Expanding Access to Fertility Care - Tammy Sun, CEO of Carrot Fertility

SHIV GAGLANI: Hi, I'm Shiv Gaglani and today on Raise the Line, I'm really happy to be joined by Tammy Sun. Tammy's the CEO and Co-Founder of Carrot Fertility, which is a customizable fertility benefit solution for employers, including egg freezing, in vitro fertilization and other fertility care. Prior to that, she was Director of Partnerships at Evernote and has over a decade of experience in politics, having worked at the Clinton Foundation and the White House previously. So, Tammy, thanks for taking the time to be with us today.

TAMMY SUN: Yeah, thanks for having me. It's great to be here.

SHIV GAGLANI: So can you start by telling us a bit about your background and what led you first to politics, then to entrepreneurship?

TAMMY SUN: Sure. It was an unconventional path and I never expected to be an entrepreneur or a founder. What I was really drawn to about politics and campaigns and government as a platform, was just really the ability for government to be a way to impact change at scale. And so I spent a lot of time between New York and DC really focused on what are the different levers within government and also within politics that can help improve people's lives at scale. And I think that's one of the real similarities between government and technology, even though there might seem like a lot of distance between sort of those two worlds, between Silicon Valley and the Hill or DC. But really, I think, a major commonality is that it attracts a certain type of person and the type of person it attracts are people who want to do things at scale. 

So after spending about a decade in New York and DC, I came over to Silicon Valley to work in the private sector and as you mentioned, I started at Evernote. While I was at Evernote, I went through a health issue with regards to my fertility and really fell down this rabbit hole and completely fell in love with the problem, and really thought I was going to build a consumer facing company because I had this patient experience and my co-founder is a fertility doctor. But ultimately, really decided that delivering healthcare in this country is largely done through employers. And so that's what we do today is we partner with employers to deliver fertility health care and make it as standard as medical, dental, vision, vision health.

SHIV GAGLANI: Yeah, it's a really impressive goal and traction you've achieved so far. I've been really enjoying seeing how much investment has been going into women's health. I know Halle Tecco at Rock Health did a lot of this early on, and it seems over the last two, three years, there's been an explosion in the number of companies doing this. Can you tell us a bit more about Carrot and the growth you've seen as well as the just completed series B funding? What do you think is driving your expansion and what are your plans for growth?

TAMMY SUN: There's been a lot of really great activity, as you mentioned, over the past couple of years, and I think it's a reckoning and a recognition of just how big this category was. When I first started the company, when I first started talking to investors, there was a predominant idea that fertility was a niche part of healthcare, that this was something that only a small group of people would really care about or only women of a particular type who wanted to do egg freezing. And I think fast forward three years, three or four years, and there is broad consensus and broad recognition now that this aspect of healthcare is much, much bigger than that, and that there are many diverse ways that people engage with their fertility health. Not just women who want to do egg freezing and not just for the treatment of infertility as a disease.

So I think one of the things that we have seen over the past several years is a recognition of the diversity of ways that people engage. So LGBT people will look to fertility healthcare in critical ways as they think about how they want to form and expand their families, whether it's through adoption, whether it's through reciprocal IVF. There's a growing need for donor eggs and donor sperm and material for fertility treatments. And so our growth has really been powered by a deep recognition that this is a fundamental part of human healthcare and that there are ways that all people can engage in their fertility health, that are meaningful and important and should be standard when people look at their health plans.

SHIV GAGLANI:  Totally. As an employer, ourselves at Osmosis, it's really interesting because we've been looking at a lot of different benefits to offer, ranging from the standard -- we have health insurance and looking at 401k. If you close your eyes and look at five years from now, do you think this is something every employer will offer and can you give us a sense of how many employers currently offer something like this, as well as the traction you've achieved so far?

TAMMY SUN: If you fast forward five years, I definitely think fertility is going to be a standard part of what people expect when they go to work. When you look at the history of how these things evolve, in the 1970s, it wasn't always the case that dental and vision were a standard part of compensation at work. A lot of that was driven by unions and demand from employees that this was important. And so now when you go to work, you expect that there's going to be some sort of medical coverage, there's going to be a dental, there's going to be vision. That's sort of table stakes.

I see the same trends around fertility care. Obviously, it's not through union movements, but really it is employers responding to demand from employees about what is critical. And what we have seen this year, particularly with COVID, is that this is definitely an important part of healthcare, that is not a perk. It's not something that's an extra or a nice to have. When people think about their fertility health, they're really thinking about it as a core part of their healthcare. We see a future where every employer has the ability to customize a solution that is right for their business at their stage of growth and implement some sort of fertility benefit for employees.

SHIV GAGLANI: Again, fairly inspiring. We've had one other leader of an insurance type or benefit company on the Raise the Line podcast. Alex Frommeyer, who you may know, started Beam Dental. Fascinating how a benefit company, a company that provides benefit in his case, dental insurance, was also taking a proactive step to educate as well as improve the dental health of their members by sending them the smart Beam Brush and whatnot. I'm curious, can you describe Carrot's offerings to date? If I were an employee and looking for a fertility benefit for myself, for my wife, what would Carrot be providing at this point?

TAMMY SUN: So if you're an employee and you have access to Carrot, essentially what you have is a few different major things. One, you have employer-sponsored dollars that you can use through Carrot to pay for your fertility treatments. For those who don't know, fertility treatments are relatively expensive -- IVF, egg freezing, these costs thousands of dollars. And so the first, most important thing you get is financial coverage from your employer for this aspect of healthcare the same way that you would get financial coverage for if you broke your arm, right? And that's scalable for your company and for your employer in a way that's right for your business at your stage of growth. We have employer customers that provide $10,000 worth of coverage per employee. We have employers who provide $150,000 worth of coverage per employee, so we really are able to scale up or down to help employees access financial coverage.

The second thing is that you get an app and a care team. So you get texts, video, and voice chat with a care team that is curated and personalized for you. So let's say you are a female who is looking to do egg freezing. You might have a fertility nurse who you can book video appointments with and help you do your shots. If you are a male employee with a male partner, and you're looking at adoption, you might have access to an adoption lawyer to help you understand how to get that process started, what are the costs associated with it? The Carrot benefit can flex to pay for both of those types of care and treatment. So if you are somebody who has Carrot, those are the things that you could expect.

SHIV GAGLANI: That's fascinating. I actually didn't realize the full scope of what you all do for the members. So one thing I've been hearing a lot about, because of COVID, is the disproportionate effect it's had on certain parts of the workforce. Not only people who have to work in person versus knowledge workers and remote workers, but also, there's all this evidence that more women are leaving the workplace because of COVID to do childcare at home. So we're kind of taking two or three steps back from all the progress that was made over the last few years. Do you mind commenting a bit on that, but also what other effects COVID has had on Carrot and maybe what you're seeing across the healthcare system as well?

TAMMY SUN: Yeah. There's a ton of disproportionate impact this year on different populations, not just from COVID, but from other things that have happened this year. We certainly recognize and see that, for example, black people are disproportionately impacted in the healthcare system and the fertility healthcare system is not exempt from that. And so earlier this spring, in the wake of the George Floyd murder, we built and shipped a feature in our product to help BIPOC members or employees who have Carrot access fertility doctors and fertility clinics and providers who are also BIPOC.

There's a lot of data that shows that when people connect with a provider of a similar race and a similar culture they actually experience better health outcomes. We know that in this country, black women suffer disproportionately when it comes to pregnancy and maternal care, so the ability to build a product that supports not just women, but black women and other BIPOC people is something that is really important to us. Our mission is fertility care for all, regardless of age, race, sex, sexual orientation, gender identity. But in the wake of the George Floyd murder, what we discovered was that we did not include race explicitly as a part of that mission. We have added it since, because we want to be really thoughtful and conscious and deliberate about thinking about race as a factor when it comes to access to care and the different challenges that particularly black women face.

SHIV GAGLANI: Thank you for expanding it. I know we talked about COVID, but the racial injustice aspects are strong and you're right. I don't remember the stat off hand, but I believe it was something like black women are two to three times more likely to have a mortality issue in pregnancy than their white counterparts. We also work with a number of historically black colleges and universities, like Morehouse and Howard, at Osmosis, and are really supportive of the mission to get more people of different underrepresented minority groups into healthcare careers, not just MD and DO, but midwife and PA and pharmacy, et cetera. So that's great to hear that you guys are doing that.

TAMMY SUN: Within the context of COVID even, women bear disproportionate burden and the black community bears disproportionate burden as well. They're disproportionately impacted by COVID. So I think for folks who are building products in healthcare, for folks who are in this space, I think it's really important for all of us to think about what is the diversity of the different types of people in the populations who are using your product, and to really make sure that you are building user experiences that support everybody. And not just from a user experience perspective from a member having a great experience, which is important enough, but really from an outcomes perspective as well.

SHIV GAGLANI: Totally. We've had a number of people from the telemedicine community on the Raise the Line podcast including the American Telemedicine Association president, Dr. Joe Kvedar, but also 98point6, American Well, and others. You said you offer fertility coaches and adoption lawyers to your members. Can you talk a bit more about tele-health and other trends in healthcare that you see as here to stay because of the COVID crisis?

TAMMY SUN:  I think your emphasis on bringing guests on who are working in this telehealth and telemedicine space is a good instinct because I'm sure all of us may agree that telehealth and telemedicine really isn't going anywhere in a post-COVID world. And for us, we see similar patterns with regards to fertility care. Certainly, there are aspects of fertility treatments that you can't do at home and that you can't do online, right? IVF is a surgery so you need to be in a physical facility. Where we see a lot of opportunity and where we have seen our product and members and customers really gravitate to is these telehealth and telemedicine features. So, what are the things that we can do to support members in their fertility care at home before they enter a clinic?

There are things that you can do at home and there are interventions that you can introduce much earlier in the fertility care experience. For example, earlier this year, we launched Carrot at Home. It allows people to access interventions, products and services outside of the clinic. Ava is one of our partners. It's a world-class wearable that uses biosensors and bio-tracking to identify for a female, who is subfertile, the ideal fertile window. And so 30% more subfertile women will be able to achieve pregnancy over six to 12 months without the intervention of IVF altogether. When we look at that, we really want to be able to double down on that, double down on telehealth, double down on telemedicine in a way that allows people to get care along a continuum that is inside the clinic, but also outside.

SHIV GAGLANI: One reason I'm excited to follow Carrot's progress for the next few years is as I mentioned, I think a lot of women have left the workforce because of COVID and we're going to have to do a lot to get them back in and think your organization can really help employers do that as well. I know we're coming up on time, so I had two other questions for you. We have a large audience of current and future healthcare professionals, many of them are going into women's health careers. What advice would you give them about meeting the challenges of COVID and beyond, and what would you like to tell them about their career choice?

TAMMY SUN: I don't know if I'm one to give career advice, but what I would say is when I think about women's health, and for those who are aspiring to come into this space, I would encourage folks to really think about this as broadly as possible, because I think the opportunity is even broader than women. Even with fertility, 40% of members who come into our product are male. 40% of members are male, 53% are female and the other don't identify. We've always thought about building a brand and a company that would encompass more than just women. I think it's really, really important within the fertility space specifically, I think it's really important for women that men also engage and men also participate because otherwise the burden of care, the burden of action, falls entirely on women.

I think in order to create equity, we have to really spread the responsibility and the mechanisms of intervention so that it's all people who can manage and take care of their fertility health. So, I would think about things as broadly as possible. And if you're thinking about starting a company or joining a company, I think the most important thing isn't really the product. It's not necessarily the market. The most important piece of advice I would give to young people is find high quality people. Find a team that you really respect, that really pushes you to be better because that's the most important thing, is spending time with high quality people. Whether it's this product or this company, or the next one, if you can find those people and ride together, there's a lot more that you can do together than as one person.

SHIV GAGLANI: I'll definitely echo that. I think its people before even strategy. It's what they say, “culture eats strategy for breakfast”, and that's because the people make the culture. And thank you for that clarification. I totally agree that that's an impressive stat, that 40% of the members who engage with care are men and it's important for that to happen so that the actual caring of the child, whether it's adopted or through IVF, is equal. Is there anything else you'd like to be able to share with our audience while we have you on the call today?

TAMMY SUN: It is such an important and special time to be in the healthcare space and for those who are here, you have such an opportunity to really change healthcare for the better in the decades to come. I think this is a really pivotal moment in the U.S. healthcare system at least. I would not be afraid to dive into areas where you may not feel like you have a ton of expertise. When I started Carrot, I didn't know anything about employer benefits. I knew nothing about healthcare. I knew quite a bit about fertility treatments through my own experience. But I was able to come at this problem with a beginner's mind. So don't let experts intimidate you in thinking that you may not know enough to have an impact in that area. Just dive in. If you fall in love with a problem, that's the first signal that you're probably on the right path, then the solution will come. But there's so much opportunity, and healthcare really needs people who have a beginner's mind. It needs people who come to it with fresh ideas, thinking that things are possible that may not have been possible before.

SHIV GAGLANI: I love that advice. So with that, Tammy, thanks so much for taking the time to be with us today.

TAMMY SUN: Yeah. Thanks so much for having me.

SHIV GAGLANI:  I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line, since we're all in this together. Take care.