Tia, the Boutique Gyno, Wants a Whole Lot of Data About You and Your Vag

Tia, the Boutique Gyno, Wants a Whole Lot of Data About You and Your Vag

The Tia Clinic, a members-only doctor’s office that recently opened its first location in New York City, describes itself on Instagram as “part gyno’s office,” “part wellness center,” and “part lady fort.” Its office, near Madison Square Park, is rosy and speckled. Books by Simone de Beauvoir and Joan Didion are available in the waiting room, in case anyone had doubts about its taste.

The clinic sells natural supplements and vibrators. Patients can sip on CBD-infused seltzer while they wait. For $150 a year, a person with a vagina can become a member of this self-described “safe space,” where there are no wait times to see a doctor and everything is “designed end-to-end” “just for” an indeterminate “you.”

Women upholstered the furniture in Tia’s waiting room. Women designed the kimonos that take the place of patients gowns. Women commissioned women to create the neon prints that hang on Tia’s walls. The founders, the doctor, the acupuncturist, and the herbalists are all women. (The investors involved are mostly men.)

Tia, according to the copy on its website, believes “that women should have it all” and that one of the central access issues in women’s healthcare is that you can’t “chat with your doctor like you chat with your friends,” on demand. To solve this problem the clinic, which began seeing patients on March 7, positions itself as a one-stop shop for the working woman’s needs, incorporating gynecology services with primary care and additional offerings attractive to the holistically inclined—or those for whom traditional medicine simply hasn’t worked as desired.

In addition to an OB/GYN, Tia has a naturopathic doctor, healer, and “trained clairvoyant” on staff who offers meditation workshops and one-on-one consultations. A session of the latter costs $299 for Tia’s members, or $425 for everyone else: The membership fee only gains entrance to the clinic’s proper medical offerings, and for services like pap smears and flu shots, Tia accepts either insurance from companies like Aetna or straight cash.

Like most medical practices that charge membership fees, Tia promises same-day appointments and extended personalized meetings with a doctor. The “care team” is available to chat any time a patient wants. “There’s a lack of soul in medicine that makes women all too often feel dehumanized,” one of the company’s founders recently told Vogue. The solution, at the moment, is to allow certain women to buy an experience that’s more inspired: Tia “exists to deliver best-in-class health care for what women’s care should be, everywhere,” the company tells Jezebel by email. (Both the founders and the medical officer, we were told, were too busy to chat.)

For Tia’s purposes, this includes diagnosing and, “when appropriate,” treating issues with “an array of conventional, holistic, and lifestyle interventions.”

An adjacent Tia app encourages patients to track their cycles and health data so when they visit the clinic, patient and doctor can simultaneously view the resulting information on an exam-room screen. The company calls this “cycle-connected care,” positing that it will deepen a patient’s relationships with their doctor and add crucial diagnostic data. They refer to this platform, which combines extensive self-reported data with what a doctor sees, as “Tia MD.”

Tia the app is a chat bot, and it refers to me as “peaches.” It asks me how bloated I’m feeling today, whether I’m horny or currently a #menstruatinghuman, and how “glowy” I feel on a scale of one to 10.

When Tia launched earlier this month, it was treated to a number of positive profiles in women’s-interest magazines with an aspirational bent. Vogue called it “an important female-centric addition to the rise of the forward-thinking healthcare movement.” A Cosmopolitan writer, describing a visit to a doctor’s office that felt like “a luxury hotel lobby,” mused about how much easier it might be “to advocate for my own health if my list of concerns were displayed in front of me and my doctor.” Elsewhere, Tia has been called a “revolutionary company,” and its model has been called potentially “life-changing.”

In a story published by New York’s The Cut this week, a writer walks through a mock appointment, where a patient complaining of irregular periods is prescribed blood work, acupuncture, and a handful of supplements all available for purchase at the clinic itself. In a parenthetical, the story admits “the clinic doesn’t seem especially well-versed in trans- and queer-inclusive language, let alone medicine.” But those populations, it’s implied, aren’t really what Tia is about.

The reverence for Tia, which was founded by two 28-year-old women with no prior experience in healthcare, reflects the timeliness of its pitch. Where other so-called “concierge” or boutique primary care practices have focused on promoting preventative wellness instead of simply treating the sick, Tia has advanced the concept by integrating it into a broader set of social concerns —and market trends—regarding women’s health. At once, the company’s founders are tapping into prescient concerns about what doctors hear when women speak to them about their bodies and promoting a lucrative wellness-as-experience culture where particular combinations of salable self-help services promise relief from a range of maladies from bad skin to autoimmune disorders to ennui.

At its launch, Tia has promoted offerings that treat nebulous concepts of whole body health and wellness over some of the more pressing (and less Instagrammable) services a person might desire. The clinic does not currently offer hormone replacement therapies or abortion services, but the company is poised to be holding on to a whole lot of data: Anonymized yet still extremely valuable information about how Manhattan’s most desirable demographic—women interested in wellness with money to burn—eat, sleep, use birth control, have sex, take medication, and feel about their bodies on a daily basis, along with more routine medical information like family histories, experiences with mental illness, and genetic mutations.

The company is poised to be holding on to a whole lot of Anonymized yet still extremely valuable Data about Manhattan’s most desirable demographic.

The data used to power “the first cycle, health and wellness tracker that connects to care” has so far been an aside in Tia’s story. As one of its founders told Bustle recently, the goal is to build not just a healthcare center but a “radically inclusive and open community.” To this end, and in response to criticism that Tia is exactly the kind of company that would cater to the Goop-adjacent crowd and name itself after a Spanish-language term of endearment, Tia has said that abortion services, mechanisms for trans-affirmative care, and Medicaid reimbursement are all under consideration for future care. Some of those projections, given the laws and regulations governing the practice of medicine, may be more likely than others.

Screenshot: (Tia app)

Tia also recommends patients use the clinic as their central point of contact for whatever primary care or gynecological issue they have. The company plans to open 20 clinics across the country in the next four or five years. They say they expect to be treating 3,000 patients in New York City by next year.

Tia’s founders, in various interviews, have referred to the clinic as a “concept store,” and the company as a “big, bold, sex-positive brand.” In response to questions from Jezebel, Tia describes itself as a “tech-enabled healthcare company with a relationship-driven approach” but also a doctor’s office, first and foremost.

At the time of its launch, the company is overseen by a single MD: A licensed OB/GYN and “stress expert” who relocated temporarily from California and will act as the company’s chief medical officer. The rest of the physicians currently involved, including those on Tia’s medical advisory board, are naturopathic physicians for whom the honorarium of “Dr.” is not currently recognized by the state of New York.

Some of the details of the Tia Clinic appear to still be in flux as the company transitions from an app into a doctor’s office, though it has polled users via Instagram on how to best address issues like sexual trauma. Tia tells Jezebel that it’s planning on hiring more MDs and nurse practitioners “in response to the outsized patient demand.” (The job listings currently on its website are for nurse practitioners and physician’s assistants.) The company says that when a patient needs care beyond the clinic’s abilities, they will be referred personally by the Tia Clinic’s team to designated experts. For issues like diabetes that fall outside of its wheelhouse, Tia says, it has partnered with Mt. Sinai’s independent practice association, through which it will be able to facilitate some referrals. It expects more partnerships to come soon.

Tia’s origin story, as recounted in that recent smattering of profiles, goes something like this: Carolyn Witte, now 27, suffered from a commonly misdiagnosed endocrine disorder as a Google engineer in New York. She says it took a few years to get proper help. Shocked at the quality of womens’ healthcare for even a handsomely compensated and well-insured person such as herself, Witte quit her tech job to start Tia with her good friend and fellow tech worker Felicity Yost. Yost, a product manager, most recently worked for Owler, a startup that provides real-time data insights for competitive companies.

Tia is named, as Cosmopolitan helpfully pointed out, after the Spanish word for aunt, a concept the founders have said actually refers to any trusted relationship between women. Since the company’s launch in July 2016, the pair have appeared on a Forbes 30 under 30 list and done scores of interviews about a woman’s right to make decisions about her vagina and how tech can “hack” America’s expensive and incomprehensible healthcare mess. In one press photo, the pair is pictured wearing matching T-shirts that say, “This vagina is insured.”

In its first iteration, Tia fielded user questions about reproductive health and insurance coverage, as well as offering trackers for menstrual cycles and birth control. At first, Witte says she and Yost answered user questions, though as the two are fond of saying, their only experience in healthcare has been as patients. Eventually, the company hired experts to be on call. By late 2017, the app was in beta and said it had answered 100,000 user questions. It drummed up $2.5 million in seed financing from well-known investors in San Francisco and New York that year.

As Witte told Vogue recently, “Women love Tia, but we referred them to the shitty health care system—we had to build something better.” In a number of interviews, she has mentioned hearing about women “hacking” the app by bringing it to their gynocologist. So Tia raised more capital, bringing the total to $6 million, and polled its users to ask where they should open a proper clinic. Perhaps unsurprisingly, they chose Manhattan, and hired a number of swanky designers to create heated exam rooms and place crystals and succulents around the space. “We wanted to build a company that makes women feel heard,” Witte has said.

Tia’s transition from cycle-tracking app to doctor’s office came at a lucrative time for both industries. “Femtech” companies—smart vibrators, fertility trackers, tampons that diagnose illness—raised more than $1.1 billion in venture capital between 2014 and 2017, a number which is expected to grow to $50 billion by 2025. And “concierge care,” the longstanding but somewhat controversial practice of building a membership-based boutique healthcare experience to sit on top of America’s existing network of clinics, hospitals, and private practices, drew Silicon Valley’s interest most recently with the founding of One Medical, a membership-based primary care startup that’s raised more than half a billion dollars since 2007.

Screenshot: (Tia app)

One Medical, once referred to as “yuppie-care for the well,” charges $150 to $200 a year and, like Tia, allows patients to book same-day appointments and keep customized medical records. Rather than sit in fluorescent waiting rooms with the truly sick and suffer through the “shitty healthcare system” described by Yost, One Medical and similar practices provide a fluid, individually tailored experience in meticulously decorated offices across the country.

By cutting down the number of patients each doctor sees and “handholding” people through insurance claims or tricky chronic issues, practices like these say they are combatting the American healthcare system’s problem-oriented culture, promoting wellness to cut down the number of patients who only see a doctor by stumbling into urgent care. Critics say these practices, even at $150 a year, enshrine a three-tiered healthcare system, where members sit just above people with decent insurance, and the one in five Americans without coverage are relegated even further below.

Tia’s “wellness director,” a nurse practitioner with so many holistic certifications she jokes she should have a trophy room for all her reiki and yoga credentials, worked at a One Medical center in California for seven years. As with many of Silicon Valley’s burgeoning industries, One Medical is a parallax-scrolling version of an older idea: direct-pay or membership based medical practices have been around for at least a decade, and by some estimates grew 900 percent between 2005 and 2010. In the mid-2000s, this practice was investigated by Congress. A few bills banning direct-pay and membership practices were introduced, but never passed.

A recent New York story profiled the latest batch to open in the city, which include the fertility clinic Trellis, “the Equinox of egg freezing”—featuring an Instagrammable mural with a Michelle Obama quote—and Parsley Health, offering genetic testing and several 45-minute “health coach” appointments over the course of a year.

“Concierge care is a solution of the rich.”

“The more you see economic disparity growing, the more people are going to say, ‘I don’t want to go to a waiting room, and I want my phone calls returned quickly,” says Dr. Arthur Caplan, the director of the medical ethics division at New York University’s department of public health. “Concierge care is a solution of the rich.” As the model gets more popular, he worries, the already shrinking number of primary care physicians will migrate to offices like these, which offer higher salaries and a lighter workload, worsening the demonstrable lack of doctors for the middle class and working poor. And in the process, reform at the non-concierge level will “lose the voice of rich,” he says, making it less likely the powerful will agitate for change, or even know what’s going on with everyone else’s care.

In some clinics, he worries, a focus on the metrics of customer satisfaction—things like, for instance, acupuncture, Instagrammable murals, and CBD seltzer—may overtake more traditional concerns about what kind of care to offer, and how.

Tia decides what to offer based in large part on data they collect from patients and the women who use the app. In the first week of operation, the company says, all of its patients visited either for gynecological needs or its wellness services. It doesn’t yet have enough information to indicate what primary care needs it most often expects to meet. Charitably, the clinic seems best positioned to care for healthier people with a nebulous desire for—and an incentive to buy—things that could make them feel better. Asked how Tia decides whether to refer people with tricky chronic issues to an outside specialist, or whether to treat them with naturopathic remedies in-house, the company says patient care is rarely so black and white: A true statement, but one that brings up uncomfortable questions when the clinic is positioning itself so clearly to sell pricey services to people for whom the aesthetics or practices of traditional medicine haven’t worked out.

In an email to Jezebel, Carolyn Witte writes that the Tia clinics’ two core services include preventative health services covered by the Affordable Care Act, and “chronic women’s issues that commonly ‘fall through the cracks’ in our fragmented healthcare system.” “Just looking at endocrine disorders alone,” she writes, “this is 10-20% of women.”

“Furthermore, these chronic, systemic conditions are not isolated to a specific income bracket or race or ethnicity but ignored and mistreated in women across populations,” she adds.

On the Tia Clinic price sheet, published on its website in the name of transparency, four primary care services are listed: the flu, strep throat, sinus infections, and flu shots. A consultation for autoimmune diseases—of which there are more than 100 known types, from multiple sclerosis to arthritis to inflammatory bowel disease—has a cash price of $240, plus up to $300 for lab tests. Like most of Tia’s consultations, the service may or may not be covered by an insurance plan, as is noted on the sheet. It’s an awkward quandary for a wellness center attempting to provide both individualized holistic solutions and routine care: In the end, it will be an insurance agent deciding what kind of treatment is necessary enough for reimbursement, and for the naturopathic and specialized programs Tia is offering patients could need to spend quite a bit of additional cash.

In terms of offering Medicaid, as the clinic has said that it hopes to, there could also be hurdles: Tia tells Jezebel it’s committed to waiving the membership fee for low-income and “vulnerable” women and that it aims to create partnerships that will allow it to take the state-subsidized insurance. But Roy Schwartz, the vice president of payer relations at the University of Pennsylvania, finds some of this difficult to believe, and not only because the idea of concierge care for a very low-income population is counterintuitive.

“Practices that offer such services at highly discounted rates or for free will likely run afoul of federal laws that prohibit providers from providing inducements to patients” to provide services covered elsewhere by the state—say, at, Planned Parenthood—for free. Carolyn Witte, the company’s founder, writes to Jezebel that it’s obviously tricky, and that Tia is thrilled by the interest of women on Medicaid plans, but that “we are still working to assess the best approach.”

The professionals currently affiliated with Tia give an indication of what the company believes women need most in a provider. In marketing materials, they are referred to as “consultants” working for patients, rather than the “directors” of their health, and are experts in some of the more atmospheric issues that attend women’s health. It’s telling, for instance, that the company associates better care for women more with individualized stress types and gut health than with abortion services or prenatal care. In a blog post published before the company’s official launch, Tia’s wellness director offered Tia as a way to navigate the endless books, videos, and programs sold to women as ways to manage their wellness needs. The most important thing, she infers, is trust.

It’s telling that the company associates better care for women more with individualized stress types and chakra health than with abortion services or prenatal care.

Dr. Stephanie McClellan, the clinic’s only current OB/GYN and Tia’s medical director, has been practicing in Newport Beach, California, for decades. She designs and sells a line of scrubs and lab coats for “functional femininity” and co-wrote, with her medical partner in California, a book about women’s stress. The book is part diagnostic tool, part self-help program, describing common stress-related issues like dull skin, “fat around the middle,” hair loss, and premature aging. It offers tailored nutrition and workout regimens for women according to their personalized “stress profile.” She is also working, Tia tells me, on expanding the “Tia MD” platform, the proprietary program that integrates a woman’s historical health data with the self-surveilled daily information tracked through the Tia app.

Dr. McClellan’s practice in Orange County tells Jezebel the doctor has relocated for three to six months to open a well-woman clinic in New York. Tia says Dr. McClellan is planning on staying in New York “as long as is required to meet the needs of our patients in NYC.”

Erica Matluck, the clinic’s wellness director, offers naturopathic consultations and meditation workshops for members. Described as a “gut-health guru” in Tia marketing materials, she operates her own private practice of consultations and mindfulness retreats under the name “Seven Senses.” The next retreat, in Tuscany, retails for up to $4,000 (not including travel), and, like most of her workshops, is focused on a different chakra every day.

Recently, in a podcast, Matluck described how she integrates traditional Western medicine with her decades of study in energy healing and mindfulness practice. Say, for instance, a person was experiencing issues with their digestive system. Perhaps she’d associate that with a corresponding chakra, which manifests as anger and judgement and is developed in a person’s teen years. Perhaps then she’d “nudge” the conversation to ask if anything big happened to her patient during that time, and see if there was anything to note for her treatment. A self-described clairvoyant as well as a nurse practitioner, Matluck says she trained for two years to develop what she refers to as a deeply meditative “hunch” that guides her work with clients. “I have a lot of sensitivity with my hands,” she explained on the same podcast.

Tia lists two medical advisors on its website. One, Jolene Brighten, is a naturopathic physician who specializes in “post-birth control syndrome,” selling supplements and a trademarked program through her website to cure women of the anecdotally understood cluster of symptoms—fatigue, loss of period, digestive issues—that some women experience when they stop taking hormonal birth control. Both of her practices—one in Oakland, one in Portland—appear to be closed.

The other listed medical advisor, Dr. Aparna Sridhar, a reproductive health expert and OB/GYN who focuses on teaching family planning to adolescents, tells Jezebel she is no longer involved with Tia.

After I paid my $20 intake fee and $15 monthly premium to access Tia’s membership, the website asked me to complete my health record. Thinking it prudent, I was truthful about some things (surgical history, diet) and less truthful about others (whether my stress was about work or relationships, my family history of suicide or PTSD, whether I was born prematurely or by C-section). My central interest was to see if there was an additional privacy policy or waiver I needed to sign before I shared this information with Tia. There was not.

In response to questions about the particulars of the clinic’s privacy policy, Carolyn Witte said there was a separate policy available in-person, as I wasn’t yet legally a patient yet. Jezebel asked for a copy of some of these policies; we were not provided with any, though Tia says everything is standard, and there’s no reason not to believe them.

Still, the implications of merging medical data with daily reports on a woman’s acne or feelings of bloat, as Tia plans to do as it expands, are significant. Tia’s app is encrypted, and the company remains HIPAA-compliant by storing identifying information and medical records on separate servers. The privacy policy for the self-surveilled data reserves Tia’s right to “share, license, or sell information we collect or receive through the app with third parties.” In almost every state it is legal for medical providers to sell anonymized medical data without a patient’s consent, often bundled information scrubbed of a person’s name and date of birth. The Tia app and its constant monitoring of “glowyness,” headaches, and cycles, combined with the routine medical information a doctor’s office usually holds, is fantastically valuable stuff.

When Witte founded the company in 2016, she wrote about turning women’s feelings about their reproductive health into “insights that can power new products.” And data collection appears to have been of interest to Tia’s less-press-happy founder, Felicity Yost, who was a project manager for the data company Owler before abandoning ship to found the women’s healthcare company with a clairvoyant on staff.

In an interview last summer, Yost told Unleashed “the first opportunity I saw with Tia was to create a dataset that had never before existed,” specifically in reference to what happens to women’s bodies when they take hormonal birth control. Yost’s dream, she told the publication, was to further medical research in the field. Today Tia is hiring a back-end engineer with a “specific focus on enabling data collection through the conversational framework” of the Tia app’s chat bot, the one that called me “peaches.” “Overtime, this system will scale to other ways of sharing and collecting data,” the job description reads. This is perhaps a good time to point out that in addition to “chatting with your doctor” and “having it all,” one of Tia’s slogans is the belief that “we should own our own health data, and control with whom we share it.”

Tia says it currently has no plans to sell or share its data, or to use it for any purpose other than the growth of its own business: “We use anonymized data for our own purposes only,” the company tells Jezebel. “To build better healthcare products for our own patients.” And the company does appear focused on the expansion of its 20 clinics, with a “multi-pronged” expansion strategy that will follow after that.

“The first opportunity I saw with Tia was to create a dataset that had never before existed.”

Tia’s full cycle-tracking healthcare records aren’t currently compatible with other practices, though the company says it will share information “as needed.” Trans-affirmative care and abortions will likely be handled by partnerships and referrals, when the contracts are locked down. Asked what its first three priorities were in terms of expansion of care, the company told Jezebel, in the cyclical logic of a tech company that scales only in reference to the tastes and preferences of its existing base, that it’s looking at mental health services, pregnancy, and menopause.

“Tia has a big, grandiose vision to improve women’s health for all women and not just a few. Yes—there are population-specific healthcare needs that may differ amongst lower-income versus higher-income women and across racial or ethnic groups, but there are also a lot of healthcare needs that are shared across all women,” Witte tells Jezebel. “This is where we chose to start.”

Most of the criticism levied against Tia since its opening have focused on how tone-deaf it seems to open a clinic for the well-heeled and wellness-oriented in a climate where so many women can’t even get to a doctor. This is, of course, a very good point in a country where only half of rural women live within driving distance of a hospital, and where the mortality rate for black mothers giving birth remains devastating. But the better question isn’t who Tia is for; Tia already knows the answer to that. It’s what kind of company Tia, with its single doctor and that big, grandiose vision, will actually be.

In tech, it’s often said the real product isn’t the service; it’s the users. It’s probably much easier to pitch women in Manhattan who sip CBD seltzer to investors than black mothers or people underserved by urgent care.

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