Fixing Centuries of Inequities for Women in Healthcare - Halle Tecco, Executive Vice President of Everly Health

Shiv Gaglani: Hi, I'm Shiv Gaglani. Studies show that women are 76% more likely than men to have visited a doctor within the past year and control 80% of the healthcare decisions in their families. Despite this, women still face many obstacles navigating the healthcare system. Today on Raise the Line we're going to learn more about this area from Halle Tecco, Executive Vice President of Everly Health, which is comprised of the digital health companies Everlywell, The Natalist and Everly Health Solutions. Halle is the founder of Natalist and an influential digital health venture fund, Rock Health. She's also an adjunct professor at Columbia Business School. Everly Health CEO and founder Julia Cheek was an early guest on Raise the Line and before we get started, I wanted to give a shout out to Halle for joining us because we first met when I was considering going to HBS for business school and she, along with her Rock Health co-founder Nate Gross -- who's also the co-founder of Doximity -- gave me a lot of advice on that path. It's great to reunite and see you, Halle. 

Halle Tecco: Yes, thanks for having me. 

Shiv Gaglani: I know quite a bit about your background, but for our audience's sake, could we start with learning more about you, what got you interested in business development and eventually investing in women's health? 

Halle Tecco: As you know, I started my career in digital health when I founded Rock Health right out of business school, actually in business school, and then kind of launched it right around graduation and had a great run there. Obviously, Rock Health has continued to make a huge mark on the digital health space, but I have always been really passionate about healthcare, innovation, and bringing people together to solve some of the most complex problems. 

I enjoyed that work but my time had come to leave San Francisco after nine years, and my husband and I moved east, decided to go to New York, and there I was able to continue to be helpful to Rock Health but not responsible for Rock Health, which is the way I put it. At the time, this was pre-COVID, it was really important that Rock Health had an office, a very vibrant office and being in person I felt was important for the executive director. Had this been during COVID, things might have been different, but at the time, I knew that I needed to find a different role, just because I wasn't going to be in Silicon Valley anymore. Bill Evans, who is still leading today kind of took the helm and I started kind of dabbling in a couple things. 

I created and taught the first MBA level course on digital health, which I continue to teach at Columbia Business School, which is my favorite job. I love it, it's so much fun working with the MBA students on digital health investing, which is the content of the course. I continue to invest in and support the investments through Rock Health. One of the areas that I started spending more and more time in -- which, when I was at Rock Health we probably invested in maybe one or two women's health companies, Wildflower health being the most well-known one there -- but I started spending a lot more time thinking about this area within digital health and within the healthcare space that was underserved. I knew it was underserved as a patient, as a woman, as someone who faced infertility, I firsthand, realized the lack of solutions and really human- centered approaches to managing care and reproductive care specifically. So, I started spending more time learning about women's health and investing in companies like Kindbody and Tia. I probably have invested in nine or ten women's health companies now over the last five or six years. 

I love teaching, I love school and I actually went back to school at thirty five. I got my MBA at twenty five and at thirty five I went back and got my MPH with a focus on women's and reproductive health, and so that was an awesome experience. I went to Johns Hopkins Bloomberg School of Public Health and that just completely helped me reshape the way I think about investments. I feel like I was a very good investor -- in fact, I am a good investor…I have very good returns on my investments from the learnings at business school and at work -- but I wasn't an impact investor, while I would have probably liked to think I was. 

I really didn't understand the social determinants of health. I didn't understand public health and the impact that the companies I was investing in could possibly make, and so getting my MPH is like so counterintuitive for someone in business school. I remember, when I was going like "why are you doing - is this just like a hobby?" and I was like, "No, I think this is going to make me a better, more impactful investor, and that is my goal." I want to continue making money, that's important to me, but I think we can do both and I think having a better understanding of the healthcare system is important for that. Notice, I didn't get my MD because I didn't have that much time and I think I would be a lousy doctor. But that was the next iteration. So, I was teaching and going to school and investing. I started investing in more companies that were impact oriented, like Cityblock Health, Imperfect Foods, companies that you might not think of as digital health, but at the end of the day, are using innovation and using technology to improve health outcomes. 

Meanwhile, my husband and I were struggling to get pregnant, dealing with infertility and going through IVF and I recognize that within women's health, this preconception phase and pregnancy phase was just entirely lousy. I had never invested in a Consumer Packaged Goods (CPG) company before. I knew nothing about running a CPG company, but I couldn't get this idea out of my head. At the time, there were like two, FDA-cleared fertility-friendly personal lubricants on the market and one of them, that is the leader still to this day -- other than Natalist which is one of the leaders in the space – has packaging with this homely looking woman holding a baby. It's terrible packaging, and they still haven't updated it and I really want them to update it. I'm not gonna say the company, but you can probably Google it and find out. 

So, we're trying to get pregnant and I have this, like, terrible looking box on my bed stand and I'm just like, “Why hasn't someone brought the love and care that goes into beauty products to this space”? I have a whole other bone to pick with the beauty industry, but what they get right is they make you feel good and these products that you are tricked into buying, for whatever reason, have a much better user experience and you like to have them on your shelf because they're beautifully packaged. I had this idea, well, why can't we remake all these fertility products and pregnancy products and women's health products that we're buying at the store? By the way, all the incumbents are majority male-owned, male-run on the board, executives, etc…companies bringing no empathy to the space. It has been decades since they had actually tried to conceive. They're just soulless products.

At first, when I had this idea for this company, I bought the domain Baby Someday. And at first, I was like, “I'm going to put money into this. I write checks for founders all the time. Why don't I find a founder and write them a check and get this thing going?” I interviewed two potential CEOs for the job and I came home and I told my husband, "I'm so sorry. I know I said I wouldn't start a company, but I think that I have to do this. I'm just so passionate about it. It's such a big opportunity." He wasn't excited about it, but he's like, "Okay, well, I actually have this idea that I'm gonna start too.”  So we both had our second startups.

But that was the genesis of Natalist. I really wanted to just bring a human-centered approach to these physical products and again, I knew nothing about e-commerce. I knew nothing about CPG. But I knew a lot about healthcare and I knew a lot about being a woman trying to conceive. A pregnancy test is probably one of the most emotionally ridden products that you could buy and use. Life changing information is given to you and you would never guess that if you look at the packaging and read the instructions. So, just by redesigning the wording of the instructions, just by putting some loving care into that…customers just love our products over the incumbents. So, that's my journey. 

Our entire team is led by moms and doctors and we're the only female-founded fertility and pregnancy brand on the market. We’re at CVS, Whole Foods, Target…I think over 6,000 stores now carry our products. We're dedicated to building healthy families, but we also value the progress that we're making towards sustainability. We like to say we care about leaving this place, this earth, a better place for our children, and so we have a whole Mother Earth initiative. All of our products are 100% plastic neutral. It doesn't sit well with us that we make single use products, so we do what we can to ensure that our products are recyclable, biodegradable, plastic neutral, as much as we can do to just have a little bit more consciousness around this impact that we're making. Last year, in October, we were acquired by Everly Health. So now we're part of that family as we get into more at home testing and other capabilities that we can do together. 

Shiv Gaglani: It’s really quite an incredible journey, seeing your career evolve from the sidelines and interacting with somebody at different conferences. I remember seeing your announcement about Natalist and now, having you join and be a major part of Everly Health is really cool. There's so many threads to pull on. We launched this podcast right at the beginning of COVID. It's been two years we've done three hundred episodes on a number of women's health tech ideas and amazing leaders. You mentioned Cityblock, we had Toyin Ajayi on the podcast. We've had Carrot Fertility. We had on Chelsea Clinton, who's obviously, with her firm Metrodora Ventures, very focused on women's health. It's very heartening to see how much attention and investments are being made in the space. You've clearly been a major driver of that. 

Earlier this year, you and Julia Cheek authored a piece for Harvard Business Review arguing -- and I'll quote -- "We must look beyond female anatomy and reproductive health to uncover and rectify the impact of centuries of navigating the healthcare system that wasn't built for women." I wanted to give you an opportunity to delve further into that and talk about women in the healthcare system and how we can make the experience better for them, and by extension their families, too. 

Halle Tecco: Yeah, it's a great question. That article came out of a place of, “Well, what is it that we're getting at in this industry?” And it's not just products for people with ovaries. I personally like, cringe, when I read ‘this is a product for someone with ovaries.’ It's like, do not reduce me to my reproductive system. There's currently some uncertainty if we should use ‘women's health’ or ‘femtech.’ This happened in digital health five years ago. Is it ‘digital health’ is it ‘health tech’ is it ‘health 2.0’ or whatever. We're having that same sort of conversation and I think it's an important conversation because words matter and we want to get it right. 

But the article was about the fact that we're navigating a world that was not designed, or built, or meant for us, and we're still trying to fill the holes that have been left in a very inadequate system. This ranges from clinical trials where women are disproportionately not represented, to maternal health outcomes. I mean, let's face it, if men got pregnant, they would not die at the rate women die. There is a lot of sexism that is built into the entire system, literally from the bench to the bedside. The overarching goal that I think anyone in this space has within women's health, or should have, is reducing these disparities and improving the health outcomes for women who are in many ways the backbone of families. 

We know that women are making the majority of healthcare decisions for their entire families. They're making the appointments, they're picking up the prescriptions, they're the ones showing up in managing not just their health, but the health of everyone around them. They're also more likely to be the caregivers. They're the ones that are more often taking care of the children or the elderly in the household and yet, women are not taken care of enough within the system. 

That article was great. If anybody hasn't read it yet, you should read it. We got a lot of great feedback on it. We dove into examples of where we have fallen short for women, but I think an important piece of that is that we don't want to serve women at the cost of leaving out anyone who is nonbinary, trans etc. I don't think that's the goal of saying ‘women's health’. We're not trying to exclude someone who was born female and identifies as male. That's not the point. The point is that we want to fix literally centuries of inequities for us and, hopefully, everyone will benefit from that.

Shiv Gaglani: Yes, absolutely. I think we're seeing a lot of this interest burgeon largely because what's happening on the political scene. Obviously, there's so much organizing left to do to respond to the Roe decision. That's a very charged topic that's worthy of discussing at some point, but I know we're short on time, so we may not go deep into that. 

I would like to give you the opportunity to talk a bit about Everly Health because when we spoke with Julia, it was very much about home diagnostic tests. Now with Natalist and the brand kind of growing, we'd love to hear how you made that decision to join them and what the overall vision now for the larger entity is? 

Halle Tecco: I was one of Julia’s first investors. She and I were business school classmates and I've known her for a long time and have always really admired her leadership. Natalist is a much younger brand, much smaller brand, but we were always very aligned on a couple of things and things that I'm really proud of. I think one is being evidence backed, and Everly has been in a space that I think minds have changed and acceptance has changed around at-home testing, and at-home collection. But it wasn't always this accepting, right? Julia has had to go through years of skepticism by the industry, but she has always been very dedicated to the science, and that is something that her and I align on quite a bit is like, “no junk science.” Focus on what has clinical evidence and be buttoned up about it. So, that's one area that we both care deeply about. 

I think the other area we care deeply about is having a team that is representative of the people we are trying to serve. It sounds so easy, but it's just hardly ever actually done in industry, which is just ensuring that you're building a team that, literally, is made up of women and people of color, but also that you're creating a culture and an environment where they can thrive. So that's something that I always admired of Everly and Natalist as well. So those are a couple of areas that we are aligned with. And within the Everly brand, my work kind of is broader than Natalist. I do support Everly as well, but it's all about consumer demand for accessible, affordable lab testing and digital health solutions, which is obviously something that's quite timely and continues to grow and is, in my mind, recession-proof because we have so much to catch up on within healthcare. Even after doctor’s offices and clinics have returned to normal services, consumers are making home testing and telehealth a permanent part of their lives. So, the timing of this business, I think, has been really critical to its success and building those strong fundamentals early on will help Everly really continue to grow and make a positive impact in the lives of the customers.

Shiv Gaglani: Absolutely, it's been super exciting to see some of these trends be accelerated in the last two or three years, because back when you were starting Rock Health… 

Halle Tecco: Oh my gosh, 

Shiv Gaglani: …there was definitely some excitement around digital health but I think like the Gartner Hype Cycle…there was a lot of over hype about it. 

Halle Tecco: Oh, yeah. But honestly, Shiv, I feel like we were so gaslit. I mean, certainly we had believers and I am forever grateful for those people who dove in the deep end with us, but it was a deep end and there were a lot of people that were on the sidelines with their life jackets being like, "I'm not getting in there. You're crazy." I had meetings early on in 2010-2011 where I was like doubting myself, I was so gaslit. I mean, they just had no belief that the healthcare system would support any sort of innovation and I think we proved them wrong. There have been a lot of great advances in this space, and I'm really proud of everything that we've done. We still have a lot of work ahead of us but I think overall, I'm really proud of what the industry has accomplished. 

Shiv Gaglani: Absolutely. A quote we often talk about on this podcast is Amara's law, which is: people tend to overestimate the impact of technology in the span of a year and underestimate its impact within the span of 10 years. And I think it's exactly right with digital health and what you and Nate saw with that whole industry. Obviously, there have been some graveyard companies along the way that were overhyped. Proteus is one. I was an early adopter of Zeo, which I loved. I thought it was a great product, the sleep monitor, but now people just wear Apple watches and they get their basic sleep actigraphy every day. 

I wanted to get your commentary too, because since telehealth, digital health, and at-home health are all becoming more and more mainstream over the last two or three years big companies are jumping in. I'm talking to you right after doing my first One Medical appointment. I hadn't done it, but after Amazon bought them a couple weeks ago, I was like, "Alright. I gotta go check this out for myself." It was a wonderful, really good patient experience. 

Halle Tecco: Was it virtual or was it in person? 

Shiv Gaglani: I went in-person. Got my lab tests. I literally booked this two days ago. Went in and in less than forty-five minutes, they handled my annual physical plus lab testing. Super easy, like Amazon and others have made the customer experience. What are your thoughts for the next decade for digital? 

Halle Tecco: That's such a great question. Obviously, the adoption of telehealth on both sides has been the most impressive change that we've seen. Not just patients getting more comfortable with it, but actually the clinicians being more comfortable with it and the hospitals and clinics investing in telehealth as an arm of care that they offer.  I think that we've leveled out at a place that is much higher adoption than where we were before COVID. Obviously, it isn't what the peak adoption rate was in April 2020, but it’s in a place that accelerated adoption faster than what it would have been before. 

So, if there's any silver lining in the pandemic, which I don't think there is, but that is one thing that I think has made a difference and will mean that in six years, seven years, that sort of care, which was mainly video, will move to phone calls, text-based, easy, more asynchronous conversations with clinicians and other people within your care circle. I think that's something that can help kind of lower these barriers for people that don't want to wait six months for an appointment, for instance. 

I think there's gonna be a lot of consolidation. That would be another prediction I have. We have a number of highly-valued companies -- they might not be as highly valued this year as they were last year -- but they're still impressive sized companies that have real revenues, real customers and so I can imagine that there'll be a ton of acquisitions in the coming years, where they're starting to consolidate and roll up. I think we're already starting to see this with 23andMe and Lemonade, for example. My third prediction is that we're gonna build tools that truly serve everyone where women aren't an afterthought and people of color aren't an afterthought and left behind on these new products, but are really built in from the beginning. 

Shiv Gaglani: I love that and as we talked about right before this, Osmosis just joined Elsevier. As we joked, we are acquisition buddies in 2021. One of our sister products is Complete Anatomy, which has a great partnership with Apple among others, and just this year, they released the first fully-developed female 3D anatomy model. Elsevier is the publisher of Grey's Anatomy and Netters, some really great brands. This was really awesome because before what most anatomy providers would do was basically change the hair on the on the male model, and obviously there are a lot more anatomical changes that need to be taken into account. So, it's really cool to see companies like this make these progressive and important, scientifically validated changes. 

I know you joke that you don't want to be a physician. I think you'd be a really good physician given your passion for the space and impact you've already made in the space. As you know, we serve quite a few current and future healthcare professionals…doctors, nurses, PAs, et cetera. What would your advice to them be about approaching the next phase of their career, and it could be just general career advice.

Halle Tecco: Well, you know, thank you. I think it's a very admirable career decision, and we obviously have a shortage of providers. There are certain areas such as fertility care for instance, where there are eighteen million Americans who live in a fertility care desert and don't have a reproductive endocrinologist available within driving distance. So, thank you. We need more physicians and people who will serve patients. We unfortunately lose a lot of physicians, because it's so exciting to be in a digital health startup. That's something that concerns me. While I encourage you to dabble and consider where you can make the biggest impact, I hope that you can find a way to continue to see patients, and a lot of physicians still do that. 

I think being able to find that balance is important where you're still working with patients, which can really help guide your insights to supporting companies. If you're listening to this podcast, you're probably someone who cares about innovation and wants to have a hand in it. I think that there is a way to have a hand in that without giving up the patient care. I'm just saying that with my public health hat on because I do worry about our provider shortage. 

The nursing crisis is something that is very concerning to me right now. On my podcast, The Heart of Healthcare, we did an episode on the nursing crisis and just knowing that the fewer nurses at a hospital, the more patient deaths there are…that being able to just draw those sorts of lines and understand the critical importance of all providers is really important. So, thank you for what you're doing. If you are an OBGYN or family medicine doctor going to a red state, thank you for what you're doing. I think, you know, it's going to become even more political to serve patients in OBGYN and other specialties where birth control access and abortion care is part of standard care, but it has now been politicized. So, again, thank you. Thank you for your work now and in the future. 

Shiv Gaglani: That's really heartening. The fact you've gone back at thirty-five to do your MPH is a good model. I think a lot of people who go into these careers burn out early, trying to squeeze in everything. “I gotta do my MD, PhD, MBA, MPH, JD, all in my twenties and then do a seven year residency. So, hopefully, if you think long term, the changes you can have for your professional life, your career, you can do a lot when you think in terms of decades, not in terms of years. 

Halle Tecco: Yeah, and school is expensive, man. Med school debt is already something you'll be paying off for a while. You can always go back to school, not that it's easy, but you know, you'll always be able to go back, and I encourage it. I would say the MPH program had probably a third physicians that were trying to advance their careers and do new things. I think that it was great to be in a classroom with people from every aspect of healthcare, including people that were new to healthcare, which was cool as well.

Shiv Gaglani: Totally. It's good to see that talent across the board. I just have two other questions for you. The first is, Osmosis obviously cares a lot about education. We are a training and education company. If you could snap your fingers and teach anything to healthcare professionals or students, what would it be and why?

Halle Tecco: Oh. I have to be the teacher, so it has to be something that I know, which would be digital health investing. I've been an angel investor. It's a high-risk asset class, but physicians well into their career are making certainly more than the average American and if you can think about being a smart angel investor and putting your money into the companies you believe in and supporting them, I think that would be a great course to learn how to do that. 

Shiv Gaglani: I agree and not everyone can benefit directly from taking your Columbia course, so if we were to make that a Coursera course or an Osmosis course, that could be very interesting and good for the companies to have that clinical background in their investor base. 

Halle Tecco: Totally. Yeah. 

Shiv Gaglani: Last question, is there anything else you wanted to cover today, leave our audience with that we haven't gotten to? 

Halle Tecco: Can I do a shameless plug for my podcast?

Shiv Gaglani: Of course.

Halle Tecco: (laughs)So I also have a podcast called The Heart of Healthcare, and I talk to guests -- like I had this week Anne Wojcicki from 23andMe – who really kind of span public health and medicine and digital health and what folks are doing and kind of just get to know them. It's a lot like this podcast, so if you like this podcast you'd probably also like The Heart of Healthcare. And as Shiv knows, it's a lot of work that goes into a podcast.  We do it for the love of these conversations and shedding light on work that we think is really important, so I always appreciate listeners. 

Shiv Gaglani: I've really appreciated hearing it as well. Even since I first met you, you were a great convener of some of the best people in the space and you've made bets on them not just with your time, but with your money that have proven to be very, very successful and not just financially. Most importantly, as I know you agree, it’s the impact it's had on healthcare and the patient experience. 

Halle Tecco: Yeah, yeah. 

Shiv Gaglani: With that, Halle, thank you so much for taking the time to be with us on our podcast and more importantly, for the work you've done to strengthen our healthcare system, or as we say, Raise the Line.

Halle Tecco: Thank you. Thanks for having me. 

Shiv Gaglani: With that, I'm Shiv Gaglani. Thanks to our audience for checking out today's show and remember to do your part to flatten the curve and Raise the Line. We're all in this together. Take care.