There are significant barriers to accessing healthcare for low-income women and specifically for women of color. Some figures make clear these challenges: 45% of 18-29 year olds do not have a primary care physician; one in three doctors don’t accept new Medicaid patients; and, there are at least 72M women of reproductive age in the United States.
Specifically, access to quality sexual and reproductive healthcare is critical for the health and wellbeing of women, yet many women in the United States struggle to access quality and timely care. As a result, unintended pregnancy rates are 3x higher and maternal mortality is 2x higher for low-income women. While the gaps in access to care are clear, few solutions within the women’s health space cater specifically to underserved women, and as a result, many women struggle to access essential health services.
Solution
Twentyeight Health is a women's health platform focused on increasing access to reproductive and sexual health care for underserved communities. Twentyeight targets a large, underserved market as there are 38M underserved women in need of women’s health access. Medicaid alone spends over $200B on healthcare for women of reproductive age. Twentyeight’s vision is to become the digital healthcare home for women, building trust early and providing care throughout a woman’s lifetime via telemedicine, medication delivery and ongoing care. Twentyeight provides medically accurate, accessible, convenient healthcare and currently offers various methods of contraception, emergency contraception, prenatal vitamins, and STD treatments, amongst other services. Twentyeight is available today in 34 states and in Washington DC. In 2021, Twentyeight launched full Spanish language telehealth services for their healthcare offerings to cater to Spanish speakers, a largely underserved population as a Health Affairs study published in 2021 shows that Spanish speakers receive approximately one-third less care than other Americans.
Twentyeight has been strategic in its go to market strategy by initially offering contraceptive care to underserved women via its direct-to-consumer approach. As a result, Twentyeight developed strong relationships with thousands of women as a trusted healthcare provider while also gathering meaningful data around underserved women and their habits and health needs. Because Twentyeight builds long term relationships with their users by providing subscription-based access to birth control, the company is uniquely positioned to provide care coordination when users want to pause birth control and may be thinking about conception (or already pregnant). This fills a significant gap for health plans who want to proactively offer additional services to women at appropriate times to improve maternal outcomes and reduce costs but often cannot due so because of the lack of member engagement and accurate data. Now that Twentyeight has developed a strong foothold via its initial product offerings, it has expanded its healthcare offerings, such as herpes treatments, prenatal vitamins and emergency contraception. Twentyeight developed its own proprietary platform to easily engage with users, their provider network and their pharmacy partners. Additionally, the scalable platform will allow them to easily add additional healthcare offerings to the business.
Why We Invested
Twentyeight is specifically focused on reaching historically underserved populations via its platform and increasing access to health products and services for low income women. We found Twentyeight to be differentiated from other players offering digital health solutions to address women’s health for two main reasons:
Many women’s health solutions are point solutions - solutions that address and deliver on one specific need, often in isolation. However, while point solutions can target specific parts of the patient journey, it is important to keep in mind the holistic health of the woman in order to drive outcomes. Therefore, we are excited about Twentyeight’s approach to building a women’s health platform because we believe that winners will be solutions that address the woman’s whole health and/or integrate with other solutions to support various social and medical factors that may affect a woman’s health throughout various phases of her life.
A majority of the women’s health solutions currently in the market are offered as direct to consumer products that women pay for out of pocket. As a result, these solutions are often price prohibitive to underserved populations and therefore cater predominately to middle and high income populations. Therefore, low income women are typically unable to access these solutions. While Twentyeight has both direct to consumer and B2B business models, the services Twentyeight is offering are mostly fully reimbursed and so women do not pay out of pocket to access Twentyeight. Therefore, Twentyeight is reaching a population that has historically struggled to access these types of healthcare services.
Beyond reproductive health, Twentyeight seeks to increase women’s access to healthcare more broadly. The company aims to empower individuals with information, affordable access and convenience for their reproductive and sexual health. Twentyeight is comprised of doctors, public health experts, designers, engineers and builders who are committed to changing the face of healthcare for underserved communities.
Impact
We believe that Twentyeight can reach populations that have historically struggled to interact with the health system to improve health outcomes for women. Twentyeight’s user demographics indicate their success in engaging underserved populations: of Twentyeight’s users, 58% identify as BIPOC, 59% live in non-urban areas and 55% of users are on Medicaid. 63% of Twentyeight’s users report that they did not have access to birth control prior to joining Twentyeight. Overall, Twentyeight has impact on various levels: the company can reach populations that have historically been left out of the health system (underserved, low income women), help to prevent unintended pregnancies, and bring women into the health system for regular visits and preventive care to identify conditions or illnesses at an earlier stage to improve outcomes and lower costs.