From the Frontlines
Reinventing Women’s Health Starts With the Well-Woman
When I joined Tia with the charter to extend the Company’s ambitious mission into real-world care delivery, the foremost question I asked myself as Chief Medical Office was where should we start? How are we, as an interdisciplinary team of designers, clinicians, engineers, and data scientists uniquely positioned to intervene and make a difference within the highly complex healthcare system?
With women’s health getting worse instead of better with respect to many important metrics — from the rise of maternal mortality rates and cardiovascular disease to diminishing access to reproductive healthcare services, to skyrocketing rates of provider burnouts and rising costs — the necessity for systemic change is paramount.
As an OB/GYN with both surgical and hormonal health expertise, and more than 30 years of experience bridging the translational divide between clinical and bench science to frontline care delivery, the most obvious start was reimagining the Well-Woman Exam. Here’s why:
#1: The Well-Woman Exam is an “every woman” issue.
Whether 13, 33, or 63 years old, every woman in the U.S. under the age of 65 is entitled to a 100% covered Well-Woman Exam by law under the Affordable Care Act. Given Tia’s commitment to building a better model of women’s care that can, one day, serve all women and not just a few, this annual exam represents a clear opportunity to innovate and improve care quality within the confines of the existing payment models that dictate access.
It is the universal portal of entry into the healthcare system, and therefore the best opportunity to influence care both acutely and longitudinally.
#2: The Well-Woman Exam is ground zero for triaging in women’s health.
While many people think of the Well-Woman Exam as synonymous with a Pap test, it’s intended to be more expansive than a cervical cancer screening (though this screening is undoubtedly a critical part of the exam for women in certain age groups). According to the American College of Obstetrics and Gynecologists (ACOG), the Well-Woman Exam is: “a fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician-patient relationship. It should include screening, evaluation and counseling, and immunizations based on age and risk factors.”
As a provider who’s performed thousands of Well-Woman Exams in my career, I can tell you first-hand that it has been my best opportunity to triage my patients from a holistic brain <> body systems point of view, escalating what most would call “non-gynecological issues” like thyroid dysfunction and nodules, insulin resistance, chronic anxiety, markers of inflammation, and sleep disturbances (to name a few). This approach requires thinking about patients from a neurological, immunological, and endocrinological point of view in the context of that individual female’s psychosocial and socioeconomic reality.
When we wrongly minimize a Well-Woman Exam to the medical equivalent of “speed-dating” — just a Pap or a checkmark required to refill your birth control prescription, an experience disappointing to patients and care providers alike — we risk missing the deeper stuff that all-too-often, falls through the cracks in women’s healthcare.
#3: Done right, the Well-Woman Exam is a powerful conduit for personalized health that’s truly preventive, transparent, and collaborative.
To address the epidemic of chronic illness in the U.S., we need to make preventive healthcare truly preventive; we need to evolve as a healthcare system from simply treating sickness to promoting and enabling wellness; we need to empower and educate providers to think about health as mind-body systems-level communication — not a reductionist point of view that is most effective in specific disease state interventions.
As a core preventive healthcare service, the Well-Woman Exam is an opportunity to hold up the mirror to a patient and really ask — what does being healthy mean to you? What is working well in your life? What is at risk? And what can we discuss together, transparently and collaboratively, to help a woman not just get healthy, but stay healthy?
At Tia, our clinical practice is rooted in an understanding that health and vitality are a combination of genetics, epigenetics, family history, sleep quality, nutrition, the distinctly female stress response, and much more. We collate this data — in combination with a highly personalized 1:1 discussion, counseling, and evidence-based research — to help our patients understand not only what matters about her health, but why.
As the modern medical home for women, the Tia Clinic’s hallmark offering today is a reimagined Well-Woman Exam — the foundation for Tia’s comprehensive care offering, critical to both preventing illness and promoting wellness. Our new patient Well-Woman Exams are 40 minutes (more than twice as long as a typical visit) and include:
- A physical exam, which may include, a Pap test and an STI test (in accordance with ACOG screening guidelines)
- A comprehensive review and discussion of your health record, including your medical, reproductive, family history (including personal and family genetics), and lifestyle (e.g. sleep patterns) in the context of a “goal” or discussion topic set by the patient when she books her appointment at Tia. Some of Tia’s most popular discussion topics are headaches, mood swings, and cycle irregularities.
- When appropriate, a blood panel: as a baseline, Tia’s “Well-Woman Panel” includes a thyroid and lipid panel, complete blood count, diabetes and vitamin D screenings. Tia providers may recommend and discuss additional blood work if appropriate for a patient during her visit.
- An analysis of your self-reported tracking data from the Tia app — a powerful longitudinal data source that enables Tia patients and providers to see patterns, correlations, and abrupt changes in connection to a patient’s cycle, which can be difficult to grasp through recall alone.
- A personalized Care Plan developed in the context of a patient’s goal — designed in collaboration by a patient and her provider during her appointment.
Almost one year into seeing patients at the Tia Clinic and delivering this reimagined Well-Woman Exam, it’s exciting to begin to see what the future of women’s health could look like — a personalized, collaborative, and evidence-based healthcare paradigm in which every woman feels seen, heard, and truly cared for.
Does a Well-Woman Exam always include a Pap test?
No, a Well-Woman Exam does not always include a Pap test. Depending on your age and the results of your last Pap, Tia providers will recommend a Pap test every 6 months to every few years, in line with ACOG guidelines and your individual needs.
Do I need an annual physical in addition to a Well-Woman Exam at Tia?
No. Typically, you do not need an annual checkup or a physical from a Primary Care Provider in addition to your Tia Well-Woman Exam. Tia’s Well-Woman exams most often include a comprehensive physical exam and health evaluation in addition to a Pap, STI test, and any recommended blood work. We are not internal medical sub-specialists, so if you have a seizure disorder, for example, Tia will refer you to a neurologist, or an endocrinologist for diabetes.
Do I get an ultrasound as part of my Well-Woman Exam?
Typically, ultrasounds are not necessary as part of Well-Woman Exams but they can be extremely helpful for clarifying or elucidating problems discussed or uncovered during your Well-Woman Exam. In July, we brought on in-house ultrasounds at the Tia Clinic, which we use for pelvic pain, cycle irregularities, thyroid nodules, breast tenderness, pre and post IUD insertions, and when recommended by Tia clinicians.
How do I know if my Well-Woman Exam will be covered by insurance?
Typically, insurance plans cover ONE Well-Woman Exam per year — without copay or coinsurance. Lab coverage tends to vary from plan to plan. If you have already had a Well-Woman Exam with another primary care provider or gynecologist, your Well-Woman Exam at Tia may not be covered. If you are unsure or want to double-check ahead of your appointment, your Tia Care Coordinators can run an eligibility check for you!
What is the purpose of the “discussion topic”?
In our research with patients and providers, we heard time and time again — on both sides of the table — complaints about feeling rushed and “speed-dating” style healthcare. We know women come to the doctor’s office with a laundry list of questions banked up all year that they often forget to ask in the moment. And we know, too, that providers are under increasing pressure to see more patients in less time and struggle to “guess” what’s on a patient’s mind in the moment.
By allowing our patients to choose a discussion topic ahead of time, we are able to set expectations between patients and providers, personalize your health intake, and better focus the appointment around a top complaint, ailment, or goal. As a starting point, Tia patients can choose from: bloating, headaches, mood changes, vaginal infections, UTIs, STIs, acne, pain with sex, weight, cycle irregularities, cramps/pelvic pain, sleep disturbances, and contraception.