It's difficult for women in America to access the reproductive and sexual healthcare they need, especially those on Medicaid. There are 20 million American women who live in contraceptive deserts, one-third of doctors don't accept new Medicaid patients, and 45 percent of women ages 18-29 do not have primary care providers (PCPs). This has led to staggering health disparities: Black women are three times more likely to die during childbirth and women in the top one percent have a life expectancy that is 10 years longer than women in the bottom one percent.
Twentyeight Health launched in 2019 to help improve access to reproductive health care for everyone from upwardly mobile college graduates to working mothers on Medicaid. Here's how they're breaking down barriers to access across 34 states and Washington, D.C.
Bringing reproductive healthcare online
Telemedicine is central to what Twentyeight does. Twentyeight Health does not replace a patient's PCP. It is not a stand-in for a family doctor or OBGYN. Twentyeight Health gives women access to the reproductive healthcare they need quickly, seamlessly, and without hassle. Whether a woman is seeking a morning after pill, birth control, or prenatal vitamins—they are able to access prescriptions for those via telemedicine.
“Telemedicine is so important to what we do because low-income patients often cite an inability to miss work or school as one of the top reasons why they miss in-person appointments,” co-founder Amy Fan says. “Telemedicine allows us to fit healthcare services within their day-to-day lives.”
Fan and her team at Twentyeight Health heard a critique repeatedly: that there was an aversion to telehealth among low-income people because many of them do not have smartphones. But they didn't believe that was true, and they've been proven correct. “Unfortunately, there's a lot of misconceptions around low-income and BIPOC communities that we heard early on,” Fan says. “And that's that they will never use our service because they don't have smartphones, which is actually untrue.” And the data backs up the Twentyeight Health model: 76% of Americans who make under $30,000 own a smartphone, per the Pew Research Center.
What helps set Twentyeight apart from other healthcare services or providers is they accept Medicaid in many of the states where they operate. “We're one of the only telemedicine companies that is able to accept Medicaid,” Fan says. “And Medicaid affordability is a really important component of increasing access.”
It's not just Medicaid, though. While the majority of Twentyeight Health's users are on Medicaid, they also work with insurance providers and accept cash payments for those who are uninsured.
Nearly 30 percent of Medicaid's $700 billion annual budget spent on women of reproductive age.
Meeting people where they are, through people and organizations they trust
Twentyeight Health knew that to get buy-in from patients across the country, both rural and urban, they would need to work with organizations in the communities they serve. “We work with nonprofits, community colleges, and other organizations that are already engaging women from these communities,” Fan explains.
One example is Bottomless Closet, a workforce entry program for women in New York City. “What we have found is that because they're a trusted organization for these women, a lot of their clients ask them for support services beyond re-entering the workforce,” Fan says. “So you want to be there when women are asking these questions to their non-profit supporters, and be able to engage with women directly at that point of need.”
That pre-existing relationship allows Twentyeight Health to serve people easily and immediately—with the trust already established.
Working to give women in need what they need when they need it
Healthcare for low-income women and women of color in the U.S. today is broken. “It's incredibly grueling for anyone from those communities to navigate it,” Fan says. But considering nearly 30 percent of Medicaid's $700 billion annual budget spent on women of reproductive age, it's a massive market in dire need of innovative solutions.
Twentyeight Health saw an opportunity to help a population while building a business. “We want to build a better experience for these women to ultimately lead to better health outcomes and lower healthcare disparities,” Fan says. Twentyeight Health wanted to democratize access to reproductive healthcare in the United States. As they grow, there is a heavy focus on expanding methodically and continuing to ensure access to reproductive health to women on Medicaid.
“One-in-five women of reproductive age are Medicaid recipients,” Fan explains. “There's a lot of women that need our support across the U.S. that we're not able to reach right now. A really big piece for us is thinking about how we continue to grow so we can support those individuals.”
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