

Prior to the initial virtual visit, women complete a comprehensive pre-visit assessment which allows the Midi providers to be highly focused and to customize the visit.  The NP’s, working in conjunction with the women’s providers, can order tests. Once a treatment plan is decided upon they can prescribe the appropriate hormonal or naturopathic treatment.  Joanna shares that it usually takes a few follow-up virtual visits to adjust and correctly titrate the right dosing, and then these women are followed up as needed or annually.  

What’s important to point out is that the Midi model is one that is complementary to provider groups and health systems. Midi NP’s will refer back to the women’s PCP or ObGyn for testing and for more clinically complex situations such as bone fragility or bleeding. I was pleasantly surprised to discover that it is a collaborative and not a competitive model of care. As Joanna states during the interview, “Our women are getting mammograms and they’re finding out that they have breast cancer.  We are diagnosing a lot of osteoporosis.  We want to partner with hospital systems because we’ll be sending a lot of patients to them.  We don’t view it as competitive.  Instead, we think our goal is to be this initial screen, to do this initial care and then refer into the hospital’s systems for what they do best, which is the more specialized care and more specialized procedures.”

Menopause has been a hidden giant of a problem that women have suffered with, and it’s breathtaking to see how Midi Health is solving for it. One of the core underlying reframes here is the segmental focus that Midi has taken. The team at Midi has developed a highly focused, highly customized solution that addresses a very specific – but large – gap in American healthcare.  I think there’s a lesson here that can and should be transposed onto other conditions. I believe that Midi, and others in this genre are creating a whole new category and categorization of healthcare.  

As you may have noted, Midi Health provides care for women with commercial health insurance. While we did not explore this topic, one would hope and expect that the solution will be made available to women who are uninsured, under-insured, as well as those on Medicaid.

Midi is charting a bold new direction in healthcare and they are differentiating themselves in numerous ways.  First, they are differentiating themselves as a highly credible and reputable healthcare company, not as a product company.  Second, they are creating a virtual platform with the ability to scale, as opposed to the more typical brick and mortar clinics that are much more costly and geographically limited. This model will be able to treat women across the country and across the globe.  Third, due to the virtual visits and their digital tech platform, they will be able to collect significant amounts of data that can be analyzed and used to improve and further personalize care.  And finally, they are creating a collaborative model of care that can be integrated with providers and healthcare systems. 

I truly admire and respect what these folks have done. It’s awe inspiring.  I believe that we will be seeing and hearing a lot more from the tremendous leaders and team at Midi Health.

Until Next Time, Be Well.

Zeev Neuwirth, MD