Maven Clinic CEO Kate Ryder on healthcare in a post-Roe world

Sitting in front of a laptop, in Maven’s airy Manhattan offices, Kate Ryder dives right in. “We’re going to talk about the overturning of Roe v. Wade,” says Ryder, CEO and founder of virtual fertility, pregnancy, and family healthcare provider Maven Clinic. “Our team has been working closely with our clients, [and] participants in the broader ecosystem—from fertility clinics to cryopreservation facilities, adoption agencies, surrogacy agencies, individuals, ob-gyns, midwives, hospitals— . . . to understand the rapidly evolving landscape.”

On the other side of the computer screen are more than 250 HR leaders who have tuned into this midday webinar in late July looking for answers. With the fall of Roe this June, the country’s entire reproductive health landscape has shifted, with 12 states banning abortion or heavily restricting it, and 10 states likely to soon follow suit. (Despite the actions of a conservative-leaning SCOTUS and Republican state lawmakers, the majority of Americans support access to safe and legal abortions—as evidenced by Kansas voters’ recent decisive rejection of an antiabortion state constitutional amendment.)

For employers who offer healthcare and other family-building benefits (through Maven or other providers), the SCOTUS decision has opened up a number of sticky questions: How can they ensure employees living in restrictive states have abortion access, like their blue-state peers? What does this mean for workers pursuing IVF or surrogacy as a means to grow their families? If a company offer employees travel reimbursement for out-of-state abortion care, will individuals have to disclose their pregnancy to their HR department and/or manager?

The webinar is a natural opportunity for Ryder and Maven’s chief medical officer, Dr. Neel Shah, to make their pitch about how Maven Clinic—with its slickly designed telehealth app, personalized care representatives, and recently secured $110 million in series D funding—can help employers now scrambling to support workers. But it’s clear they’ve also hit upon something bigger, too: real uncertainty about the role companies should be taking on reproductive healthcare and related benefits. (Ryder says Maven saw a 67% month-over-month jump in new sales opportunities immediately after the SCOTUS Dobbs vs. Jackson ruling.)

Over the course of the next hour, Ryder and Shah walk attendees through the nuts and bolts of U.S. abortion access (or lack thereof). There’s a lot of “legal uncertainty,” says Ryder, showing a map of different regulations across states. “What we are hearing from our own [general counsel] and our own legal team is this is not going away. It’s not like we’re going to just figure all this out in 30 days. This is going to be constantly evolving.”

Abortion access is part of full-spectrum reproductive healthcare—not just people who don’t want to be pregnant. People who desperately want to grow their family also need the ability to terminate a pregnancy if their health is at risk, says Shah. During the webinar, Shah puts it simply: “You can’t take care of pregnant people without [abortion] being in the mix.”

Ryder, for her part, discusses the benefits some companies are now offering, how millennials and Gen Z are looking for jobs that offer family-building benefits, and even how Maven recommends framing conversations around reimbursing reproductive health-related travel. (“Frame this as a benefits parity issue,” the relevant slide recommends, meaning that employees living in all states should have the same access.)

Of course, employers aren’t the only ones trying to figure out what to do in this moment. The confusion and lack of clarity about what this means for patients and providers is “another layer of cruelty,” says Dr. Shah, when I meet with him and Ryder in the Maven offices. “There’s an incredible amount of uncertainty about what can be done, and it’s leading to harm.”

The Maven offices look like any other well-appointed startup, complete with Rise cold brew on tap, soundproof meeting pods, and a freshly painted lactation room. We gather in a conference room named “Crumpler,” after Dr. Rebecca Lee Crumpler, the first Black woman to become a medical doctor, and Ryder walks me through how the Maven app allows users to virtually connect with providers, and healthcare support representatives that help patients navigate virtual care options.

“I’ve been through one miscarriage and three pregnancies [using] Maven,” says Ryder, a former business journalist who founded the company in 2014. “I have three kids—6, 4, and 1—so I use our pediatrics products as well.”

Pick any of the stats that she frequently cites, and you can understand the magnitude of the problems she believes Maven can help solve, like the fact that the U.S. has the highest maternal mortality rate of any industrialized country, where 50% of counties don’t have a single ob-gyn. Or that 43% of women drop out of the workforce after having a child.

The first unicorn in the women and family healthcare space, Maven works with a number of the largest companies including Microsoft, L’Oreal, and Boston Scientific, and was recently No.2 on Fast Company’s Best Workplaces for Innovators list.

All of that puts Maven–and Ryder—in a unique position to help companies help patients access care, she says. Since the fall of Roe, they’ve seen an increase in interest from new clients. “We’re continuing to see a ton of interest and confusion around what to do,” says Ryder.

Fast Company spoke with Ryder about how employers are adjusting to changing legislation around reproductive healthcare, the promise of telehealth, and how Maven plans to scale. (This interview, taken from two separate conversations, has been edited for space and clarity.)

What have you been seeing from companies since the fall of Roe? Are more clients reaching out?

A lot of HR teams, ours included at Maven, have had their hands full. And so in the lead up to Roe v. Wade, I think a lot of people were in wait-and-see mode. They wanted to wait and see what the industry was doing. They wanted to wait and see what their employees were going to say. The second it came down though—not the leak, but the actual decision—we saw just a frenzy activity that we actually didn’t even expect. I remember I was having my weekly one-on-one with some of our sales leaders. They’re like, “we can’t get on the phone fast enough to answer these questions.”

What’s your take on the recent Kansas referendum, where voters rejected the antiabortion amendment to the state constitution?

Women’s and family health had been underserved long before Roe v. Wade was overturned and our country has paid the price. I’ve been encouraged by the referendum in Kansas and also in how the business community has responded by offering support to employees. That said, it’s still early days and there is so much more work to be done to ensure that people have access to the care they need.

How do you see companies beginning to take action?

In America, companies pay for healthcare, so at about a thousand employees, you are the payer. And so that means there are teams inside these big employers, and their core goal is to prioritize the well-being of their employees. Because . . . better well-being leads to higher retention, higher satisfaction, better talent attraction, more productivity at work—all of that. And then there’s a huge equity component, too. And all of a sudden, if you are creating inequities in a core part of women’s healthcare—you know, one out of four women get abortions in their lifetime—and you’re a company with a bunch of offices in different states, it just becomes yet another thing that you have to now figure equity out for.

Of course, there are some companies that maybe have a different belief system . . . but I would say most companies that are in America that are in a capitalist system that need to create good business performance for their shareholders, and they need to have great employees to do that. This is detrimental to the well-being of a large part of their workforce.

One of the things that Fast Company has been reporting on since the fall of Roe has been privacy concerns—for employers, potentially having some knowledge of employees accessing out-of-state abortion, and, of course, patients. Is there any legal risk to Maven or for Maven’s patients?

Everything is very uncertain right now, and I’m no expert on state-by-state laws. But I do know that there is a trend right now of states enacting privacy shield laws . . . meaning that there would be major procedural hurdles, if there were subpoenas from out of state requesting data. . . . That is the one trend that’s emerging, in a post-Roe world.

How do differing state regulations affect the actual Maven product? Does it mean you have to remove some of the options that people can view?

No, because we are always in compliance with the law. So an OB in Texas can still talk to somebody. But it’s still uncertain on these aiding and abetting laws. She could say, “you know what, I can’t answer these questions for you; you should go back to your care advocate and your care advocate can help you.” And then, for provider types that are not regulated across state lines, like a care advocate, they might be able to help the person. So it’s clunky. But at least you can still get support. And we continue to monitor how that all works.

Maven raised $110 in its series D in August 2021. What is your priority with this funding?

A lot of it has been going toward continuing to partner with a lot of our employers and payers. We have continued to scale with the payers. So we work with many of the large payers out there. . . . But then also it’s an entree to Medicaid, and so Medicaid is the population that we are continuing to work our way into. We launched our first Medicaid pilots this past year. We have more coming next year. And that is a totally different market.

Where are things at with the pilots?

We launched our first pilots this past year in January [in Arkansas], and we’ll hopefully have more next year. We’re currently taking some of the learnings from the first pilots, [and] feeding it back into our product development process. Medicaid is not going to be as quick as some of the other markets. It’s just slower. But one of the things that we are very much hoping that will speed things up is the fact that in a lot of states with restricted [abortion] access, those Medicaid costs will go up because there will be more babies, there will be more high-risk pregnancies.

Right now, it just covers pregnancy?

Yes, our Medicaid product is 12 months at the moment. Nine months of pregnancy, and three months of postpartum.

How do you figure out which benefits employees want?

We have client advisory boards of some of the biggest companies advising us on what [their] employees are asking for and how we can help. And in the beginning it was a very straightforward process because, if we were focused on that core family-building experience, there were a few things we had to do: we had to have a maternity program, we had to have a return-to-work program. We had to have a fertility [program], we had to have surrogacy, adoption.

The menopause product is an example where menopause is obviously a natural extension of what we do. It’s a core part of women’s health. And some of our OBs on the platform are treating pregnant women, but they’re also treating menopausal women. . . .

All of a sudden there was . . . an explosion in [interest in] menopause benefits, and so we were able to spin that up really quickly, and have a high-quality product because we already had all the providers on the platform to help. We have the prescription abilities on the hormone side, we have the content, we have the classes. So really it’s just about packaging that all up, personalizing it to that specific part of healthcare, making sure that we’ve tagged which providers in the Maven ecosystem support menopause, putting them in that product, training some care advocates who are going to work in that product on menopause.

I know you used Maven throughout your pregnancies, and now with your kids. Have there been any surprises from trying the product yourself?

The surprising thing to me is every time I, as a high-health literacy woman, had an appointment on Maven, particularly with a lactation consultant or an OB—I’m not breastfeeding, thank God, anymore—I learned more than I walked into the appointment looking for. I could walk into an appointment with a prenatal nutritionist with a specific problem and walk out knowing three things that I didn’t even seek to understand that are really important. [With virtual appointments] you have the time to really sit there and . . . you can follow up via message. You have all of that, but then there’s a ton of compassion when things are a little bit less rushed in a virtual setting.

What is the most persuasive argument for telehealth?

I think it comes back to outcomes, on a population level. . . . All of this access to these different types of care providers—including mental health, which has never been in the care model—does … [lead to ] lower C-section rates, lower premature birth rates, and lower rates of time spent in the NICU, [and] better mental health for women after having kids. And so, in 2015, I mean, we launched with 12 different provider types for this very reason. And if you think about, on average, you know, if pregnancy, the latest, I think Kaiser’s latest report [found it costs] on average $19,000 [to have a baby, and] they actually didn’t quantify everything. Telehealth is a fraction of that. And if telehealth is actually—and I can even speak from personal experience—providing and filling in those gaps, so that I’m a more empowered patient, I’m not going to the ER, I’m getting the care I need. I know how to talk to my OB. That pays for itself.