Comprehensive primary care model drives better health outcomes for women, Tia data shows

Primary care integrated with gynecological care and mental health and wellness drives better health outcomes for women compared to national standards, a new study from startup Tia found.

Tia's model, what it calls a "modern medical home for women," helps to fill critical preventive care gaps with higher rates for cancer and mental health screenings among its patient populations, according to the company's new outcomes report based on nearly 18,000 patients.

Two-thirds (65%) of Tia patients completed a comprehensive physical examination, compared to a national benchmark of 14%, according to a review of national data in JAMA Internal Medicine, or four times the national rate. And, 72% of Tia patients with diabetes have their condition under control, compared to a national benchmark of 55%, according to an analysis of 2022 MIPS historical quality benchmark data.

Tia's care model also leads to much higher rates of cervical cancer screenings with 94% of its patients up to date with this critical health screening compared to a paltry national benchmark of just over 35%, nearly three times the national benchmark. 

Tia launched in 2017 with the aim to provide whole-person, integrated and personalized care for women, or a "one-stop-shop" for women's healthcare. The provider offers virtual and in-person services, fusing primary care, mental health and gynecological care with wellness services like acupuncture in one integrated experience. The company is now in four markets—New York City, Los Angeles, Phoenix and San Francisco. 

Tia's first outcomes report proves out its thesis, said Jessica Horwitz, chief clinical officer, in an interview.

"Engaging women in preventative-focused primary care works to improve outcomes," she said. 

According to the analysis, 91% of women seeing a Tia provider were screened for depression (PHQ-2 or PHQ-9), as compared to a 49% rate nationally, or nearly double the benchmark data. Tia's analysis looked at a study from the Agency of Healthcare Research and Quality.

And, 74% of Tia patients who are receiving care for depression report a significant improvement in quality of life compared to a previous study of patients with major depressive disorders, which found 67% of those receiving monotherapy reported a quality-of-life improvement. 

"Every woman has a unique experience and thus deserves a unique and coordinated clinical approach. At Tia, we work meticulously to ensure that our entire care team not only follows the most stringent, evidence-based clinical protocols, but also can personalize a woman’s care for her own lived experience,” Horwitz said. “That’s why we’re driving better health outcomes compared to what studies suggest is the norm at the national level. We build trust with women and make sure they are getting all of the care they should.”

For its outcomes report, Tia analyzed anonymized health record information from 17,883 patients in New York, California, and Arizona, where Tia delivers hybrid virtual and in-person care. The company compared its outcomes to national health benchmarks reported in peer-reviewed studies as well as federal guidelines or objectives, such as the Merit-Based Incentive Payment System (MIPS) and Healthy People 2030. 

The analysis focused on ICD-10 codes, LOINC codes, claims data, and screening responses. In some cases, such as tracking quality of life improvement metrics, the company relied on industry reports and peer-reviewed papers, including those from the Kaiser Family Foundation, Harvard Medical School, and The Commonwealth Fund.

Tia's mission from the start was not to just create a "pretty space" for women to get healthcare services, Horwitz said. To that point, Tia's eight brick-and-mortar locations are definitely more modern and comfortable than a typical doctor's office. The waiting areas look more like a lounge-ready living room, the exam rooms have a custom armoire allowing women to store their personal belongings and change into a comfortable Tia robe and the locations offer yoga classes and speaker events in communal spaces.

But Tia is focused on more than just clinic design.

"We are keenly focused on making women healthier, with a belief that you make women healthier by engaging them in primary care. Tia is exceptionally good at engaging women who are sort of what we call 'medical orphans,' who do not have a primary care provider and do not have an OB-GYN, and engaging them in healthcare, for the first time ever, for most of them. And we believe that engaging them actually results in better outcomes. This is the first of many reports so that we can show this longitudinally over time," she said.

According to a third-party analysis of Tia’s patient population, 70% of members did not have a primary care provider before joining Tia and 86% had no OB-GYN—even though 61% suffer from a chronic condition.  Tia also serves a patient population with a diverse lived experience, as 44% identify as Black, Latinx, Asian, or mixed race, a shocking 29% report a history of abuse or sexual trauma, and 6% use a pronoun other than she/her. 

"Differentiated clinical outcomes come from a differentiated clinical experience that actually is focused around women and is rooted in something that actually gives people an experience with healthcare that they feel seen and heard and loved," said Horwitz, a board-certified family nurse practitioner and public health clinician (MPH) by training who joined Tia three years ago and previously ran clinical operations and clinical strategy for Nurx.

She points to Tia’s 85 net promoter score (NPS) compared to -1.2 for the PCP industry at large.

Data shows that women command 80% of all healthcare dollars and 70% of all prescription fills from drug stores. However, even with their outsized impact on the industry, most are skipping preventive care services.

Horwitz believes this is a result of access issues as the country faces massive shortages of primary care providers and OB-GYNs while, at the same time, health systems often underinvest in primary care services.

"Our data shows that holistic primary care for women, done well, actually does work. This model engages them and creates a sustainable business that really results in high-quality outcomes for women," Horwitz said. "I think that in traditional medicine, there's sometimes a concern that primary care is just hard. The takeaway here is, yes, it is really hard. But, it's also achievable to deliver a patient-centered experience that creates a different way that women can engage in care and has the outcomes to prove that it works at scale, as well."

Tia has grown rapidly in the past three years as it opens new locations and expands its health system partnerships. Earlier this year, the company inked its largest health system partnership to date teaming up with Cedars-Sinai to open up clinics in the Los Angeles area. It now has four clinics open in that market.

Tia's first partnership was with CommonSpirit Health, which operates 137 hospitals and more than 1,000 clinics, to launch Tia-branded women's health clinics. The first brick-and-mortar clinic opened in October 2021 in Phoenix with planned expansions in Arizona and other CommonSpirit markets over the next few years. 

Tia landed its second major health system collaboration with UCSF Health in San Francisco last year. UCSF Health plans to collaborate with Tia to develop a new network of clinically integrated clinics for women in the Bay Area.

It's also opened two clinics in New York City. Last year, Tia also expanded into fertility services and now offers medication abortions via virtual visits in New York and California.

"We are deeply focused on doubling down on the markets that we're in to grow and expand," Horwitz said. "We're focused right now on thoughtful, comprehensive primary care, and with a particular lens towards prevention."

The provider also is strategically looking at how to support women's health longitudinally, she noted.

"How do we think about engaging women throughout their lifespan and keeping them tied into high-quality healthcare as they age and as Tia ages with them," she said.