It’s no secret that the American health care system is often difficult to manage, even for industry experts.
Finding a doctor, figuring out insurance and accessing care can be especially challenging for young people doing it for the first time, said Lori Evans Bernstein, CEO and co-founder of Caraway. Young women and others assigned female at birth also face a complex landscape of abortion restrictions, as well as a growing need for mental health care in the wake of the COVID-19 pandemic.
Caraway, which offers virtual mental and physical health care for women ages 18 to 27, is expanding into new states and recently added services in Ohio and North Carolina. The startup came out of stealth over the summer with $10.5 million in seed funding.
Bernstein sat down with MobiHealthNews to discuss bringing Caraway to new states and what the startup has learned since launching in September.
MobiHealthNews: What are some of the needs that have arisen in the population you serve: young people, female students? Is there anything that surprised you?
Lori Evans Bernstein: There are many questions about birth control. There are many questions about ADHD. That’s interesting, because in the company we have a lot of expert knowledge about ADHD, but we don’t prescribe stimulants, we don’t diagnose ADHD, we don’t fill prescriptions. But we have incredible expertise with our chief health officer, with another psychologist, so we can answer questions about that. And our plan for ADHD — later next year — is to start with a lot of executive functioning training and then see what our path is to start supporting patients with existing diagnoses. And then new diagnoses. So we’re committed to that, but that’s where we get a lot of questions.
A lot of questions about nutrition, a lot of questions about nutritional supplements, which is kind of interesting. The way members asked about mental health, they may feel a lot of stress and discomfort. We saw a pattern with a lot of really significant stress and anxiety. That’s how quickly we managed to develop a tool for stress tolerance skills. It’s an audio clip that walks you through the steps to do that, and members can listen the whole time in the app.
One of the plans we have later this year is to release a mental health wellness program that is in the spirit of teaching skills. These are digital tools that the member interacts with, that the care team can comment on and collaborate with the member, and then the therapy can be scaled up or down in the context of what’s going on for that individual member. And so we’re almost ready to release the first part of it. But in the beginning we saw so many problems with stress tolerance that we were able to work something out quickly.
MHN: Why did you see this as an important group to focus on for Caraway?
Bernstein: The short answer is a tsunami of need. We saw that access to care was really, really limited. The mental health crisis that was brewing before COVID really escalated during COVID, especially for women.
In our opinion, you cannot effectively treat mental health without treating physical health. The mind is connected to the body; we see them as inseparable. So we saw that in the data, in the headlines. I personally have many friends and family in this age group that I have seen first-hand the suffering they went through. And then when the Dobbs decision happened, of course we had another crisis. The higher press immediately talked about Dobbs’ decision as yet another one crisis on university campuses.
So, this tsunami of needs combined with inadequate opportunities for people aged 18 to 27. Whether it’s student health or urgent care, trying to find a doctor, trying to make an appointment, really struggling to navigate our system and insurance. Our model is to be as proactive and personalized as possible. We want to teach our members health as a life skill. We want them to really understand and get involved in that journey, to gain independence and freedom of action in making decisions.
MHN: You recently announced plans to expand into North Carolina and Ohio. Ohio has restricted access to abortion, while the situation in North Carolina is uncertain. What is your reproductive care strategy there?
Bernstein: We have to take a state-by-state approach and really examine all the implications, the legal implications, the medical malpractice implications, the privacy implications, any advertising or employment.
We think the answer in limited conditions is contraception and education – and being able to, as much as we can, help women understand their bodies, understand their menstrual cycles, talk about contraception and advise on choices.
There are many choices today. We have an adolescent physician on our care team who was just at the American Academy of Pediatrics meeting and there was a lot of discussion about long-acting reversible contraception, which are spirals, and then, now there is the implant. They are not prone to user errors and last a long time. Initially we will try to direct women to get them if that is what they want to get. Next year we hope to be able to do some of that from a personal care perspective. But we really want to educate, and we really want to lay out the contraceptive options and help advise what’s best for young women.
MHN: You have had an established career in healthcare and healthcare technology, both in the private and public sectors. How did this affect the development of Caraway?
Bernstein: A lot of time has gone into different aspects of the system and attempts to drive change, and everyone is working hard and doing their best to drive improvements. But we’re not doing a very good job, like the collective “we”, are we? Costs go up and quality goes down.
When you think about Generation Z and everything we know about this generation and the desire to drive a proactive approach to care, showing a different experience for the system – given the enormous need already at this age – and really setting the tone for the systemic change that needs to happen in the long term. I think that if we show this generation a different experience, hopefully, it will encourage constant change in the system.