Women are facing a "triple threat" to their health in the U.S. with the compounding effects of primary care provider shortage, a mental health epidemic and a reproductive health crisis in a post-Roe world, according to Carolyn Witte, CEO of Tia.
Women are twice as likely to experience depression compared to men and three times as likely to experience anxiety, according to data from the National Institute of Mental Health.
In Tia’s own patient population, almost one-third of members have been diagnosed with a mental health condition.
"There’s never been a greater moral or economic imperative to invest in building comprehensive care for women. Women and communities will be healthier when we start to manage their mental, physical and reproductive health together," said Witte, who co-founded the women's health company back in 2017.
Tia is expanding its mental health offerings integrated into its primary care and gynecological practice as part of the company's "modern medical home for women."
The new services include Groups, an eight-week program designed to drive connection with other women facing similar challenges or circumstances and provide support, education and tools to process emotions and feel belonging and encouragement.
Another new service, Coaching, is an appointment tool designed to release feelings of anxiety, sadness, stress and emotional tension and enable productive stress processing for improved mental and physical health. Groups and Coaching are facilitated by Tia-employed licensed mental health professionals and grounded in the latest research about peer support and stress release, Witte said.
Tia has grown rapidly in the past two years and now has virtual and in-person operations in California, New York and Arizona. In 2021, the startup inked a partnership with CommonSpirit Health, which operates 137 hospitals and more than 1,000 clinics, to launch Tia-branded women's health clinics. The first brick-and-mortar clinic opened in October 2021 in Phoenix with planned expansions in Arizona and other CommonSpirit markets over the next few years.
Tia landed its second major health system collaboration with UCSF Health in San Francisco in 2022. UCSF Health plans to collaborate with Tia to develop a new network of clinically integrated clinics for women in the Bay Area.
Earlier this year, Tia inked its largest health system partnership to date as it collaborates with Cedars-Sinai to open up clinics in the Los Angeles area with a goal to serve 100,000 women.
The company closed a $100 million financing in 2021, representing one of the largest for a healthcare company focused on women.
Tia has raised $132 million to date, backed by investors Lone Pine Capital, Threshold, Define Ventures, Torch Capital, ACME, Compound, Combine, The Helm, Human Ventures, Seae Ventures and Gingerbread Capital.
Over the past few years, Tia has built out mental health services integrated into its primary care and wellness services and evolved programming over time. The company has "baked in" anxiety and depression screenings into its health exams and wellness-oriented services like acupuncture.
Tia also offers assessments for patients experiencing anxiety, depression, mood changes and chronic stress, including a review of a patient’s comprehensive health record and a personalized care plan with treatments connected to root causes that may include medications, hormone testing, diet and lifestyle recommendations.
The company also offers in-house mental health medication management administered by Tia’s primary care providers for mild conditions and in-house psychiatric providers for moderate or more complex needs. Tia also will facilitate appropriate referrals for patients who need other services.
"Our early quality data around mental health shows that we are screening women for depression and anxiety at rates much higher than the national average and effectively treating depression and anxiety when diagnosed,” said Jessica Horwitz, Tia’s chief clinical officer.
But the company also recognized that many patients have subclinical symptoms of mental health issues, or patients who report anxiety, chronic stress or feeling burned-out, but do not have an official mental health diagnosis. These women often want access to mental health services that can support mental health holistically, Witte said.
"We've seen that mental health and physical health are deeply connected with many of our patients with a chronic condition like PCOS or diabetes also having a mental health diagnosis. We've learned that one-on-one therapy is an effective and clinically appropriate modality for some patients, but not for others. And it's not a panacea. Women want more tools to support them wherever they are in their journey," Witte said. "We've learned that women who use multiple team modalities, what we call multiple tools in the toolkit, to support their mental health have better outcomes."
"Through all of these learnings over the last two years in delivering mental health care integrated into primary care, we are evolving our mental health offering as part of Tia's 'whole women, whole life' care model. That includes doubling down on certain services that we've been doing and rolling out some new ones as well," she noted.
Tia recently announced the decision to sunset its 1:1 therapy program due to clinical, operational and financial challenges to delivering the service at scale.
"The reimbursement landscape for one-on-one therapy is very challenging. Reimbursements are typically far below the cost to serve patients. When you pair that with a national therapist shortage with insufficient labor supply to actually meet patient demand or clinical demand, it creates a really challenging environment to deliver this service in a high-quality way that is also operationally feasible," Witte said.
She added, "Putting all those factors together led us to the decision that this is the best opportunity to address women's mental health in the prevention space, focusing on diagnosis, screening, routing and ensuring our patients get access to the right mental health care modality at the right time, across the acuity spectrum. We're focused on delivering services that are more oriented around prevention, that are about connecting women's physical and mental health together and about giving women a community-oriented space to address their mental healthcare needs."
Tia is now focused on expanding its wellness-oriented tools for managing mental health, such as acupuncture and new nonclinical services such as Groups and Coaching.
"We've been piloting and are now rolling out our Groups program, which has a ton of patient demand. So far, we've sold all the seats in our pilot for Groups within a few days," Witte said. "That is a testament to women's desire to connect with other women in the context of shared experience, life stages and challenges as a way to support their mental health proactively rather than reactively."
With its mental health offerings, Tia aims to address the root causes, not just symptoms, of mental health issues, executives said.
The Groups and Coaching services also represent a more cost-effective modality of care, Witte said. The Groups program costs $45 per session as a cash-pay service. "This is oftentimes less than what a patient even using their insurance might pay for one-on one-therapy in terms of a copay," she said.
The Coaching service is priced at $99 per session as a cash-pay service.
Tia aims to expand its service lines to care for women throughout their entire lives, from puberty to menopause, according to executives.
"We're constantly looking at the clinical need in our patient population to determine where we go deeper. Mental health care has been the area where we've invested the most in terms of going deeper with new services and modalities that support their mental health as connected to their physical health across the life span," Witte said. "As we look at other areas, whether it's PCOS or maternity care or menopause, we're constantly looking at how do we take the same Tia focus on prevention and integrated services and deepen our offerings to better support women across different life stages or different health conditions."