Start-Up: Telehealth for Women • Chelsea Kohler

Digital health start-up, Favor,  is on a mission to make reproductive care more accessible and convenient, especially to members of Gen Z. Chief Marketing Officer, Chelsea Kohler, joins Niki Christoff from San Francisco to break down the latest trends in digital health and to discuss how the pandemic has shifted attitudes - and regulations - around telehealth.

"I can't imagine a world in which any other medication that people are on for three plus decades still needs to be picked up every month." -Chelsea Kohler

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Intro:

Niki: I’m Niki Christoff and welcome to Tech’ed Up. Today I’m joined by policy communications expert Chelsea Kohler of The Pill Club. We’re talking about the digital health boom and how the pandemic has shifted attitudes and regulations around telehealth services. Yes, we’re discussing birth control, but if you’ve received any video or app-based healthcare, this matters to you. 

A note to our listeners: This episode includes some gross generalizations about Gen X, Millennials, and Gen Z which are 100% based on stereotypes but also totally true. 

Transcript

Niki: Chelsea, welcome to Tech’ed Up. 

Chelsea: Thank you for having me Niki. Happy to be here.

Niki: So you're calling in remotely from San Francisco. And we know each other from our days in the Bay Area, overlapping, but you used to be a Washingtonian working at the State Department. 

Chelsea: I was there from 2005 to 2012 first on the Hill and then in Foggy Bottom. And I just, I think there's an energy to D.C. that I actually tried to seek in Silicon Valley after this like, there's always that energy of, y’know, new people coming to Washington, hoping to make change. And I sort of miss that. I think it's definitely left the Valley. So, it's nice [chuckles] to, y’know, that's what I think of when I think of D.C. 

Niki: Tell me a little bit about The Pill Club and your role there.

Chelsea: The Pill Club is a digital health company that focuses on women and people who menstruate to lead their healthiest lives. What does that mean? We started with a focus on basic reproductive health services, contraception, making them more accessible and more affordable. Honestly, ‘cause somebody had to, um, the average wait time for new patients to see an OB GYN today is 24 days and that's just to get the first appointment. So, this seems like an area that, y’know, we can do a little better and be more efficient. 

In many developed Western countries, you do not need a prescription for birth control, but here in the United States, yes, you need a prescription.

And then after that, of course, we've all had the pleasure of going to a pharmacy 12 times, you know, a year. Or maybe your listeners haven't, but that's the next step after you get your prescription, then you're going in and in a lot of states you can't get an advance on that Rx and you're going every 30 days to get your next prescription filled. So, it's highly inefficient, certainly forget about us coastal folks. I think for people that have to drive a long way to get to their doctor, let alone their pharmacy, and are working jobs that are less flexible and have not worked at home during the pandemic at all.

It's hard to stay on this medication, and it shouldn’t be.

Niki: So, in a perfect world, we would have a situation in which people could go into a pharmacy and over the counter buy birth control. They can't. The next best thing is they can potentially text with a provider and not do an in-person visit. Do even just texting, not even video as a visit [Chelsea: mm-hmm] to get a prescription and check through the list to make sure that it's safe for them to take it and then get it via mail so they don't have to park and walk into a pharmacy 12 times a year to get a medication that they've been taking for maybe a decade or two decades. 

So, these are, this is sort of the world we're living in and what's your job? Your role is to think through, what?

Chelsea: I think, how we explain what we do, not just to patients or potential patients, but also to regulators, to, y’know.  [long pause]  The pandemic really, there’s so few silver linings that maybe one is, it's helped folks who had not considered telemedicine a legitimate way of getting care, showing folks that have made allowances and emergencies and during COVID to have telemedicine covered or certain telehealth visits covered.  Even though we're going back to, hopefully, truly going back to the way things were before and a lot of regular life in society is reopened.

I think there's some benefits to, again, if it's a routine re-upping of a prescription that you've been on for a long time. And even if it's not, this is a very, y’know, there's, this is a pretty well-regulated drug and this is not a new kind of medication. So, it's been around for a long time and we should be able to help people get on it more quickly. 

Niki: And set aside birth control. This is for any kind of healthcare, including potentially mental health care, which is not allowed across state lines often via video chat. Which, there were exceptions made in a lot of places, including federal for this technology that are going to expire [Chelsea: Yeah] and are expiring. And, suddenly, we've all gotten used to being able to do these visits, as you say, either asynchronously via an app or over video visit and suddenly where you're physically located, the state where you are standing is going to determine how you get your healthcare broadly way outside of the scope of just what you guys are doing. Right? 

Chelsea: That's right. I mean, regulatory flexibility here is pretty key to helping people even keep up a continuum of care at this point

Niki: [interrupts] The other side to think about is the provider. So, you think about how many nurses or practitioners or therapists have also moved around during this time and reshuffled and are no longer located where they were located before. So, it allows them some flexibility if you have this cross-state ability to provide care via video.

Chelsea: To your point, the patient, the provider, and then also the healthcare plans who I think would also like the care to continue for different, for a variety of reasons. So, it does seem like someone that makes sense to all sides of the equation 

Niki: And yet…

So, what part of your job is working on telling this story and your team's job here in Washington, who I've met. Part of their job is explaining to regulators, the inefficiencies in the system. And actually your CEO has a logistics background. 

Chelsea: She does. She comes from Uber, like us. She, she was a co-founder of Eats and started it from the ground up.

And, so definitely sees the benefits of on-demand healthcare. A mom of three. So, I think, you know, we've always laughed about how, at the beginning of the pandemic, you would never have done a pediatrician appointment remotely. You were like, “No, you need to see my baby in person. My baby's the only one that's had this arm rash.” 

Uh, and then you cut to like, none of us ever want to go back in for anything anymore. We'd like to even just do the COVID test and hold it up for them and ask what it means. So, I  think attitudes have definitely shifted as well. This company was founded before the pandemic and I think, that it's really been an accelerant in terms of adopting a more accepting point of view around this kind of care.

Niki: There is something of a generational expectation about how healthcare works. So, if you say to me, “Niki, you've got to go see the doctor. You've got to go get treated in person to get a prescription you've taken [chuckles] since 1995. [Chelsea: Since forever] [both chuckle] Forever. And then you're going to have to go to CVS.”  Like, I'm friend-. I know my pharmacist, I know all about my pharmacist. Like, I have to see him every, every four weeks for the last time. To pick up something I've been taking.

So like, but I'm going to do it because I'm a Gen X-er and that's what we do. Like, we're just, we just take the aggravation that that's and that's okay. That's, that's how it works for us. But there's a new generation, Gen Z, which is anyone under 25. That is your target demographic. And you guys have done some studies and seen some patterns in how they think about healthcare and just in general about Gen Z. [Chelsea: mm-hmm] So, this is backing way up, but how are they thinking about their lives and how they get treatment and how they buy things? Because again, I'll take what I'm given. I'll take scraps [chuckle]  because I'm Gen X, like, that's just how we do things.

Chelsea: I'm an elder millennial, and I feel like we're sort of that in-between of, we'll take what we can get but then we might whine about it. And I don't know what else we're known for, like, message tees and drinking wine and a lot of embarrassing-

Niki: [interrupts] avocado toast!  [Chelsea: Yeah, exactly!] You guys are known,  what you guys, what elder quote-unquote millennials are known for is trying to claim that Superbowl halftime show when I'm telling you that Eminem’s daughter is a millennial.

Chelsea: Yes. That's dark for me. [chuckles] 

And I think millennials are more into find workarounds in the system. To your point, like, we're not digital natives, but I think there've been a lot of,  totally well-founded jokes, about how a lot of the, the, on-demand economy companies were born out of sort of millennial laziness. And thank goodness for that! 

But Gen Z is really interesting to me because like you said, they're born in a post 9/11 world. They grew up in the shadow of the great recession. They are digital natives and they, of course, like everyone else have, have also endured the very strange last two and a half years, y’know, in terms of not just the pandemic, but sort of civil unrest and racial justice issues and seeing… I think climate issue and racial justice issues tend to be the things at the forefront of their minds.

 So, because of all those things, lots of trust issues, right? 9/11, Great Recession, and then the last two years. They’'re more aware of, of danger or more skeptical of stability, y’know, than a lot of us.  They, sort of, they didn't get to see the 80’s boom, and the excitement y’know?  [Niki: mmmh!] So, there's sort of, or even the nineties and  [Niki: The nineties!} 

Chelsea: Yeah. It was great.

[crosstalk]  

Niki: Early aughts. I'm rewatching Sex in the City. O.G. Sex and the City.

Chelsea: Yeah, exactly!  That don't even, when, y’ know, the, the formative experience of the cosmos and the, exactly the, I don't know, stilettos?  

Niki: Smoking indoors? 

[crosstalk] 

[chuckling] Being a social smoker?   But now, on the flip side of it, I've been rewatching, to our point of how we know each other, I've been rewatching Sex in the City, and she's constantly trying to hail a cab,  [Chelsea: Oh, perfect!]  which is hysterical to me because I realized that was unacceptable. She's, y’know, downtown Manhattan, trying to get a cab at three in the morning. 

So, if they're under 25 and they've spent the last two years, which is a significant portion of their over 18 life in a pandemic world, they are, as you said, skeptical of stability. Are they anxious?

Chelsea: They are the most anxious. Who can blame them? And I think, if I had always had access to social media, but I'm, like, it's truly terrifying to imagine that. I went to an all girls school from K through 12. And that really seems like it would have been a weapon in those formative years. [chuckles] Bbut I think also, yeah, there's just, because of this social first digital content connectivity from youth, there's a much more aware of world, sort of, like, world issues than I was.

Right. I mean, they just sort of have a window into everything that's going on, which, I think it makes them much more socially conscious. Unlike millennials, millennial searching for a work around, this generation, rethinks, what can be and how it should be. I think they're much more vocal and, like, in a totally admirable way.

But I think in general, they also don't accept the status quo around the experience we're describing of “we're going to pick up medication 12 times a year.” They're just sort of, like, that, that really doesn't make sense. Which then I'd never had anything delivered to me until the pandemic. I think they, most of them have not spent a lot of time in a pharmacy.

Niki: It's a great point that I haven't really thought about, which is, so again, going back to Uber Eats. So your CEO worked in logistics at Uber Eats, and I've heard her talk about getting a hamburger delivered to your door, which is actually kind of a miracle that that is something that we can do. [Chelsea: Yes]  A hot hamburger delivered to your door! 

And we now take it for granted, but we have not had that for very long as a, as a construct. And now suddenly, we get everything delivered at any time of day. Although I do want to talk for a minute about people who live in, in rural areas where actually, I mean, I'm like a hardcore fan of the post office.I don't know. I'm just saying, like, I'm 85 years old on this entire thing. 

But the post office is critically important for Americans. And again, we are living in cities, but there are places you still can't get a hamburger up to your door and you might not be able to visit the pharmacy in the middle of the day, but at least if the U.S. Postal Service can deliver your medications to you, any of your medications, all of your medications, that is critically important for your quality of life.

Chelsea: Today we know that rural and urban patients telehealth use for the patterns to date from the last two years are actually the same. Which to me means one) this is still a very early trend. Right. There was this sort of tip of the spear, but also maybe that there's some infant, we know that they're in special network speeds and this is a whole other, you know, the 15% of Americans struggle to pay for internet so we know there's that issue. But I think it's another reason to sort of invest in some of the less sexy things people think about in terms of infrastructure. Hopefully Mayor Pete's taking care of that for us.

Niki: I think Mayor Pete, he, well, he was dealing with the planes not crashing with 5G or whatever he was working on last week. [Chelsea: mmmh] 

But yes, definitely broadband is an issue, but this also goes to your point about texting. Because if you can use this, has occurred to me before and we've talked about it, it isn't just young people who benefit from asynchronous healthcare via text. It can be seniors too. 

Chelsea: Totally!  Yeah. My gosh. That's when I got my, I lived with my parents for part of the pandemic and getting their prescriptions on delivery has been life-changing for them. That's definitely something they're gonna keep. 

Niki: And that's something we should also think about is as the population ages. Again, everyone driving and parking and standing at a pharmacy in line to get prescriptions that they're taking over and over and over, it doesn't make any sense for that population either.

So, this seems like a win-win, I mean, I know I'm agreeing, we're in violent agreement on this. But I do think that there's a role for the government to play in thinking through how these asynchronous, remote, texting telehealth or even telephone visits for basic healthcare need – the things people are getting over and over again – can make everybody's lives simpler, and it's frankly, just enormously more efficient.

Chelsea: And also, in the long-term I think it will drive down, the systemic under-investment in primary care in America generally could be some, not totally, solved out, if we can decide to take one solution at all. But I think, clearly, if we could help with rates of inpatient spend from reactive, let's say, situations, issues that weren't dealt with until they were acute. We can bring down the cost of care. 

Niki: Right. So, just regular maintenance care, and also preventative care, and also hopefully mental health care. [Chelsea: Yeah] And all of these things working together, the easier you make it for people.

And by the way, we're talking about, I mean, we have the ability, I have the ability to just go to CVS in the middle of the day and hang out with Dustin [chuckling] when I pick up my prescription. [Chelsea: I hope you hear this, Dustin] Shout out to Dustin. Don't think I haven't given him my QR code for this podcast. I have!

But people who are working jobs during the day, who can't get to their pharmacy, who have trouble driving, who might have a reason, they don't want to be exposed to people right now until a lot of our restrictions lift.  [Chelsea: Yeah] Like, it just doesn't make any sense. And so, then you have people not getting preventative care and regular care, and then you do end up with more acute situations and that's more expensive for everybody.

And it's more expensive and more of a drain on their employers, their families, their overall quality of life. And so, The Pill Club is doing one piece of this puzzle, which is working on preventing unwanted pregnancies by trying to just make it a little bit simpler to get people oral contraception. 

Chelsea: We're trying to cut down that 24 day, wait to two to three days. 

Niki: Right? So, instead of 24 days to wait to get your prescription, it's two to three, and then you get it in the mail. 

What is your last message for people? Whether it's people thinking about how to interact with gen Z, what works?  [Chelsea: mm-hmm] What resonates?  Have you like, do you think that, do they want viral ad campaigns? I mean, I'm on Tik Tok because I'm trying to figure out, like, what's happening. 

Chelsea:  That’s good! I alluded to this a little bit earlier, but I think Gen Z is just a lot more aware, kind of back to the, even the anxiousness thing, of the world, around them. More socially conscious, but also sort of, like, less to the point a traditional ad is not going to work. And y’know, that's also, it's interesting to see the rise of influencers because I'm starting to wonder when influencers will, sort of their lens on marketing will change, and the influencers will be seen in the exact same way. But even that content already, I think what resonates most with them tends to be firsthand experiences. 

Like, we're already moving away from the unboxings, which was huge when you and I, when I was at YouTube and I met you and you were at Google, to somebody really talking about their experience and what it was like and why it was meaningful to them. Even though they have this huge awareness of the problems in society, I think they are also the most compelled and moved by personal stories and connection. As a result it feels less salesy. So, if you let someone try your product and they have a great experience and they talk about it, I think that's a lot more effective than a posed photo with it, for example. 

Niki: It does seem like a generation that really is looking for authenticity. And by the way, my assistant, who is Gen Z,  told me that I'm overusing the word authentic. [chuckling]

Chelsea: I also received that feedback. Um, 

Niki: But I do think that's what they're looking for? Right?!  Authenticity. [Chelsea: Totally!] They're looking for real, real people talking about real things. Not as filtered, not as perfect. 

Chelsea: Right? I think they're more informed than the average consumer to a point they're, like, always online and I feel, like, I'm always online, but they're more online. Value connectivity and expect convenience so even, like, saying something is convenient, that's sort of, that's again, assumed and, like, doesn't need to be called out as much. I think they want to be a part of the conversation. And then it'll be interesting to see the next couple of years. 

Niki: I know we're making gross stereotypes about people based on their age and generation, but 

Chelsea: [interrupts]  Most of them are positive, we're positive for Gen Z. I'm like, I, I respect it. They're demanding a lot of the things that I think that other generations virtue signal. 

Niki: Said like a woman who lives in Northern California [Chelsea: laughs] and not like [chuckling] a cynic sitting in Washington D.C. whose like, uh, “Yeah, I'm going to need you to fill this stapler and not complain about it.” 

Chelsea:  Fair enough. [chuckling] 

Niki: So there are also regional differences [chuckling] in how we think about them, but I will say this about Gen Z. I have found the Gen Z population that I interact with are resilient. They do seem to have almost a sense of urgency [Chelsea: uh-huh]  around what's happening around them. And climate obviously is at the top of that, but I think you're right.

They aren't going to just look for workarounds. They actually are deeply mission-driven and that really doesn't necessarily matter what is most important to them. They are people who move jobs more frequently, have higher expectations of their employers, have higher expectations of convenience, and also fairness and what works. And the inefficiencies make no sense since they have grown up with the magic of not just the internet, but the smartphones [Chelsea: Yup] for their basically their entire existence.

And so, I think that they apply it in different ways. Like, I don't think, actually, we can stereotype them based on what their politics might be, but they do seem as, as a group, as a cohort to be really action oriented [Chelsea: Yeah] and they do seem pretty resilient. That's my observation,  so far as someone who's largely, up until recently, managed millennials, which is a different kettle of fish. I feel like this is a group that, they just seem like doers. 

Chelsea: They  are, I think that they liked being a part of the solution and driving the conversation around that. I feel that we're drawing a contrast with my generation, but I'm going to let it go because I think it's sort of undeniable as someone who's on a team that many of whom were born after 1995. There's a lot of, “Okay. We all agree on that, but now what?  And what are we going to do?” 

Niki: Poor millennials. I mean, I don't think millennials, millennials right now are everyone from the age of, what, 26 to 41. [Chelsea: There are a lot of us.] There are a lot. And a lot of millennials are doing the parenting and are now starting to become a sandwich generation taking care of their parents too. I think we've got to ease up on millennials.  You guys have a lot on your plates. [Chelsea: Thanks!] It's true!  

I think people need to give millennials a break. I mean, I know we talked about how Gen Z and almost a set with a lack of, are growing up with a really scary lack of a sense of stability. And especially with what's happening with the climate, which seems new to me but to them has been the case for several years, for as long as they've been paying attention. They, they see these sort of horrors on TV, around climate and I think millennials, we also need to remember graduated right after a huge economic, almost devastating, almost didn't make it, financial collapse and have been sort of digging out ever since and have been having a really hard time achieving the same quality of life that their parents had, [Chelsea: mm-hmm] or even the people just several years older like me have had.

So. anyway, I just think we should give everybody a break. [chuckling] Cut everybody a break! Everybody gets a pass. Everybody should be able to call their doctor via video or at a minimum texting or using a survey to get basic medications. We absolutely need to keep the postal service shored up so people can get their medications if they live in rural places.

And you're going to keep working on this. Do you have a final message for our listeners, Chelsea? 

Chelsea: Not at all!  Keep listening to Niki.  And for the men, 30 to 50, is that the age? 

Niki: It's 30 to 45. I mean, I don't know why?!  This is what Spotify and Apple Podcast say, that it's 30 to 45 year old men listening to this podcast. 

Chelsea: Yeah. Tell your, tell your lady friends about the show. That's the way to sound like a millennial. 

Niki: I got a chart of the topics that most people listen to on podcasts. [Chelsea:  Ooh!] The number one topic across every age and all genders. [Chelsea: The unifier] is comedy. 

Chelsea: Everyone needs a laugh. 

Niki: Everybody needs, everybody needs a laugh. And then there's a group of people, it's also the people who listen to this podcast called, “info seekers” and they listen to podcasts to learn something. So, there are people who want to laugh. There are people, smaller set, who want to learn something. And then there are subsets of people., like they might want sports, or they might want murder podcasts. That's almost all female listeners, and then news is only seniors who listened to news. And technology is almost, almost exclusively men on the top 10 list of the top 10 topics. It's men between 30 and 45. So, that's why that's, who's listening to this podcast. 

But in fact, what you are doing is on-demand delivery of a really complicated product that is more important to get there on time and intact than even a hamburger, which is what your CEO was able to pull off. So, this is absolutely a tech solution to a real life problem.

Chelsea: I couldn’t have said it better myself. Thank you for having me. 

Niki: Thank you for coming on, Chelsea.

Outro: 

Niki: Next week our guest is Laura Shin, author of the brand new must-read book, “The Cryptopians.”  Be sure to follow Tech’ed Up wherever you get your podcasts.