Dr. Neel Shah (00:00):
Year over year there are more rural hospitals shuttering their obstetric services, but now bringing in the Big Beautiful Bill, it is going to be a significantly larger challenge for reproductive age people, particularly when it comes to maternity.

Rae Woods (00:15):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. I want to start off today's episode with three data points. First, the average per-employee cost of employer-sponsored health insurance reached $16,500 in 2024. That's an increase of about 5% over the previous year. Second, 69% of employees have taken, considered or might take a new job so that they can get better access to reproductive and family benefits. And third, less than half of US rural hospitals still offer labor and delivery services individually.

(01:02):
These stats might be a little bit scary. If we take them together we start to get a sense of some of the challenges employers are facing when it comes to managing their employees' health. We've talked on this podcast before about healthcare costs rising. Employees are serious about their access to holistic healthcare benefits, particularly as it relates to family building and the care landscape for reproductive health and women's health more broadly is facing enormous challenges as hospitals struggle financially. So, to help us unpack how employers and purchasers can control their healthcare costs while maintaining supportive benefits, I've invited Dr. Neel Shah, Chief Medical Officer from Maven Clinic. Hey, Neel, welcome to Radio Advisory.

Dr. Neel Shah (01:49):
Thank you, Rae. Thanks for having me.

Rae Woods (01:55):
I have to admit, I have been following and fangirling over Maven for a while, but I have to imagine that Radio Advisory listeners might be a little bit less familiar with this product. So, give us the quick overview of what health leaders should know about Maven Clinic.

Dr. Neel Shah (02:14):
Sure. So, Maven Clinic is the world's largest clinic for women and families. What that means is that we're scaled now to cover 24 million lives in 175 countries.

Rae Woods (02:24):
Wow.

Dr. Neel Shah (02:24):
So, the way that Maven works, we provide an always-on service where you can connect with a clinician within 30 minutes to an hour at any time of day, no matter where you are. And we use that capability to wrap around people who are going through reproductive health journeys. So, we're not a condition-based company, we're a phase-of-life company. We're meant to be the partner for people who are building their families, who are going through a fertility journey or whatever pathway to parenthood they're undergoing. We take care of people who are pregnant, who are parenting and all the way up through menopause.

Rae Woods (02:59):
How does the business model work? You sell this service to employers, right?

Dr. Neel Shah (03:05):
That's right. Anyone who purchases healthcare in bulk, so largely employers, and those employers are almost from every different sector of the economy now, everyone from Amazon who has a baby every 18 minutes.

Rae Woods (03:17):
Wow.

Dr. Neel Shah (03:17):
To small businesses with some fun logos. I don't know which ones I'm allowed to say and which ones I'm not, but there are some fun ones. Also, labor unions, Medicaid plans, anybody who purchases healthcare is the client.

Rae Woods (03:31):
And I think it's important to make a clear business case to those purchasers on why in this moment in time we need to focus on women's health. And if I'm channeling the purchaser, they're really focused on cost control, right? Healthcare costs have been unsustainable for employers for plans for a very, very long time, and they're really trying to wrap their arms around that. My question is, what is the benefit to purchasers in focusing on women's health specifically?

Dr. Neel Shah (04:02):
So, for the purchaser, every benefit to your point, needs to have value, if not ROI, right? Which means strictly sense in sense out at that level of precision putting in, they need to see that back and impact on their healthcare spend. But also I think reproduction is different than, say, chronic condition management or diabetes or MSK care or mental health care in the sense that one, fertility and reproduction is in the zeitgeist right now because fertility rates on the macro level are declining, and there's many whys there. But one is that starting a family in the United States today and in many parts of the world is more challenging than it used to be a generation ago.

(04:44):
And part of the reason why it's more challenging and less affordable and potentially even more dangerous is that it's really complicated to do that while you're also trying to build a career. And in 2025, if you're trying to recruit and retain frankly the best talent, they need more support. And so you can do that historically with a good leave of policy, parental leave policy, maybe making sure you have a lactation room. But again, in 2025, what you really need to do is to make sure that people are supported in the places where their health is actually happening, which is actually not the doctor's office.

Rae Woods (05:19):
What's interesting is you also went to the employer specific benefit of helping to support and engage the employee so that you can actually retain that talent over the long term. And something that you said that I just want to repeat back is that doing that well in women's health is just not the same as doing it well in say, musculoskeletal care. It requires different kinds of tools.

Dr. Neel Shah (05:45):
Yeah, I mean, listen, I'll put it this way. I think that there might be some people out there who are choosing their job based on the cancer benefit. It's possible. There are many, many, many people who are selecting or opting into jobs on this basis and are choosing to stay in their jobs on the basis of planning their families. Because right now, intended parents or people who are parents who are trying to build and grow their families, they're trying to figure out how to make it all work and making it all work is I think more fraught and more complex than it used to be. And so for purchasers doing this well is really important to the business.

Rae Woods (06:25):
Do you ever have leaders at those purchaser organizations push back a little bit and say, I understand the upside that you're trying to get me to by focusing on all these life stages in women's health, but I just have this impossible drug spend that's only getting worse with the rise of GLP-1s and I've got to prioritize that? Or you know what, the cost of the back surgeries that I have for my employee base is just too high and I have to make trade-offs, so I'm going to downplay or put to the bottom of my to-do list women's health because I've got to focus on drug spend or musculoskeletal spend. What do you say to that kind of pushback? Or do you even get that kind of pushback?

Dr. Neel Shah (07:05):
Not that directly anymore, Rae. I mean, I think that there is an economy, but it's not exactly a zero-sum, if that makes sense. Finite resources. And so you do have to make trade-offs as a purchaser. That being said, there are certain types of benefits that are table stakes. And to run a business of any size, a small business or a very large scaled one, you need reproductive health benefits. You need mental health benefits in 2025. That's just how it works. Now, what you also want though is not just any benefit, one that generates value and in certain spaces creates ROI. So, maternity, just to give you an example, yes, MSK costs a lot of money, cancer costs a lot, diabetes costs a lot of money.

(07:49):
But I think there's still opportunities to educate folks on maternity because we take it for granted. For example, 25% of all hospitalizations in the US are the mom or a baby after a birth. Just hospitalizing the mom and the baby is 0.7% of our entire GDP. What that means is you take our whole GDP as a country, spread it out across the table, you can see the cost of hospitalizing moms and babies with your naked eye. Meanwhile, one in three get major surgery to give birth, and one in 10 of their babies goes to the NICU, which is crazy and doesn't need to be that way.

Rae Woods (08:27):
It doesn't need to be that way from a health outcome standpoint. It doesn't need to be that way from a population health standpoint, and it doesn't need to be that way from a purchaser's cost standpoint. And you said something that I want to reiterate. We've actually talked about this before on Radio Advisory, is that women's health does not just mean maternal health. We actually have talked about it as women's health beyond the bikini. It's not just a synonym for maternal health and maybe let's add in breast cancer screening to that. I will say that in my conversations with health leaders, they're still doing that conflating, women's health equals obstetrics. How do you think about breaking that narrow view of women's health so that you can take this kind of life cycle approach?

Dr. Neel Shah (09:09):
Yes, people do do this conflation and also have empathy for the fact that if you are the actuary at a health plan or you are the person in charge of the budget for your benefits, what you're seeing in your highest cost claimant, your top 10, your top five, your top three claimants is neonatal ICU spending. And so from an ROI standpoint, that's the opportunity. That being said, women's health is much more than that. And I think even the house of medicine has done this conflation where we treat people as body parks, like when you go to the OB-GYN about the body parts that OB-GYNs are trained in.

(09:46):
And that's not how human beings think of themselves. And so at Maven, one of the things we've tried to do is to make sure that we are experts in the context of people's lives when they're building their family. And that's often how to bring in the purchaser as well, because that makes sense as human beings. And when we show ROI to the purchaser, it's not just about the NICU, it's also about the mental health benefits. We turn on the journey benefit for 21 months for the full year postpartum, when of mental health impacts hit.

Rae Woods (10:14):
That's also when the sharpest rise in maternal mortality has happened over the last several years is in the 12 months postpartum. The sharp rise in maternal mortality isn't happening during pregnancy, during delivery, or in the immediate six weeks postpartum. It's in this aftermath period, this year afterwards.

Dr. Neel Shah (10:31):
You're exactly right. Yeah. A third of maternal mortality happens in the 12 months afterwards. The ROI calculation the actuary is doing ends the minute the delivery happens.

Rae Woods (10:40):
Yes.

Dr. Neel Shah (10:40):
Really important to show the potential for impact in that whole year, which is mental health, but it's also, there's good claims data showing that the incidence of ER visits is double for a woman in the year postpartum compared to age match controls.

Rae Woods (10:58):
Let me ask you this. Is it more difficult or maybe less difficult to get health leaders to think about women's health as an area of focus and thinking about it beyond maternity care in general? And I'm thinking about two things here. I will say in the fall of 2024, just a few months ago, I was speaking on stage at the health conference actually right after then First Lady Dr. Jill Biden was on main stage with Maria Shriver talking about menopause, right? We saw pictures of Halle Berry lobbying on Capitol Hill about menopause care. Fast-forward to right now, it almost seems that focusing on specific populations and the equity needs of specific populations has become a bit of a red line. How are you thinking about the kind of change in the general dynamics around women's health when it comes to the kinds of support that Maven wants to provide?

Dr. Neel Shah (11:56):
Well, I think the terminology of diversity, equity, inclusion has become a political football. I will say that terminology aside, the work is still the work, and you are in charge of a population of people, and your mandate is to make that population of people healthier. The work always from a public health standpoint is to find the people who are the most vulnerable and support them to be healthier. I always say at Maven, we're not splitting the atom, Rae. We're literally just finding people who need more care and support, giving it to them and measuring that they're better off. That is the work, and people are clear about that. Our clients are clear about that. Our prospects are clear about that. Our health plan partners are clear about that in spite of what terminology in favor may be. You're asking about menopause though, and I'll tell you, menopause in this environment right now continues to be our fastest growing product.

Rae Woods (12:53):
Wow.

Dr. Neel Shah (12:53):
Clients or prospects are still clamoring for it, and once you turn it on, enrollment always exceeds expectations.

Rae Woods (13:01):
Wow. Okay. Okay. Let's get into then the kinds of chapters of the life cycle that Maven supports. And I think it will be helpful for us to do this in kind of chronological order. So, let's actually roll the tape backwards and think about the fertility and family planning phase. First of all, is this a benefit that is often included among employers? And what is the differentiating factor that Maven provides when it comes to family planning and fertility?

Dr. Neel Shah (13:28):
So, fertility right now, a lot of Americans and a lot of people across the world are not able to access it, but infertility impacts one in six people. So, the latent need or demand is many times the degree of access, even in a country like the United States. And by the way, IVF is only as old as I am, which makes me think not that old, although I guess I'm [inaudible 00:13:55], but it's-

Rae Woods (13:55):
No comment.

Dr. Neel Shah (13:57):
People know Louise Brown, who is the first IVF baby in the world. The first IVF baby in the United States is Elizabeth Carr, and she's exactly my age. She's 43. So, IVF is relatively new and compared to other areas in healthcare, which can be pretty calcified, fertility is a space that changes really rapidly from a technology standpoint and from a benefit to science standpoint. But the last decade, we've seen an explosion of fertility benefits, and we've also seen a trend towards carving fertility benefits out from traditional health carriers.

Rae Woods (14:30):
Wait, why is that?

Dr. Neel Shah (14:31):
There are a lot of reasons why health plans are not well positioned to administer these benefits. For example, typically a health plan needs a diagnosis, and some people are diagnosed with infertility in the traditional sense because they have a condition. But what if you're a same sex couple? You might not have a classic infertility diagnosis that would be coded, but you still may benefit from fertility benefits. For example, historically health plans have used utilization management as their main leverage.

(15:04):
Imagine how abrasive that is in a fertility journey on a service by service pool. So, increasingly, if the employer is adopting these benefits and purchasing them in the first place to retain and recruit employees, they don't want an abrasive experience and they definitely want to be inclusive of their full population and need. We've seen this trend and just like people have a vision plan and a dental plan that's separate, fertility now that's the same way. And Maven is the digital care manager and the payer for fertility.

(15:33):
So, that's how we're different. The other way we're different is that we take care of people who are trying to conceive and from a business perspective are agnostic to whether or not they get IVF. If they need IVF, get it as quickly as possible. But our goal is the shortest pathway to a healthy baby. And the reasons is that some people that you know, Rae, they get pregnant easily. Some people that you know, they really struggle, most people are at a gray space in between, most people. And for them, there is no service. It is literally like the internet and good luck. Even if you go to a doctor, the doctor is like, okay, go try. Most people actually-

Rae Woods (16:12):
Come back in a year.

Dr. Neel Shah (16:13):
Come back in a year, yeah, and meanwhile it's existentially stressful for people. And so one of the things that we started to do is that we stood up a service that nobody is looking for, but everybody opts into when it's offered, which is conception coaching. No one is out there shopping for a conception coach, but when we offer it to people, 90% opt in, and when they do, they're 55% more likely to conceive naturally without needing IVF.

Rae Woods (16:40):
So, again, if I come back to the cost standpoint because you're providing this benefit, this extra support that by the way doesn't exist elsewhere, you're still able to ultimately reduce costs and get the employee what they want and ultimately get the outcome, the clinical outcome that you want.

Dr. Neel Shah (16:56):
That's exactly right.

Rae Woods (16:59):
I said earlier that we can't conflate women's health with maternal health. And I'm going to double down on that for a moment because fertility and family planning involves more than just women, right?

Dr. Neel Shah (17:10):
Yes.

Rae Woods (17:10):
And I know that Maven is focused on more holistic fertility care by in part, including men.

Dr. Neel Shah (17:18):
I mean, you have to include men because they're 50% of fertility issues or infertility. Also, men want to be part of reproductive journeys it turns out. And I have a lot of empathy for men, and it's so funny because our healthcare system is designed largely by and for men, but we are much less willing to use the healthcare system. And so men live less long than women do, and we have a lot of needs and issues. And so in reproduction, it turns out there's this amazing opportunity to engage men so that women don't end up becoming a treatment surrogate for what's effectively a male issue.

(18:00):
Because if you go through IVF, it's the woman who has to take all the drugs and the woman who has to have the egg retrieval. But meanwhile, one of the things we've started to do at Maven is offer at-home semen analysis for men. Men have been very reluctant to go to a clinic and get tested for reasons that are pretty clear. In fact, a third of IVF cycles happen without the man ever being tested. And we have deployed the first ever clinical grade at home semen analysis test. Men are very curious it turns out. It also turns out that sperm regenerates every 30 to 60 days.

Rae Woods (18:35):
So, there's another theory of the case that I want to test with you here. So, one of the things that we've talked about on Radio Advisory in the context of women's health is that it can be helpful to engage women in care because women tend to be the decision-makers for their household when it comes to healthcare. And by engaging the woman, you're better able to engage and get the business and the loyalty of their spouse and their children and their family members. It strikes me that a similar opportunity might be here when it comes to engaging men, not just in fertility care, but in healthcare more broadly. Is that right?

Dr. Neel Shah (19:13):
All right, here's a hot take. I think that all men should probably get a screening semen analysis every year.

Rae Woods (19:16):
Wow.

Dr. Neel Shah (19:17):
The test is cheap, easy to collect, pleasurable. It's not getting a mammogram, right? Women's tests like pap smears and mammograms, they're invasive and expensive and uncomfortable. This is such an easy thing. It turns out sperm is very sensitive to metabolic health and toxic exposures. It might be a better biomarker than cholesterol.

Rae Woods (19:40):
Interesting.

Dr. Neel Shah (19:40):
Yeah. It turns out that for men and for women, reproduction is also the kind of on-ramp into the primary healthcare system, which is by the way, ambition for Maven too. I think that Maven is the on-ramp into the entire primary healthcare system because there are these key moments in life where you are engaging with the system. When you're a kid, you go to the pediatrician, and then for a lot of people, you're not really interacting with a doctor until you're starting to have a family. By the way, menopause is the other window where all of a sudden your mammogram, your colonoscopy, all this midlife screening, and all of a sudden you have these weird hot flashes and brain fog and these symptoms that you want immediate help with. And then we go in. But it turns out menopause is not just about hot flashes, it's equally about bones and brains and hearts and long-term health.

Rae Woods (21:31):
So I want to get to the next episode in my kind of chronological order before we get to menopause, which if we've just talked about fertility benefits and family planning, we need to talk about maternity care. And allow me to be a little bit, perhaps a little bit too kind of business focused for a moment. If we think from the employer's perspective of fertility benefits as an investment, making sure that maternity care is a successful and low cost and has positive outcomes is almost thinking about protecting that investment that you've made. My question is, what does it mean to manage pregnancy and postpartum well, that the traditional delivery system is not doing such that it needs this extra support?

Dr. Neel Shah (22:18):
Thank you for asking that question because I think that the capabilities of Maven can seem like a luxury.

Rae Woods (22:23):
Yeah.

Dr. Neel Shah (22:23):
Right. Let me explain it this way. As an OB-GYN, my friends and family, when they're pregnant ... I have a lot of cousins. My dad is one of five, my mom's one of seven, and we're all part of the same kind of age group. And so I'm just exiting the phase of my life. But for a long time, whenever any of them were pregnant, they would call me all the time. I didn't have their medical record in front of me. There's a lot of information I didn't know, but I was think really helpful to them because I could cut through the noise. And when you are pregnant, everybody has a hot take on what you should do or not do.

(23:00):
And the idea of Maven Clinic in some ways is that it should be that for everybody because the alternative to Maven is not even Dr. Google. It's actually TikTok. 40% reproductive age people are on TikTok. And we've actually done formal studies that we've published in peer review about the degree of misinformation and disinformation in those spaces. So, I don't think it's a luxury. I think that pregnancy should be an empowering journey for people. And pregnancy is a time when, I don't want to frame it necessarily as fraught with risk, but it's the body's first physiologic stress test.

Rae Woods (23:35):
Oh yeah. It is not a health neutral event. Having had two kids, I can confidently say that pregnancy postpartum is not a health neutral event.

Dr. Neel Shah (23:43):
Even for the healthiest people, we unmask a lot of things. We unmask gestational diabetes that becomes chronic diabetes. We unmask hypertension that becomes chronic hypertension. We unmask mental health needs that can convert into long-term mental health needs. And so the incumbent system can't do that with punctuated fifteen-minute visits.

Rae Woods (24:04):
Yeah, I mean it literally can't, there is not capacity. So, you're saying that there is this interest in this moment of first of all being more involved in your health because your body is changing quickly. You're caring for this fetus, you're dealing with symptoms, you have questions. There's all of this information, true or not, that is out there. And the traditional delivery system literally cannot keep up with that at all.

Dr. Neel Shah (24:28):
You come in for your prenatal visit. My job is to measure the heart rate of your baby and measure your belly and then go through a checklist. I'm not educating you really about ... And I'm under tremendous pressure. The prenatal visit is the easiest one on my schedule, because you can be in and out in 10 minutes. And meanwhile, people's health is being literally produced in their homes and their workplaces and in their communities. And the purpose of Maven is to reach people there.

Rae Woods (24:54):
Or that obstetrician might not have the specific expertise that that pregnant person is looking for. They're not a registered dietician, they're not an exercise physiologist. So, even if they had the time, and that's where I think what Maven's model is so interesting is it's not just virtual visits with physicians with obstetricians. I mean, tell me about who it is. It includes maternal fetal medicine specialists. It includes lactation consultants, nutritionists, what else?

Dr. Neel Shah (25:22):
Yeah, I mean, imagine it being 3:00 AM and you're struggling to breastfeed, and the difference between getting a latch and not getting a latch when you're breastfeeding is a lactation consultant who within 30 minutes can connect on your phone, look through your phone, and help you out. And let me give you a very concrete example. Gestational diabetes impacts about 10% to 15% of many of our populations. And you're 24 weeks pregnant and all of a sudden you're being told by your doctor, you have to radically change your diet. And the solution then is not necessarily an obstetrician. It's not even necessarily insulin.

(25:55):
It's a nutritionist or a registered dietician who can coach you through it, and not only that, can look through your phone at your refrigerator in real time and help you plan a meal. And if you live in the Mississippi Delta where we serve Medicaid recipients, you don't have access to a nutritionist. You definitely don't have access to nutritionist who understands your diet or your context. But even if you live in Manhattan, you still would have to schedule with that person several weeks from now and in those several weeks. That's the difference between good blood sugar control and bad blood sugar control. And that is the difference between your baby being in the NICU and coming home with you.

Rae Woods (26:31):
And there are a lot of people in healthcare that are looking to digital solutions like this as the answer to not only closing gaps and addressing gaps that exist in our existing delivery system, which we just named, but also dealing with some of the more extreme cases. And there are a lot of folks that are looking to digital tools to help support some of the maternity care deserts that have popped up. We are recording this conversation just after the One Big Beautiful Bill passed the Senate, has been signed into law by President Trump.

(27:04):
The impacts of the Medicaid cuts, the ACA cuts and more are likely to see a lot of rural organizations struggle and rural organizations even close. That of course could make maternity care deserts even worse. Maternity care is often on the first list and behavioral health of things that are cut back. As great as these digital tools are in creating more outreach and more connective tissue between patients and employees and the care that they need, you still can't deliver a baby over Zoom. How do we deal with the reasonable limitations of some of these digital tools so that we can support the brick and mortar in a way that it also helps women and families in need?

Dr. Neel Shah (27:49):
Yeah, I think one of the things that is not well understood is what digital health is and what it isn't. You can't deliver a baby through a screen, to your point. So, what that means is there's some things that have to happen in person. And just to fully amplify and augment your point in the current state right now of the United States before the Big Beautiful Bill, there are parts of our country where you have to drive farther from your home to get to a hospital that's qualified to deliver your baby than you would at any point in Kenya. The farthest you have to drive from your home to a hospital in Kenya is three hours. And there are parts of the heartland of our country where you have to drive farther than that. And we are also seeing as a secular trend year over year, there are more rural hospitals shuttering their obstetric electric services.

(28:36):
But now bringing in the Big Beautiful Bill, it is going to be a significantly larger challenge for reproductive age people, particularly when it comes to maternity. And so digital health cannot replace brick and mortar infrastructure. That's the point. Also, there's some things that can happen in person and some things that can happen virtually. We were just talking about them, right? You can go meet with a nutritionist about your gestational diabetes or you can use the economy as a scale in the digital world to connect with somebody seamlessly and have them be in your home so they can look at your fridge.

Rae Woods (29:07):
Or even a maternal fetal medicine specialist, right? There are some things that require those clinicians to put hands on patients, and there are some that do not.

Dr. Neel Shah (29:14):
That's right. So, we have maternal fetal medicine doctors. We have 30 different types of specialists at Maven and they can connect and offer assistance. I am most interested in the things though that you can only do digitally, not the things you could do digitally or in person or the things you can only do in person. Although all those things are important. To me, some of the most exciting things are things that I never imagined and actually turned me from being sceptic to full on evangelist. For example, for my whole career I never believed that you could predict when someone is about to go into labor. As an obstetrician I thought if there's a full moon, I'm going to be busy tonight. That's it. It turns out that in order to predict when someone is going to go into labor, you need to be able to take their basal body temperature like every minute, which is impractical.

(30:02):
Only, it's not anymore because we have great hardware in the Oura Ring, which we've announced a partnership with in the last couple weeks. And all of a sudden now we have basal body temperatures and all kinds of physiologic parameters that are being continuously monitored. And it turns out you can predict when someone's going to go into labor. By the way, the way that's helpful is if you live three hours from the hospital and you have to figure out is it actually time to go in or not? That can be tremendously helpful. It can even be game-changing.

Rae Woods (30:28):
Interesting. Yeah. Before we move off the importance of maternal care, I want to channel the mindset of the employer specifically. We've talked about health outcomes, we've talked about costs, but managing the investment means, as you've already said, continuing to engage that employee over time. And there's plenty of data that women in particular tend to leave the workforce after they have children either within the first year or several years later, which can be a huge challenge for employers. How does Maven support the employee return to work experience?

Dr. Neel Shah (31:05):
We support return to work, but we also support being able to work. So, we have a product and it's called Parenting and Pediatrics. We're centering the parents here too. And so you can access pediatricians and pediatric specialists, but one of the most popular features is the ability to text a doctor. If I were to go to the hospitals and ask the doctors to text their patients, most of my colleagues would probably quit. And it's not because of it's communicative with their patients, it's because there's literally nothing about their day that allows them to do that. We have a platform where we've set it up so that doctors can text you back.

(31:39):
And so you can have a kid with a fever and you can be in a CVS and you can be looking at the baby Tylenol and the kid Tylenol, and you can text and within a few minutes you'll get a text back, which will explain the differences in the dosage and what you might need. And honestly, what parents mostly need is convenience and ease, and the healthcare system is not known for convenience and ease. So, we take all of that platform capability from the Oura Ring to the other wearables, to the ability to connect with clinicians right away, and we wrap it around parents so that they can be supported. And when we do that, what we do see is really high rates of returning to work compared to baseline because unfortunately, in the absence of that, parenthood becomes a large source of attrition.

Rae Woods (32:25):
Yes, exactly. And I appreciate your push on me of it's not just that kind of acute return to work period. It's the entire parenting life cycle. And if we continue to round out our approach to the life cycle, we have to talk about menopause. We've talked about that a little bit already in this conversation. And something I want to come back to that you mentioned is that menopause can be another gateway into the healthcare system because all of a sudden there's acute changes happening, changes that don't feel very good by the way, and make you actually want to go to the doctor to get them addressed. But you can start to then layer on other changes that happen to be happening at midlife. I want to channel the reasonable pushback that I'm sure our listeners might be having, which is okay, pregnancy and postpartum, those only impact pregnant people. When it comes to midlife, why is it important to just focus on women and the kind of clinical episode that is menopause versus focusing on everyone in midlife?

Dr. Neel Shah (33:26):
I think focusing on everyone is always important. So, even in pregnancy, male partners matter. In fact, our membership is made up, I don't want to misquote the exact number, but the plurality of our members are actually male partners, who by the way, in the absence of Maven, have nothing. They have nothing to really help them prepare. They have nothing to help them figure out how to be good partners. And even as an obstetrician, one of the things I was always conscious of in the labor and delivery room was how to make sure the male partner was involved and to be helpful, because it's a rite of passage for them too, and it sets up their whole parenting journey if you do it right. But in midlife, everyone goes through acute shifts in metabolism. Anybody who's woken up after the 4th of July feeling a little more hungover than they thought they were, men do not go through menopause.

(34:12):
There is a concept of andropause, but men don't have the phenomenon where their sex hormones drop off a cliff all of a sudden. So, there is a male need and journey to serve. But on the women's side, it's really different. And the needs of women are unique. Women are much more likely to have osteoporosis, and by the way, huge source of morbidity mortality and healthcare spending in the long run. And by the way, the time to fix that is not when the house of medicine says you should get a DEXA scan when it's too late, but actually upstream in midlife. So, that's the answer.

Rae Woods (34:51):
If we think about these chapters, fertility and family planning, we think about maternity care and we think about menopause, should the health leaders listening to this podcast all be focusing on all three chapters, even if they can only get a little bit better? Or alternatively, would you rather them focus on one chapter and be really, really good at menopause care or really, really good at maternity care?

Dr. Neel Shah (35:14):
I don't think it's zero-sum. I think everybody should focus on everything and just be good enough. I mean, you think about it, our healthcare system is not competent at producing the results that people need and deserve. So, I'm not going to give people credit for being excellent at fertility and then not taking care of the actual pregnancy when the purpose of fertility is a healthy baby, not to become pregnant. Now, if you're a purchaser, if I was speaking to a client, I'm aware that they've got fixed budgets and they've got to figure it out. And so maybe they're going to start with bringing on a fertility benefit or a maternity benefit, and of course we're very happy to support them. But aspirationally, of course, what I want is support across the journey.

Rae Woods (35:59):
If that's the case, and this is us literally giving you a microphone to speak directly to health leaders that listen to Radio Advisory, what's the one step you want them to take now to making meaningful impact on their members, their employees, their patients, their community when it comes to supporting holistic women's health?

Dr. Neel Shah (36:18):
I think it is to lean into the fact that digital health is not a fad. They may remember a time where to get a movie, you would walk into a blockbuster, you would rent a VHS or you'd rent a DVD. And then there was a phase where Netflix became a thing. But Netflix would mail you the DVD.

Rae Woods (36:40):
Yes.

Dr. Neel Shah (36:41):
And then there was a phase where they stopped mailing you the DVD and they were streaming. And when it comes to digital health, we're not in the streaming era, but we're definitely in the mail you the DVD era, and that blockbuster is already obsolete. And a lot of digital solutions have made an end run around the incumbent system. Ultimately, it's all going to converge.

(37:05):
But the rate of adoption of these technologies and the rate of advancement of these technologies is so rapid that you will absolutely be left behind. And just to put a little bit of a pin on this, in 2025, generative AI will fully dichotomize organizations that are competent with these technologies and organizations that are naive to them. Whatever it is your ultimate goal is competitiveness, bottom line, whatever it is you're going for. Unless you take digital health seriously and have a digital health solution, particularly for your reproductive age population, I believe you'll be left behind.

Rae Woods (37:45):
Well, Neel, thank you so much for coming on Radio Advisory.

Dr. Neel Shah (37:48):
Thank you for having me, Rae.

Rae Woods (37:53):
I hope we've convinced you of three things in this episode. First, it's that women's health is important, and as Neel said, it's not a zero-sum game. Focusing on women's health also means focusing on things like musculoskeletal health and brain health and cancer care. I also hope we've convinced you that focusing on women's health means more than just obstetrics. It means family and fertility planning. It means holistic maternal care that doesn't end when the baby is born, and it extends throughout midlife. And lastly, I hope we've convinced you of the business case of why it is so important to make these investments, whether you're a purchaser or an employer specifically, and remember, there are partners out there that can help you, including us because remember, as always, we are here to help.

(39:23):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. We'll see you next week.