Subscribe on Apple Podcasts, Spotify, Buzzsprout, or follow the podcast on LinkedIn for new episode drops.

In this episode you’ll discover:

• Why menopause is such an important time in a woman's life to pay attention to her health care

• Why telemedicine is perfect for menopause care

• Why millennial demand for personalized reproductive services will continue as they move into their 40-50s and what that means for workplaces

Keep scrolling for a transcript of this episode.

Key Takeaways

• Menopause is not a disease, it’s a natural phase of life and it impacts the quality of life for many women. They need to find resources so that they could find relief sooner. 

• Hormone therapy is a real savior for many women who qualify for it, but the process of understanding the decision to go for it or not involves continuous patient-provider conversations. 

• Alleviating the symptoms of menopause would mean determining a solution that’s specific for the individual as not every woman experiences the same symptoms. There must also be lifestyle changes. Menopause is an uncomfortable topic for most people and that’s why telehealth is perfect for it. 

• The trend right now regarding menopause is that there’s a lot of curiosity around it both from employees and employers. Everyone’s trying to educate themselves. We must lean hard into those conversations and make healthcare for menopause more accessible to all. 

Learn more from Carrie and Rebecca: 

Healthcare insights (monthly email) | Telehealth/Virtual Care Mgmt Update (biweekly LinkedIn update)

Website | Carrie on LinkedIn | Rebecca on LinkedIn | NGL on LinkedIn

Learn More

Website: https://www.gennev.com/ 

LinkedIn: https://www.linkedin.com/in/jillangelo/ 

Twitter: https://twitter.com/jillangelo 

NY Times Article mentioned in the discussion: https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html 

Read the transcript:

Intro (00:01):

You're listening to Decoding Healthcare Innovation with Carrie Nixon and Rebecca Quilt, A podcast for novel and disruptive healthcare business leaders seeking to transform how we receive and experience healthcare.

Carrie Nixon (00:17):

Hi everyone, I'm Carrie Nixon and welcome to the latest episode of Decoding Healthcare Innovation. I am really, really excited about today's episode because we're going to be focusing on an area of healthcare that has historically been dramatically underserved, if not ignored completely, and that area of healthcare is menopause. I'm really pleased to be joined today by my guest, Jill Angelo. She is the CEO and founder of Gennev, and Gennev is a tech-enabled provider of Medicare menopause care for women. Now, some of you may have heard the big news that Gennev recently joined forces with Unified Women's Healthcare. So congratulations, Jill, on that important step and we're going to want to talk about what that looks like for you, for the company and for your patients. But first, I'd love to hear a little bit about your background, which if I'm not mistaken, did not begin in the healthcare industry, and your journey towards founding Gennev. So welcome to the show and please tell us a bit about it.

Jill Angelo (01:27):

Excellent. Well thank you Carrie. It's, it's a pleasure to be here. I love talking about Gennev and menopause care and everything we do, so I jump at the chance anytime someone asks me to do so. A little bit about me, obviously you mentioned I didn't grow up in the healthcare space, I grew up in tech and I love tech. I think tech can enable a lot of things in safe and secure ways. Predominantly when I started my career—I'm not an engineer by trade, I'm a marketer and a business person—but I've worked with a lot of engineers and product folks to really understand, I think, over time what technology can do. I started at an accounting software company. We took it public and then Microsoft acquired us in 2001. And so I moved into Microsoft. I went through that acquisition and integrated in, and during that time I was at Microsoft for about 15 years.

(02:23):

So I kind of always think about the majority of my career was there. It's a long time at one company, but I had kind of three different careers for one third of that time. I worked a lot with what we called partners, so developer partners, ISV partners, people that were small technology companies that were building on top of Microsoft technology, bringing it to life for different industries, healthcare, publishing, retail, manufacturing, you name it. It was great because I got to work with a lot of small businesses. From there, I moved into a product management role in emerging markets. So I traveled the world and worked on incubating new products that also kind of had a social good component to them in emerging markets—internet cafes, micro loans and lending on your immobile phone and payments, things that are kind of commonplace now, but at the time it was revolutionary. The more that we could make those businesses sustainable and do good for the local economy in addition to be sustainable from a business perspective, that was always my job. So it was a little bit of startup-y starting new kind of products and businesses and countries that we hadn't done in the past. And then the third chunk of my time I worked as the chief of staff to the CMO, and in Microsoft terms, that's Chief Marketing Officer, not Chief Medical Officer.

(03:50):

And so I got to run a lot of large marketing organizations and I did everything from Xbox gaming marketing to managing media to working with direct to consumer device marketing. And through all that just got a good kind of realm of skills across all those experiences. I was in between jobs at the time at the company, I was taking a sabbatical and I met my co-founder, Jacqueline Brandwynne, who really helped build Neutrogena and sold it to Johnson and Johnson. And during that time, she's the one who, when we got to talking, she talked about how underserved women's health was in menopause care. She had been through it herself. She was older at the time and really said, there needs to be a company that takes this on. And she said, we need someone to start it and run it. And one thing led to another and that was me.

(04:45):

And so I quit my corporate job and came on board to start. We started the company first selling an over-the-counter product for feminine dryness that Jackie had developed with Roche Laboratories. From there, we started to fully understand what women needed and they were missing education. So we started publishing a lot of content and education and we continued to listen to our customers, which then led us to telemedicine and to stand up a full telehealth clinic that now is supporting patients in all 50 states. So that gives you a little bit of my background. And now I'm in perimenopause. So I'm a client, I'm a customer and patient of what we do, but at the time it was really interesting to hear about a need that I knew I would experience at some point, even though I wasn't in the thick of it myself. And now migrating there, I can appreciate what we do from the empathy of a user.

Carrie Nixon (05:42):

And that's got to be incredibly important. Well, so first of all, Microsoft is a heck of a revolutionary company to grow up in, so that's pretty impressive. And I'm sure it sounds like your experiences there just gave you sort of a breadth of insight and opportunities that you've probably carried with you as a founder in this next endeavor. Second, it sounds like you have kind of a dream team between you and your co-founder. Jackie has got to be incredibly helpful to have sort of been down the road before of building a company and selling and growing that company and then selling it and integrating it into another big entity, which I think is probably what you're doing here with Gennev and Unified.

(06:31):

But let's turn to the substance of the topic for a moment. So just a couple of days ago on February 1st, there was an article in the New York Times that caught my attention and I think probably caught a lot of women's attention. And it was titled, it was a long article. It's titled Women Have Been Misled About Menopause (see show notes for link). I asked you before we started recording if you had read that article and you said that you had. I would love to hear your reaction to this being misled about menopause and to the article in general, and talk as well about why menopause is such an important time in a woman's life and maybe why it has been ignored for so long.

Jill Angelo (07:20):

First of all, just kind of commenting on the article itself, I thought it was one of the most comprehensive, easy to consume overviews of the kind of misinformation around hormone replacement therapy and treatments for women during this time of life. I've read the reports, I've read medical journals, I've heard about it from our medical team, but for me from a consumer perspective in the New York Times, I thought the writer and the journalist did a fabulous job of outlining all the kind of hurdles. And if there's one thing that we hear from women all the time: you mean I could have found relief sooner had my doctor not said, oh, that that's not good for you? So what I appreciated about what the article really accomplished was that continual education exposing the misinformation that was benefit number one. I think really the second thing that it underscored, which confirms the way we treat menopause or provide menopause care within Gennev, obviously menopause is not a disease.

(08:31):

It is a natural phase of life. It underscored that. However, it really impacts the quality of life for so many women. And again, hormone therapy is a real savior for many women who qualify for it. But that qualification and understanding the contraindications or helping a woman get to that decision on whether it's right or wrong for her really involves patient provider conversations. And that underscores why we've designed our care model at Gennev as a telemedicine clinic where provider/patient conversation is the first thing you do. That's why we've designed our care model the way it is. The first thing a patient does is she sees an OB/GYN for 30 minutes. It's a 30 minute conversation around what she's experiencing that our clinicians get to ask her questions around the menopause assessment intake that she's created or she's filled in before the appointment.

(09:30):

And then her and the provider together can determine, can look at the options and understand if HRT is right for her, along with lifestyle change (because our clinician and our clinical model believes, yeah, there's medical interventions, but you're also going to have to make some lifestyle changes around nutrition, sleep habits, fitness, mindfulness, maybe even mental health support). And so together we've got a multidisciplinary team at Gennev, it's OB/GYN led and it's backed by registered dietician nutritionist and that's her team. And the article talked about some of the risk factors or there's contraindications or challenges around figuring out what are the risk factors for a woman, whether or not HRT will be good for her or not. And again, I don't feel oftentimes that telemedicine where we're just doing an intake on paper, reviewing it, and then you're prescribed something is the right mode because there's a lot of risk factors.

(10:31):

And again, for me, one big takeaway and it kind of affirmed were evidence-based care provider, patient led first. It's not just based on any kind of intake. And I loved, I couldn't agree more with with that article stated in that way. And two, what I loved it addressed, why is menopause so underserved in the first place besides just flawed studies around medications, it's, we're a society of 'I don't want to get old' or 'I don't want to admit'. I think I've heard other leaders in the menopause space say we have a reluctant consumer or patient. None of us love to say 'I'm in perimenopause'. It's not really just like I'm pregnant. That's something to be celebrated. This is something that's a different transition and it's okay that we do. We don't need to celebrate it, but let's make sure women feel as best as they can as they go through this transaction because it's going to get better and it will come to an end.

Carrie Nixon (11:33):

Yeah, so very well said, and I couldn't agree more. The article, I agree, really laid out the hormone replacement therapy sort of controversy in an understandable way. And I remember my mom was diagnosed with breast cancer when she was 55 and they immediately took her off of any kind of hormone replacement that she was on. And so my initial knee jerk reaction was hormones, bad, bad. But I think it's a really nuanced discussion to have, and this is why, I mean, you mentioned that your patients have a 30 minute consult with a practitioner, with a physician. That's almost unheard. It feels like that's almost unheard of these days if you're going into your primary care or your typical GYN appointment, 30 minutes is a long time to get to spend with them. But I think given what we have learned that you need that kind of a really nuanced deep dive conversation with a provider to understand what is best for you to understand what your risk factors are, to understand what are the right levers for you to pull.

(12:58):

I, I know that there may be some types of supplements that help for some people nutritional supplements. I know I take a probiotic that helps with bloating and that type of thing, and that's something that I have found to be very, very helpful. But people, different people have different symptoms. So paying attention to the intricacies of those symptoms as opposed to just being like, 'well, it's menopause, so here, do this' I think is really, really important. I'm interested in, I didn't realize you, that your platform is also includes dieticians. Tell me a little bit about the role that dieticians play.

Jill Angelo (13:43):

Our Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, is board certified ob gyn certified by the North American Menopause Society. She focuses on menopause patients. She's really set up our online clinic and built out our OB/GYN team, but she was the first person to say, medical care is not all that a woman needs at this transition. She needs lifestyle change. And she said, I'm not an expert in supplements, in nutrition, even in fitness, and then bringing all those things together, nor can I be that person to hold the patient accountable over time. I don't have enough time, I don't have enough bandwidth. And so she really advocated for this multidisciplinary model that we have that includes the OB/GYN working together with the registered dietician nutritionist. And so our DNs, or we call them health coaches sometimes as well, they are all trained in menopause.

(14:44):

They're also trained in cognitive behavioral therapy. So they are helping women go through change, figure out how do you change lifestyle or how do you get your head around it. They work a lot even on emotional wellness. They are not therapists. So we obviously have growing partnership models where we're partnering with mental health providers that can be that kind of partner with us in collaborative care for a patient. But the dietician is that always on sort of supportive guide. So the way it works, you see the doctor, doctor will always recommend you work with an RDN regardless. Some women choose not to, but those that do, then you set up monthly appointments with your registered dietician just like we're talking here on a video appointment. And then in between you've got unlimited tech support with that person. So you've got a guided coach if you will, not only that's designed your plan but is helping check, refine, test, et cetera, it with you and also hold you accountable.

(15:44):

And it's interesting when you talk to the dieticians, they say, we very much start with seek to understand, advise, consult, and then they over time really become this accountability partner. Even on other aspects of a woman's life, they are working with her 360. Sometimes it's like career advice, this, I'm struggling with this thing at work relative to my health. How do I address it? How should I talk about it with my manager? They become this supportive guide that, again, is quite helpful during this transition when women are getting it from all sides. A lot of our patients come back time and again throughout a period of time until they feel like they have the toolkit and for this next phase of feeling great and transitioning through their perimenopause or post-menopause. So that kind of gives you a frame of reference on why we started with the dieticians teaming up with the doctors, but then also their ongoing role and how it's evolved over time.

Carrie Nixon (16:51):

Yeah. So it sounds like a lot of what you're describing fits into what we call it at my firm, virtual care management services. So you really, it's, it is a more continuous, a more high touch kind of environment where you're not just seeing a provider one time and then there's no interaction until the next time. But instead you're dealing, you're interacting with the dietician who's also helping with some behavioral health issues. And I have observed, and we're starting to see clinical evidence, that type of care management service really does improve patient outcomes and reduce the overall cost of care. So not only good from the patient perspective, but can even be good from the cost of overall care perspective. So I love the fact that you all are also very rooted in evidence-based practice. I will tell you, and I think I may have texted you this at one point, but I recommended Gennev to my best friend and she had a very, very good experience with her provider, was just really delighted after talking with a number of folks live and in brick and mortar settings and finding that weren't a lot of people who really, a lot of practitioners who really understood menopause.

(18:14):

From my understanding there's a lack of education in medical school about menopause. And so that's a barrier to overcome. But anyway, setting all that aside, Gennev is specifically a virtual care provider. You do not have bricks and mortar physician offices as you sort of currently exist. So tell me, and you mentioned this earlier, tell me a little bit about why telehealth and telemedicine is so particularly well suited for this type of care.

Jill Angelo (18:48):

I think the care starts again with the conversation between the physician and the patient. You don't need blood work, you don't need a physical examination. You can accomplish so much in that initial 30 minute appointment. If one of our patients receives a prescription, we prescribe a lot of birth control or low dose birth control. That's a better option than HRT as well. And then again, if she's receiving any kind of prescription, the doctor's going to see her again in three months to make sure that dosage is right. Again, it's based upon how are you feeling? Yeah, are you seeing any patterns? Because any kind of blood work will give you information in that moment, but it might not be different the next day. And so while I know a lot of women want to know what's my hormone levels or I want a blood test, our physicians are always quick to say, you can get that, but how I'm going to treat you is based on how are you feeling?

(19:45):

And I'm going to ask you a series of questions and it's going to start with a longer conversation. So again, that is so well suited for telemedicine. This is an uncomfortable, sometimes embarrassing conversation for women. And so doing it from the comfort of their own home or wherever telehealth plays into that for sure. But I think over time, what we learned or how we wanted to support our patients holistically, because oftentimes women come to us when they've tried everything, kind of like your friend, they've gone to various kinds of physicians or whatever. So we're not the first call. And so if she does eventually need any kind of physical examination or procedure, we want to have the right vetted group of brick and mortar physicians that are there to catch her. And you know, you talked a little bit about the Unified Women's Healthcare acquisition that occurred last October.

(20:41):

That is in a nutshell, the marriage of the two of us. They've got an incredibly large network of healthcare providers over 2,500 throughout the United States. They're OB/GYNs. So we have this built in network now that we're working around how do we refer patients when she needs in-person care and then vice versa. If from a in-person clinic perspective, if those clinicians don't specialize in menopause or just have too much volume for what they can support and they want to in-clinic practice and manage the things that need in-clinic support, how do we collaborate in a way that better serves that patient? And so telemedicine is so perfect for this type of treatment and therapy, if you will, but again, there's always a case in point where it only goes so far. And now with the acquisition, we're able to support her all the way through the journey.

Carrie Nixon (21:41):

I mean, it sounds like a fantastic marriage. I mean that I can't think of a better fit. Getting a huge network of OB/GYNs that are committed to women's health and combining with menopause specialties that are providing virtual care when you need it. I love your point about not necessarily having to kick off with a bunch of blood work or lab tests or et cetera, et cetera. I think that is the kneejerk reaction of a lot of brick and mortars to order the blood work to check on the hormone levels. And I had learned, heard from someone else who's knowledgeable in the space, they said, that really only gives you just this point in time of what your hormone levels are on any particular day. And part of the deal with menopause is that your hormones are going fluctuating a lot and erratically. So it's not helpful necessarily to just have that one point in time. But what you're talking about during that conversation is a more longitudinal approach that looks over what is happening over the course of time and what symptoms are you experiencing.

Jill Angelo (22:55):

Yeah, very much. And I think to double down on that point, it is longitudinal care. You nailed it. Our dieticians in a heartbeat, they would love to be doing panels around nutritional or deficiencies and so forth. So I still think there is so much opportunity there for us to add that to kind of our care model in terms of lab work all up from more of a nutritional lifestyle component. But on the hormone side, you kind of really summarized it very well.

Carrie Nixon (23:28):

So for women out there who are in their forties and fifties and even in their late thirties, right, because this can happen even in your late the start, even in your late thirties, it can be a very long journey. I think a lot of them are sitting there going, what the heck? Why are we just now hearing, why haven't we heard about this before? Why are we just now hearing about this? But for those women, what are the trends that you see for their future, for women's health, for their future and for their daughter's future? For example, what do you see happening in workplaces? What do you see happening with payers? What do you see happening with training for ob gyn?

Jill Angelo (24:12):

Obviously, in terms of trends right now, there's a lot of curiosity around menopause, both from payers and employers. Everyone's really quickly trying to educate themselves. I think it's become higher profile. So that's a good thing. We are leaning hard into those conversations because my real mission is to make our care accessible to all. And the first thing you have to do is go to how is healthcare paid for and get this paid for so it's not out of pocket. All of our services are a hundred percent covered or reimbursable within the existing insurance or coverage codes. So it's a no-brainer to just align forces to make that happen for more women. But as you think about kind of a growing trend, I tend to look at the women who have grown up with fertility support and services and benefits in the workplace. It's be hard pressed now to find a workplace that hasn't considered or doesn't have fertility support or coverage for their employees.

(25:15):

That population of women have grown to expect coverage of their care based on that and are much more, I think, open and curious and empowered around how they feel around their own bodies around managing their reproductive and post reproductive life. And those individuals will only grow older into our space. In fact, some of them are starting to spill into our space in the early forties. We do have some patients that are in their late thirties for whatever reasons that they've experienced, but that tsunami of millennial women who have had fertility support and coverage are moving into menopause or perimenopause. We want to be there to keep that continuum of care and meet those expectations by working with their employers or with payers to ensure that that's covered. So we're already starting to get in it. It's exciting because for me personally, coming out of a corporate job, changing the face of women's healthcare in the workplace is just women in their forties and fifties are at the pinnacle of their careers. Let's empower them so that they can continue to be the kinds of leaders that organizations need, and at the same time, just make them feel better and improve the way healthcare is supported for women in their post reproductive years. So I think the trend, it's obviously going to grow. It's huge and large population. All the numbers you can throw at it are there. And it's exciting to see where now it's starting to be picked up in the employer conversation as well as the payer

Carrie Nixon (26:56):

To that. I mean, you're right. As these conversations come to the front page of the Washington, of the New York Times, as we begin to, they begin to circulate around and people begin to talk about it more openly. It does empower people, especially you mentioned the millennial generation. They're going to say, I expect this. Right? They're not going to be shy about it. And I think that's exactly right. I think that's exactly right. Well, this has been an incredibly valuable conversation, Jill. I am really excited to watch your journey going forward, and I really applaud you for the work that you have done in leading in this space. Is there anything that you would like to leave us with?

Jill Angelo (27:42):

I think at the end of the day, if you are a woman that is in perimenopause listening to this, certainly ask your employer about it or seek out if it's covered in your insurance. I think it's going to take individuals pushing and expecting that to continue to drive the change. If you're a healthcare provider yourself, how are you supporting your patients longitudinally, either through training for your own teams or for collaboration with specialty organizations like a Gennev? I think that continuing to recognize how we can improve the standard of care, and then as a result, better health outcomes, we firmly believe in that If a woman gets her menopause treated carefully, it will minimize her long-term risks for hypertension, diabetes, heart disease, osteoporosis. Those are things that really, I kind of hurt your long-term quality of life. And this is easy. This is an easy thing to do. So again, I'm just a big proponent, if there's one thing to leave, continue to look into how can you support kind of menopausal women? And these are women in their forties, in their fifties, sometimes in their late thirties, sometimes into their sixties. They're an important audience for so many reasons, and it's just something I can't underscore enough.

Carrie Nixon (29:04):

Absolutely. And just so I'm clear and our listeners are clear, you will continue to operate under the banner of Gennev? Yes. Yes. Okay, terrific. Great. But just knowing that there's a brick and mortar support surrounding you, that's excellent. Thank you so much, Jill. I look forward, as I said, to following your journey, and hopefully we'll have you back again sometime to hear some more.

Jill Angelo (29:26):

Thank you, Carrie.

Carrie Nixon (29:27):

All right. Take care. Thanks for joining us on this latest episode of Decoding Healthcare Innovation. Till next time,

Outro (29:36):

Thank you for listening to Decoding Healthcare Innovation. If you like the show, please subscribe, rate and review at Apple Podcast, Spotify, or wherever you get your podcasts. If you'd like to find out more about hosts Carrie Nixon, Rebecca Gwilt, or Nixon Gwilt Law, go to NixonGwiltLaw.com or click the links in the show notes.