December 2, 2020
Carolyn Witte 0:02
I think women often feel like they’re being told by other people—predominantly men—what other people think they want. And what we did is that we said, “I’m a woman—my co-founder’s a woman—you may want something different. And let’s build a platform that lets you share your story.”
Lan Nguyen 0:16
That was Carolyn Witte, co-founder and CEO of Tia, the modern medical home for women.
Carolyn Witte 0:21
And after all that, asked myself, “If I can’t navigate healthcare, how does any other woman navigate this?” Radical simplification is one really important thing that a founder and CEO needs to have.
Lan Nguyen 0:32
In this conversation hosted by Lynne Chou O’Keefe, Founder and Managing Partner of Define Ventures, we learn how Carolyn’s experience with PCOS inspired her to redesign the women’s health experience, and how it has informed her approach to entrepreneurial leadership along the way. So let’s jump into Her Story, a program where we explore the intersection of women, leadership and healthcare.
Lynne Chou O’Keefe 1:00
Well, Carolyn, thank you so much for joining us at Her Story. I’m so excited to partner with you on this discussion, because I believe you’ve been an amazing leader in healthcare, and as a founder and CEO, and really driving change in the space, especially for women’s health. And I’m sure we’ll get into that in a bit, but, Carolyn, I’d love for you to take us in the beginning. I know that you have a very special family and how you grew up, we’d love to hear from the beginning, from you.
Carolyn Witte 1:33
Sure. I’m excited to be here and to share a little bit of my story and the Tia story. So it’s interesting. When I first started Tia about four years ago, I didn’t think that I would be an entrepreneur, I was one of those people who thought, “I’m going to start a company.” I’m just, like, looking for the idea—I’m trying to figure out how to dive in. I didn’t think about it like that. It just kind of happened serendipitously, and based off of my own kind of personal healthcare challenges that made me frustrated with the healthcare system, which I think is a common healthcare story.
But with all that, looking back, and in retrospect, thinking about what actually, potentially, subconsciously put me on this pathway, I think there were some interesting things about my childhood and family upbringing in particular, that made me comfortable, let’s say jumping out of the airplane, so to speak, into startup land. So I grew up in a family that was very entrepreneurial, and I would say my parents very much took a contrarian approach to thinking about life, careers, risk-taking, and taking the path less followed, so to speak. And so that kind of was drilled into me at an early age. And I didn’t really realize it until I started a company. And then two years later, my older brother started a company. And then my little brother didn’t quite start a company, but he’s in the music world working for himself. So he might as well start a company. So all three of us, let’s just say, don’t have normal jobs. And so in reflecting on this, I think the question is, “Why?” And I think so much of this, things that you’re exposed to—I didn’t grow up in Silicon Valley world, but I grew up in an environment in which risk-taking and thinking about the world differently was dinner table conversation, so to speak.
And there wasn’t one particular moment, which only now, again, in retrospect, and I realized how lucky I really was. When I was considering leaving my job at Google to jump into startup [inaudible] to start Tia, I had this very early, early idea for what Tia might be. And I shared it with my parents, kind of nervously, like most young twenty-somethings who have a stable job might share with their parents. Like, should I leave my really good job and have no income and take this big risk? And my dad didn’t flinch for a second before saying, “You should quit your job tomorrow—like, you should go do that.” And it was not really the reaction I expected him to give me. I was so surprised. And it made me comfortable taking that risk. And I wasn’t even so much looking for that validation, but if you think about it, I was overconfident as an early entrepreneur, and then through every challenge that I then quickly faced on the very long and treacherous journey that it is becoming, you know, a healthcare founder building a company—having that emotional safety net and a family that I think was comfortable with failure and making big bets were, I think, something that made me willing to try.
Lynne Chou O’Keefe 4:22
I’ve talked a lot about a village at times, and family is such a big part of that. And it’s not just the, if you will, the push out of the airplane, but also knowing that they are there for you, through all the ups and downs. Being a founder is just so critical.
Carolyn Witte 4:40
The emotional roller coaster, I think, is the hardest part of it. Personally, I mean, there’s financial risk, there’s all these risks, right? As someone who was a very meticulous student—never failed, had perfect grades, did all the things right—the idea of potentially failing at something was an emotional burden and continues to be one. I think a fear of failure drives a lot of entrepreneurs to be a little bit crazy, but in a good way, usually. But I think there’s a balance that can be motivating. But you also need to manage that with this support in some regard. That’s like, wait, but if you do fail, what’s the worst that can happen? And you fail for the right reasons. And I think that’s kind of the thing I asked myself now that I’m four years into this.
Lynne Chou O’Keefe 5:25
As you looked at the journey, would you call yourself an accidental or intentional leader? Have you known you’ve always wanted to be a leader throughout the career because of this family upbringing, or you kind of walked into it, in retrospect?
Carolyn Witte 5:41
I always wanted to be a leader, I just didn’t know I wanted—a leader and entrepreneur were not the same thing in my mind. And so I think I had really amazing leadership opportunities while at Google, and I think there was a moment in this conversation of, “Should I quit my (then) dream job to go to the next dream job that was the higher risk?” Kind of had this conversation, I remember, with my dad, explaining, like, I feel like I have so much influence and impact within this billion-user products and like all of these things, and he asked me. I remember having this conversation vividly: “What do you want to have influence? Or do you want to be the decision-maker? Like, are you, do you like making decisions? Or do you like influencing other people who make decisions? Because that’s really what it’s about, the difference. Like, you can influence other people who make decisions. And ultimately, like, if you made the wrong decision, Google’s gonna be just fine. If or do you make the decision yourself and then live or die by those consequences?” And not, I think, is a very stark picture of the difference in entrepreneurial oriented leadership. And I was interested in trying that out. And four years in, I haven’t regretted that choice.
Lynne Chou O’Keefe 6:47
Tell us a little bit about your job at Google, because I think you did come from the technology world. And then you have this experience, which I’d love for you to talk about. And then you went into healthcare, and I’d argue Tia is the culmination of both those worlds of healthcare, technology, and quite frankly, the consumer. Walk us through that whole decision path in building Tia.
Carolyn Witte 7:10
So I’m going to go back even a little bit further. In college, I was very involved in women’s issues, let’s call it. Didn’t really think or care deeply, I would say, about the US healthcare system. I was very focused on global women’s health, that was my passion study area, if you will. And thought I would tangentially work in health on the global lens on the policy side for the UN for, like—Hillary Clinton, something like that. So that’s where I was going. And then, through a whole series of interesting events, found myself trying on the tech world for size at Google. And I was there for four years right after college and got thrown into, specifically, the brand and design side of Google, which is so interesting, it didn’t know anything about brand, or product design, or user-centric design or any of these things. But I was always, loved telling stories and writing, I was always a writer. And so the storytelling side of like, how do you tell stories that connect technology with people was the thing that was really interesting to me and kind of be this translator between these like crazy, brilliant software engineers and the layperson in the world who’s just trying to use Google Maps on their phone, or whatever it is, I thought that was a really interesting translational challenge. So I got really good at that. And being that bridge between all these very different users, and thinking about how to build brands that are rooted in trust, and humanness versus code, or whatever, you know, all the guts behind the technology company. So I learned this interesting toolkit there about how to tell stories about technology, how to design better products that are user-first, how to deeply bring the customer or the users needs to these brilliant engineers to build a better product, all those sorts of things.
And while on that journey, I went through my own set of women’s healthcare challenges in my early 20s, living in New York City working, at the time, Google’s creative lab there. And it was a three-year-long PCOS diagnosis process. So PCOS is an endocrine disorder that affects one in ten women. It’s a leading cause of infertility, diabetes, heart disease, a lot of chronic conditions that impact women disproportionately. And one of those classic chronic conditions that are really hard to diagnose, that is like a hodgepodge set of symptoms that constantly get stuck between the cracks of traditional healthcare. It’s not—it’s sort of an OB-GYN issue, but it’s sort of an infertility issue. It’s sort of an endocrine, primary care—like, where is it—and so you kind of get stuck. And when anyone who’s been through a diagnosis process or treatment for a disease or a chronic issue understands those challenges of feeling like a number—like trying to, you know, navigate the system. And there I was in my early 20s trying to do this with I often say, you know, Google Health Insurance—which is the best health insurance like you can really get—and couldn’t figure it out like it, couldn’t do it, and finally diagnosed myself and got through this. And after all that asked myself, “If I can’t navigate healthcare, how does any other woman navigate this?” This was clearly not designed for women. I felt like a number that’s so fragmented, there’s no soul. There’s no brand or trust. This is a very intimate part of my life, and it felt highly transactional, after this whole diagnosis saga then there is no real action plan on what to do about it. No focus on prevention, and so I asked myself, “What if I took this playbook around user-centered design, building brands that are rooted in humanity and trust and relationships, and apply that to the most important things in people’s lives—their health—and specifically, women’s health? How would the healthcare system be? What would it look like? Would it feel like? How would it work if it was actually designed with women at the center of it?” And I didn’t even know at the time what I know now, which is that women control 80% of the US healthcare dollars and there’s a real financial argument behind this and capture the woman you captured her family and all these things that the healthcare industry jargon that is that, you know, financial backing for my thesis. I just was a person in the world looking at the system saying, this doesn’t make any sense, and then quickly became obsessed with the cobweb that is healthcare—which, some people would describe it like banging your head against the wall every day being like, “Why? I can’t believe it works like this. There’s no way that, like this, works like this”—or other people like me think it’s really interesting. And like that cobweb, and trying to untangle it all, I would describe that’s been my journey into trying to connect two very different worlds and bring a playbook from one world to another with hopes of creating something a little bit more human.
Lynne Chou O’Keefe 11:49
Tell us a little bit about Tia in terms of, how did you mesh all these experiences together? And how did you solve for your personal experience? And what is Tia?
Carolyn Witte 12:00
I’ll start with what Tia is today, and then I’ll go back in time. So four years into this, Tia is a full-service women’s healthcare platform, really reimagining how women’s healthcare is delivered and experienced online and offline, throughout women’s reproductive lives. We didn’t start, actually, out in the care delivery space. So when I say care delivery, I mean we actually operate brick-and-mortar women’s healthcare practices. Our first is in New York City, and we are opening additional ones soon, as well as delivering a lot of our care virtually. So we really think about, “How can we meet women where they’re at?” and be that front door, that trusted place they turn to handle all of your healthcare needs online and offline. We didn’t start there. We didn’t start in care delivery. I didn’t really know what care delivery meant. The vision was the same, but the solution was smaller-scope.
And I looked at my own experience and said, “What was the problem here?” Well, there are so many problems. But the first problem was I had very, very poor information. And in fact, I was Googling my health. Then at the time, I was working on the Google Assistant—the Siri equivalent—and thought, like, “What if there was one of those for women’s health that was non-ad-based, it was all private and anonymous, that was trusted, that was built for women, that was personalized, that was science-backed?” There was Google and, like, mommy blogs and academic journals, and nothing in between. And I thought, “Give women better information and all else will follow.” So that’s the first thing we built. You might call it today, a front door of care product. And that’s essentially what we did. And we were actually very, very good then—and are very good now—at being that front door, bringing women in the door and saying, “I’m a woman, I have a need, where’s the first place I’m going to turn with my questions? I’m going to turn to Tia.” So we were very good at that, and we would answer their questions one-on-one in the earliest days. It was my co-founder and I sitting in our living room in San Francisco, literally being Tia, messaging with women around the country answering their healthcare questions.
But we were very squarely in this kind of Web MD territory where we could give them information, but we weren’t doctors, so you couldn’t prescribe, diagnose, or treat. And women liked our information so much that they wanted us to actually be their doctor. And we went from me and my co-founder answering these questions to we built out a team of health educators answering these questions, to automating a lot of it, and so on. And in over six months, we had over 200,000 one-on-one conversations with women about their health. So we were good at bringing women in the door. And then we were doing this thing where we would refer them to doctors because they wanted care. And I kind of thought to myself, “If we’re so good at bringing them in the door. Why would we then refer them into the healthcare system that they don’t really like very much? What if we became the doctor?” And that was kind of the aha moment that led to the next chapter of Tia, which is, you know, evolving to actually be what we call a full-stack healthcare platform, which is we build technology, we build front door products, we give women information, but we also deliver them healthcare, and we manage them across the entire continuum. Online, offline, online again, and eventually across the entire healthcare system
Lynne Chou O’Keefe 15:03
And really wrap—you said in your journey, you went to all these sources, these different specialists, and truly Tia’s integrating the service level of primary care GYN, OB, and what I call wellness and prevention together, which is really revolutionary, that you don’t have to go to four or five different providers for.
Carolyn Witte 15:28
One of the things with this idea, which was really interesting when we were debating becoming the doctor if you will, and opening up a doctor’s office. The question was, “What does the doctor’s office do?” Being your OB-GYN was very obvious to us. But we had this insight around, “Well, what if there was a women’s medical home?” Women’s health isn’t OB-GYN, it’s so much more: it’s primary care, it’s mental health, it’s all of these things. Like, what if we could, like, put all those things together that women wanted to one integrated model. And to test this, we brought Tia app users into our office—then in San Francisco—of you know, various ages, and asked them to chat with Tia on their phone about healthcare questions that they had. Then we said, “Now put your phone down and imagine that Tia on your phone opened a doctor’s office. What would that doctor’s office be like?” and every single woman’s eyes lit up, and they immediately described the same thing. They’d be like, “Oh, my God, it would be like, not in a medical office built and you would be in a kind of like this cool space, I would actually want to go to before something is wrong. They would have cool gowns, and it would be comfortable, and the doctors would look you in the eye and you’d have more control of your health record. And I could have all of my needs met there.” And everyone kind of had this vision in their mind and the exact same thing. And that was the moment where I said, “Okay, we have to go do this, like women are describing the thing that’s in my head before I even made it. Why doesn’t this exist yet?”
Lynne Chou O’Keefe 16:49
Well, I want to go back to something you said that I thought was so amazing. And it’s funny, we call this Her Story. But you talked about how you like to write and how you love to tell stories. How has that ability been important for you as a leader of Tia? I imagine that you would have to tell stories and articulate the story of Tia to many different constituents. Can you talk about that journey as a leader and how this story, to different groups and how you’ve gone on as a CEO and founder?
Carolyn Witte 17:21
Yeah, it’s very interesting. I think, initially, in the earliest days of a company, in Tia’s case, we had one customer, which was the consumer, the female user, and then the patient. And so we had to figure out how to tell a story to her and instead of actually telling a story to women, we actually built a platform that let them tell their stories to us. And then we use that in a way to share those stories of the world. I think that was one of our big differentiators from a brand perspective. And I think women often feel like they’re being told by other people—predominantly men—what other people think they want. And what we did is that we said, “I’m a woman, my co-founder’s a woman, but you may want something different. And let’s build a platform that lets you share your story.”
And I think that was really interesting. And then it’s evolved. And we’ve decided to open up, you know, become the doctors, we to go tell stories to doctors. And that was a totally different story that we had to tell about how we were changing medicine, how we were delivering higher quality care at lower costs, how we were using technology to empower—not replace—providers, these sorts of things. Flash forward to we’re raising a Series A financing way to go tell a story to the investor community about why Tia is going to be a billion-dollar business and why we are just a cool clinic in New York City, but a truly a technology platform that’s changing the face of women’s healthcare and flash forward to where we are now, which is actually in the process of partnering with so many other constituents of healthcare; insurance companies, employers health systems, and saying, “How do we take our very engaged female consumer base and deliver her a connected care experience across the entire ecosystem?” and that’s a very different story as well. So I’ve learned one thing on the journey. To become a healthcare founder, you have to figure out how to create aligned incentives between all the different customers of healthcare—and healthcare dies, typically with misaligned incentives. And so if you can build a product and a business that gives women what they want, but also benefits providers and health systems, and payers and employers and figure out how to tell all those different stories together, you have something really powerful.
Lynne Chou O’Keefe 19:25
I’ve always felt like you were such an amazing storyteller as a leader and visionary of how you saw women’s health going. What are the other attributes, Carolyn, would you say have been so important, or lessons learned as a leader, that you think are important to impart other than just storytelling?
Carolyn Witte 19:43
I think that the attributes of a leader and a founder change across every chapter. So in the earliest days, I think being a product-oriented founder who can iterate really quickly, be obsessed with insights and scrappiness, and MVP, and all that stuff is the most important thing. You need to have laser focus on getting product-market fit. And then you’re not so worried about the corporate governance or building a company. And then, you know, move to the next stage or figuring out how to tell your story to the world or raise capital is a different set of skills. And now she has 65 people, we’ve doubled in size since COVID started and this skill set, the attributes that I’m needing to have, and gain on the fly, in many ways, are much more around management and figure out how to build a company, not just a product and a business, but a company and a culture that people want to work at that is inspiring, continues to be innovative, despite hyper-growth pressures, and all of that. And I think that’s a totally different story. And so across all those, I would say there was a singular theme of radical simplification, I think is like one really important thing that a founder and CEO needs to have, is to be able to simplify everything. In a business as complex as Tia, that’s really hard, but as you get more employees, like you need to actually not say more, but say less and say more succinctly. As you have more users, you need to be able to explain your offering and fewer words, not more words. And so I think that’s a constant challenge for me is, think, how can I simplify this more and more and more.
Lynne Chou O’Keefe 21:20
As you reflect back to your younger self, I mean, you are the CEO and founder of a women’s health company that had one of the largest Series A raises in 2020. It’s amazing. And I know a lot of entrepreneurs look to you and the success that you’ve had to date. So if you were to look back to your younger self, or if you were to give advice to some younger entrepreneurs, what advice would you give them?
Carolyn Witte 21:44
Find a problem that you’re obsessed with and really can’t stop thinking about. Tia’s story, and my story, is one of evolution and iteration. Tia, when I jumped out of that airplane, is so different from what Tia is now that the vision of transforming women’s healthcare was the same but the how, the what, and how, I didn’t know what that was—I thought I did, but I was wrong. And so I think what’s kind of sustained me and allowed us to build a very successful product that meets the needs of all these different constituents and can evolve in real-time to the continuously changing world and pressures, COVID-19 events of 2020, it doesn’t you don’t stop iterating. It’s like every day, we’re iterating is an obsession with the problem. And so when you hit rock bottom when you feel like you just feel stuck. The trough of sorrow, I think they call it, that founders experience—whatever it is, you hit it, you lose that deal, you get, you know, your hundredth rejection from an investor, whatever it is. If you’re obsessed enough with the problem, I think you find a way to iterate out of it and continue to build something that matters to your customer and to uphold the vision that you want to create.
Lynne Chou O’Keefe 22:58
I’ll never forget—I mean, I remember you and I having one of those phone calls, right? And me kind of also talking about those tough times, right, and over time. And so what is your village? Or how do you find that emotional support? Obviously, your family is one of those. But are there other people? Or is there a group of people you consistently come back to, though for support advice, development otherwise?
Carolyn Witte 23:27
First of all, there’s my co-founder—I don’t think I started at Tia with one of my best friends, which is a unique experience that is a beautiful one but challenging in its own right. But it’s enabled, I think, me personally, and Tia collectively, to kind of hit rock bottom. We kind of take turns hitting rock bottom, sometimes, which is valuable to have the other person, like, pick you back up. So having a co-founder both in terms of sharing the workload, but the emotional burden, I think is huge. She’s my first person that you just, sometimes, need to vent. And that is cathartic, let’s say, and when you can’t really explain it to anyone else—there’s like, too much context—you can’t possibly like, call your girlfriend and just tell them all the things that happen and have them really understand. I think that’s kind of a special thing. So that’s the first one. And then second, I would say, is, I do have an amazing group of friends who championed me and Tia all the way through that sometimes get me to not talk about Tia, which is also a really great thing—that’s really good too. But finding space for joy in your life outside of Tia even though it is like my life and you know my baby and all of that is a struggle, but important too, to not burning out and through those tough times especially find the drive to keep going.
Lynne Chou O’Keefe 24:47
So in the end, Carolyn, if you look at years from now, what does success look like for you?
Carolyn Witte 24:53
Success to me—I’ll start it off by talking about storytelling and building a brand that women love and trust will give you my most evocative definition of success – it has no dollar signs next to it or anything like that – which is creating a world that is as simple as this, and five years from now, or maybe it’s ten, I don’t know, but success is: I hope I can walk down the street of Chicago, Los Angeles, Minneapolis, Atlanta in New York City, Austin, Dallas, you name it and tap a woman on the shoulder and she could be 25-35, 45-55, and I could say, “Hey, what’s on your mind with it when it comes to your health? Like, do you have a UTI, are you concerned about postpartum depression, are you worried about, you know, anxiety, Alzheimer’s, you’re trying to get pregnant, trying to not get pregnant?” And she just says, “I turned to Tia, who takes care of the rest,” not, “I turned to my OB-GYN. You know, I Googled my health, I don’t have a doctor, I don’t know what to do.” But healthcare is as simple as, “I turned to Tia who takes care of the rest.” So that, to me, is my very evocative vision for success.
Lynne Chou O’Keefe 25:58
Well, I don’t think it’s evocative, I think you’re making that vision a reality. And it’s so special, it’s so clear, your passion for what drives you as a leader and what you’re building today and how you really are going to impact the healthcare system. So, Carolyn, thank you so much. I know you are busy. And this, truly, I think is inspiring for many of us in terms of again, your passion, your vision, and how you’re going to seek change in this healthcare world. And it will be different after your work here. So thank you so much.
Carolyn Witte 26:31
Thanks for having me. And thanks for being a Tia champion through and through.
Lynne Chou O’Keefe 26:35
Lan Nguyen 26:36
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