Midlife, menopause, and the benefits blind spot.

Rachel Aleknavicius: Hello, everybody! I'm just gonna give everyone a second to make sure that they're all settled into the room, and we can kick off.

Dr. Kathleen Jordan: Hey! Hi! Rachel!

Rachel Aleknavicius: Hello! So we're so glad that you are here, and really excited to have our Midi team with us, to educate you all on all things menopause and perimenopause. So if you wouldn't mind if you want to kind of go into the chat, you see the chat there where you're calling in from would be great. Just so we can kind of find out where everyone's where everyone's from.

We've got Salt Lake City and Los Angeles. I'm here in Minnesota.

Lauren Vetter: Oh, look at! We got everyone from all over. but it.

Rachel Aleknavicius: Okay. So we got, we've got pretty much the whole country covered from east to west.

Dr. Kathleen Jordan: Good.

Rachel Aleknavicius: Yeah, I see a few few familiar names as well. So awesome. So thank you so much. Today, we're going to be covering a topic that is becoming a bit of a buzz which I'm super passionate about having entered into this fabulous phase of life, and we have Midy here with us joining to educate all of us more on perimenopause and menopause, and what that means in the workforce, and how we can possibly work to better support our women, coworkers and friends through this life change so on. Today's agenda, we will have a, you know. Talk about why, now, you know, it's I laugh where it's August 2025. And we're just starting to talk about this. And so why are we talking about it now? And what menopause looks like at work.

You know what employers are missing, you know, it's just a topic that's become something I feel like we're able to discuss. And so with that it talk. We have to look at what we can do as an employer to spawn to support our our colleagues.

And then how do we close that gap without blowing our budget, blowing our benefit strategy. What are some strategies there on how we can close this care gap for women, and then we'll close up with some actionable steps as well as some Q. And a.

So 1st off we'll kick it off with introductions. My name is Rachel Alec Novices. I am a partner here at Nava benefits. I've been doing employee benefits consulting for gosh! Close to 20 years. Been in the industry for a long time, started my career as an underwriter and came to Nava because of their modern approach to employee benefits. And the technology that we're bringing into this space. The the benefits consulting world has not changed in a long, long time, and Nava's here to shake that up which was exciting and fun for me.

And also I just wanna make sure everyone's aware that we are going to be recording today's webinar so that you can revisit this and let and then we'll we'll pass it along as well, so I'll take kick it over to you, Lauren.

Lauren Vetter: Great thanks so much. My name is Lauren Vetter, and I'm our director of strategic partnerships at Midi. Health. I'm a benefits consultant by background and came to Midi a few years back. And I'm really excited about how Midi health is really closing a massive gap we've had for such a long time in women's healthcare, but also in benefits.

Back in my benefits, consulting days, we were talking about maternity. We were talking about childcare. We were talking about all of the great ways we can support women. But what about for women who are beyond those, you know, family building stages of life? How can we, you know, support them, and and that's what I'm so excited about that Midi is able to kind of tackle that that challenge, and, Dr. Jordan, I'll pass it to you to introduce yourself.

Dr. Kathleen Jordan: Yeah, I'm Dr. Kathleen Jordan. I am chief medical officer at Midi Health, and I've been on the founding team. My background. I ran my own practice, I eventually became chief medical officer within a hospital system. and really became passionate about using telehealth as a solution to answer care gaps. So I used it for all sorts of care, gaps with transgender health, and some other specialties we had, and then I discovered the giant abyss Care Gap in women's health, and I joined the team that was founding Midi health was one of the 1st clinicians there. Now I lead a team of about 500 clinicians across the nation, serving women in midlife.

Rachel Aleknavicius: Amazing. Thank you both for joining us so a little, we're gonna tell you a little bit about Nava, a little about Midi, just to kind of set the bearings in case you haven't heard of either one as I mentioned in my intro Nava is on a mission to bring a modern approach to employee benefits. So we want to be your co-pilot and your employee benefits experience. We have a internal tech team which sets us apart from our competitors.

Building AI enabled support for your employees as well as the Hr teams. So we have AI support that you can have.

Be your benefits, Bestie. We're calling it Hq. And ask that platform any type of benefit related questions. So you have all the answers at your fingertips within seconds, instead of waiting and going back and forth. Between emails for days. We have year round support with that in an app form for employees as well as a desktop format for the Hr. And you know. Just the the whole purpose is, you know, not to work harder, but work smarter. So we're not really taking. We don't want to take people out of the experience. We just want to make what you do on a day to day basis a lot easier. So everyone's more efficient.

Dr. Kathleen Jordan: All right. So what is Midi? Why are we here talking so? Midi is the premier virtual clinic for women in perimenopause and menopause? So we have a huge team of clinicians that care very compassionately about women's health care. They come in trained and experienced in women's health. Then we have a multidisciplinary expert team. So we have national experts that actually support this team and deliver this care across the nation.

I think the Passion project, too, has been that this is insurance covered. We have a whole team. So we are signed up with most insurance across the nation, really trying to bring this access to expert care to all women, because before Midi, really, this kind of care was only available in concierge practices, and in fact, I met with many of the concierge doctors in menopause, and we sort of mimicked what they did. took it online. And because of some of the efficiencies we have with being telehealth, we can take what used to be only available in high-end concierge, expensive cash, paid practices, and bring it to women in midlife through an insurance covered, accessible way.

If you want to hear more about what we do, we are@joinmidi.com. It's an easy way to learn about us also. Easy way to sign up. If you want to be a patient.

Lauren and I can both talk to this. Why are we talking about menopause at work? Well, really, because midlife women are the one, the fastest. They're half your workforce for one. Women are half your workforce, and it is the largest growing workforce actually in the Us. And this really impacts really, most women, as we'll talk about really most women in their forties and fifties. So it's really affecting women for half their life, and probably half of their career. And it's important to understand it's important to support them in work next slide, because menopause symptoms are not just hot flashes and night sweats. If I have you remember anything, it is so much more than just hot flashes and night sweats, hot flashes and night sweats are the hallmark symptom. About 80% of women will have them. Some don't, and they have these other major symptoms and can miss it.

But the hormone depletion you experience in menopause triggers a lot of different symptoms.

We know it affects your serotonin, it affects your acetylcholine. It actually has changes in your brain. Cellular metabolism. It negatively impacts sleep. So you get 2 thirds of women not sleeping. So you, it doubles insomnia. It doubles sleep. Apnea. So you see a lot of changes where women and I hear it all the time. I had a patient yesterday telling me she was so exhausted she had quit her job so sheer exhaustion. It also affects anxiety.

Panic attacks. Oprah shares that her primary symptom with menopause was panic attacks and anxiety, and she's someone who had always been calm and cool under the camera and started experiencing that. So midlife women just really suffer from burnout in a disproportionate way, because it's they have sort of this physiologic changes is also making them exhausted and fatigued, and experience anxiety. This is the experience of women. Every woman will go through perimenopause and menopause, assuming they live into their forties and fifties. So it really is affecting most women. and the idea about supporting them in their healthcare and with their benefits is, it actually is supporting both their personal and their professional life, as well as their long-term health. Because some of these changes are impacting long term health. And what we do now can actually just keep them healthier and lean into wellness and actually prevent a lot of problems as well. Next slide.

So what women are going through at work is they have brain fog. So brain fog is not a medical term. It's sort of a collective term for struggle with memory. Sometimes you forget someone's name. This is real. If you talk to women who have gone through this, they will explain it and have great stories on it.

It's fatigue, insomnia. Now, there are studies. It does not affect your ability, it does not impact your IQ. You're very productive. You are very couple. Also, people get concerned that it's beginning of the end. They feel like I'm getting old and I'm declining. So they start to become less aspirational and looking for promotions, they think, oh, this is a sign that I'm on the decline, not true. Brain fog is temporary and it's caused by hormonal distress.

Dementia is progressive. That's something that hits much later in life. Peak age of diagnosis is in your eighties. But people get concerned that this is sort of the beginning of the end, and they start to treat their career that way.

So there's also mood shifts. There's an increase in depression which affects productivity and just happiness in the workforce. It also affects their relationships, both personal and professional. It affects their confidence, you know midlife, and these hormone changes affect your hair, they affect your weight. They affect your skin. There's a lot of age, you know. There's age and ageism woven in here as well. but they just begin to become less confident at work. And we've asked women, this is polled. This is not industry. Sponsored women tell us this all the time. Next slide.

Rachel Aleknavicius: Yeah, thank you, Dr. Kathleen. I often felt all of that myself. yeah. So I'll tell. I'll share a quick story which I think a lot of folks, possibly on the line can can relate. So a while back I started noticing that I fell off, and you know I was exhausted. I was foggy. My mood was tanking. I wasn't sleeping. you know. I knew I was off, but my mom had already had just recently passed. So I'm like, Okay, it's probably still recovering from that. But after a while I'm like, No, there's something really off. So I went to a doctor, and then I went to another doctor and then another, and then 4 doctors. Later, I was still being told things like, Oh, you're just stressed. Maybe you're depressed. Maybe you should try cutting caffeine. It wasn't any of that. Turns out it was perimenopause.

And so, you know, like many women, we end up self diagnosing. And you know, everything leads to a dead end. Right? And so, thank goodness, I found Midi through a podcast. Actually, that a friend had sent me and my clinician was amazing, connected the dots and got me started on Hrt. And voila! I was back to my my myself again. But what I keep on struggling with is, I work in employee benefits, and I know this stuff inside and out. And so, if I had no clue that this was happening like I can't even imagine how the employee, the standard general employee, is is struggling with this as well. So we can talk about some of these assumptions that are happening in midlife. Assumption number one menopause is a short phase. wrong like Dr. Jordan. Just said, menopause can last up to 7 to 14 years, so that means employees in their mid forties. They're living with these symptoms for a decade or more, while juggling careers, caregiving and leadership roles assumption number 2 symptoms show up after your period ends wrong again. Symptoms often like anxiety and hot flashes or brain fog and sleep disturbances. They're starting before menopause officially begins.

Assumption number 3 is that everyone experiences menopause the same way. Nope. every woman's experience is going to be different. So that means a cookie cutter. Resource is just not going to cut it.

And probably the most shocking assumption which blew my mind is that Obgns know how to treat menopause. But the fun fact is that 86% of obgyns aren't trained in menopause care. So when women go to their doctor, chances are they're going to walk out with advice that's outdated, unhelpful, or just flat out wrong. So they're feeling it's not adding it to the distress that that's already happening within their their bodies.

Dr. Kathleen Jordan: And that's 86% of ob-gyns themselves report that they're not trained in menopause.

Rachel Aleknavicius: That's self recorded.

Dr. Kathleen Jordan: Yeah, it's self reported.

Rachel Aleknavicius: Wow. So yeah, and I think a lot of women probably don't feel safe bringing this up at work. So if they're not getting the right support. They're really suffering in silence, and then they start missing work. They're going to disengage. Many often leave leadership tracks, or, like Dr. Jordan had just said, leave their jobs altogether, and that's a real cost. So the unseen symptoms, the unspoken struggles, it's untapped potential. And so Lauren's gonna get into a little bit of how we can mend this gap. Going forward.

Lauren Vetter: Yeah. And and I mean, these are just the stats to kind of outline exactly what you just said, Rachel, and what Dr. Jordan just said, I mean, the symptoms of menopause are so varied. One. They're debilitating for so many women. And then, when the women try to get care, they're going to all of those different providers, not getting the answers they need. So it affects women at home in their lives, with their families. We hear from husbands all the time who have stories to share with us. But it of course, also affects women at work right? And so, because of that, we really view menopause as another glass ceiling for women.

This is data from a survey of working women, 99% of women. So all women right said they felt their symptoms of perimenopause and menopause negatively impacted their career. When we think about absenteeism, presenteeism, there's a huge impact here, too, 59% of women report, taking time off of work due to their symptoms, and then really astoundingly, when we think about the duration of all of this. 18% are taking time off for 8 weeks or more. So this is really impacting how women are able to, you know, show up at work.

Rachel, to your point. It also affects how women are showing up. When we think about promotions at work. 21% of women say they're more likely to pass on a promotion that they otherwise would have taken. And then there's also that workforce attrition component. So 23% consider leaving their jobs because of their symptoms. And then it's a really astounding 10% of women who do leave their jobs because of their symptoms. So when we think about ways to focus on the attraction, promotion. Retention of women in the workplace menopause is really essential to that conversation, and then I would also add that women know this right, and women are asking for this benefit. So when we work with employers, we often hear from benefits, leaders that my erg leader brought this up, or this is coming up in our surveys we're giving to our women. But you know, the question is, you know, what what can I do about it? So we're excited to answer that question for you today before we answer that question, though I want to turn it over to Dr. Jordan to take us through some more education on menopause, you know, help us understand what what benefits leaders should know about menopause.

Dr. Kathleen Jordan: Yeah, it's always good to know. Have everyone on the same page on what menopause and perimenopause is.

So menopause menopause is just when your period, your hormones deplete enough that your periods stop. So your ovaries kind of poop out, you stop making estrogen and progesterone, and your periods stop entirely 12 months after your last period. That's called menopause.

It's much more confusing for women than that. Because if you're on Birth Control Pills, if you have an Iud, if you had a hysterectomy, or if you have Pcos, or you've had a regular period your whole life. Sometimes it's harder for them to tell, so they don't necessarily know. And then we do labs to validate and things like that. But basically it's estrogen and progesterone depletion. And your whole body feels these hormones. Deplete perimenopause, as Rachel said, is what leads up to it. It's not that your ovaries just turn off full. Go to full stop overnight. There's a period of decline where your hormone levels are decreasing. And that's called perimenopause. And it's really as the average age of menopause is 51 perimenopause is most people throughout their forties.

About 6% of women have early or premature menopause. So it's some women in their thirties, or a more significant amount in their late thirties, some in their twenties, with the increasing amount of Brca testing. We see some people getting their ovaries taken out for cancer prevention, so they'll go through surgery post surgically. So there is a subset of women that are going through menopause in their twenties and thirties as well.

Key differences are that you're still ovulating in perimenopause, so pregnancy is possible. It also makes your symptoms cycle next slide, because it's easier to show with the graph. So this is the graph of estrogen which is the most studied. So think about all the body changes. You go through puberty puberty. Right? So now we're going through the reciprocal of that our estrogen levels are dropping. There's those feedback loops that we learned about in grade school. So you'll as your estrogen levels drops your hormones, sort of your ovaries. Try to make more. Your Fsh. Goes up and you try to make more. So you kind of rebound a little bit. And this is this actually leads to fluctuations. Now, these fluctuations can actually be harder on some women than actually the final sort of flat line. The fluctuations of perimenopause really are disruptive to sleep really are disruptive to mood.

They're actually known to be migraine triggers. So this is again reasons why people take off work, and it affects their impact. So these swings are actually big causes of brain fog and can be migraine triggers as well.

Again, average age 51. But there's a broad range for some people, final menopause and into late fifties, other people at 45. They're fully menopausal. And that's considered in the normal range. So everyone's experiencing this slightly differently. And then in perimenopause, I think this is the most underserved population. They have a ton of symptoms. They come in.

We finally realize what's happening. We get them on treatment. And there's they'll say this is the 1st time I've slept in 6 years, right? Because it kind of creeps up on you. You have symptoms for 2 weeks. Then maybe you have a good weeks, and you think maybe that was in my head. But it actually wasn't. So perimenopause is where we're seeing an increasing amount of literature as well as an increasing amount of attention to get people under care. Next slide.

It is probably where community-based physicians like most ob-gyns, most pcps, don't really know what to do with perimenopause, because it really is an emerging sort of expertise.

Okay, so what's happening as the hormones decrease hot flashes, night sweats, I mentioned, but it goes beyond that trouble. Sleeping, I think, is a huge impact for work in particular, but just a huge impact on life. And remember, when you don't sleep well, you actually gain weight so that hormones changes themselves actually are linked to weight gain. So you see, metabolic changes. You see, blood sugars go up. You see, cholesterol levels go up.

Vaginal dryness, painful sex genitourinary syndrome menopause means recurrent utis which can mean infections, er stays, hospital stays which are not good for your benefit, plans also for time off work, low libido affects relationships, brain fog, mood issues fatigue. But the other big thing. And I was telling Lauren we've been working with insurance company. All of these things are the symptoms, and this is, what has people come to Midi for perimenopause and menopause care? But all of these things are signs that there are other things going on internally. so estrogen receptors are in our blood vessels, and before menopause we do great with heart disease after menopause. We have more heart disease and heart disease than men. So we actually become worse. Right? So there's an increased risk of atherosclerosis.

There's increased pain. There's joint pain. We also trigger osteoporosis. Women are 2 and a half times more likely to have fractures which are er stays, pain, debility, hospital stays. These are all big benefit consumers as well as time of work, and also just impact your employees. Quality of life.

You see women tip into prediabetes. 40% get into prediabetes. You have an increased risk of diabetes, obesity, all that comes with that which is an increase in 7 cancers. There's definitely a rise in anxiety and depression. Lots of studies on the brain changes and neurochemical changes that happen in response to hormone changes, and then dementia is a complicated one. But headache disorders. You'll see the changes are definite triggers for migraines for some women next slide.

So if hormone depletion is triggering, so many of these things is is hormone therapy, the Magic Pill. It's not the magic pill, for everything. As I mentioned, right? So we know hormone depletion changes your metabolism. It can trigger obesity, obesity is a multimodal intervention. There's lifestyle interventions. There's medication. Interventions, there's activity, nutrition, there's all that.

But hormone replacement therapy does positively impact many of the symptoms and is increasingly associated with improvement in the list. I showed you on the right, so improved in cardiovascular disease, improvements in cholesterol improvements in blood sugar control, definite improvements with bone health. We've known that one for decades. definite decrease in risk of diabetes. We've known that for decades. So putting women on hormone replacement therapy and preventing diabetes is a huge win for their overall health and longevity as well as well as for benefits. Right? No. these are things we want to prevent. Right? So I am a believer in hormone therapy. About 4% of women in the nation that are eligible for hormone therapy. Take it. which is way too low. Any expert in this. It is not for every woman. But it is for way, more than 4%. And I think that just speaks to the huge care gap and the lack of access to expert advice that women have across the nation. If you start on hormone replacement therapy, it does relieve hot flashes and night sweats. This is a national study 75%. At Midi, we see 93%. We have being telehealth. We have some ways to make adherence easily and improve results. We also have. We also are expert in knowing which which formulation and which dose may be helpful to you as well.

The biggest thank you I get from patients is improvement in sleep and mood. I mean, I can't tell you how many times I said, this is the 1st time I've slept in 5 years and 10 years and 6 years or months. Right? Progesterone itself helps you with sleep. Estrogen repletion actually helps you with sleep.

And then we also have a robust sleep program that includes sleep hygiene. It includes screening for other sleep disorders. So we have about 93% of women who come in with sleep issues within a couple months. 93% say they're sleeping much better. And that's with really some basic interventions. We don't use sleeping meds, or very rarely, we can prescribe them. We're licensed clinicians, and if we do, it's usually as a crutch because they're used to having them. But you can make huge and impactful changes to sleep and mood.

Long term benefits lower heart disease risk. We have. Our average patient has a lower cholesterol. We see improvement in hemoglobin, a 1 c. We have a lot of data on that improved bone health and improved brain health.

So next slide. So I like to think of it as every. So in midlife a lot of things are changing. Our cancer risk goes up, our blood sugar risk, or all our cardiovascular. It's just such an important time to take care of yourself and lean into care, and Mini is really designed to just make it easy. You don't have to take a half a day off work to go see the doctor right? The average clinic visit takes half a day, and people are not doing it. We see that over and over again. So we've made it easy to sort of bring these kind of this kind of care that's impactful for women with the easy visit that they can do from work. And we actually also work on weekends. Early mornings, late afternoons we take advantage of our time zone differences across the nation. So we have visits happening at 7 Am. And visits happening at 8 pm. Across the nation.

We are not about just hormone replacement therapy. I wish it were that easy. I wish I could just give everyone the same prescription, and they would feel better. Certainly we believe in hormone replacement therapy, and there's all different versions, doses, things that we do with it.

But there's also non. There's also non-hormonal prescriptions that help when you look at things like cholesterol and weight and blood sugar, there's also non-hormone prescriptions that help. There's also non-prescription supplements. There's also like intermittent fasting can help with your glucose control intermittent fasting can actually help with weight. So there's some sort of non-prescription, lifestyle, things that are evidence-based that can help acupuncture, cognitive behavioral therapy can help.

We talk a lot about sleep hygiene so just environment ways to control your hot flushes and night sweats at night. So there's lots of things you can do that is not in a prescription that can actually help address. Our bodies are changing, our metabolism, changing, changing our food, increasing our fiber consumption. There's just lots of things.

We also talk about bone health. It's an important time to lean into bone bone density screening, leaning into exercise and weight training. So we see more. We statistically, I'll show that our patients actually are more likely to engage in weight training, regular exercise. And we make sure they're getting the screenings they need. So we screen for cardiovascular disease. And we do all the cancer screenings that are needed. because what we were finding is people were coming to us for perimenopause and menopause relief. But we were finding they weren't getting their basic care done. I'm an internist by background. We have lots of ob-gyns at Midi. We have naturopaths. We have all sorts of different licensures contributing to the care plans.

But my passion is really making sure people get the cancer screenings. That is low and easy hanging fruit that can really be impactful to someone's life and their family's lives. Next slide.

Rachel Aleknavicius: Hey? So this one's on me. So the benefit plans that we have today. Unfortunately, a lot of them don't cover this kind of care as thoroughly as they ought to. You know we go into our obgyn and get our annual checkup, but a lot of the benefit plans aren't covering the clinical care specific to perimenopause and menopause.

So one of the things that we can really do as leaders and consultants in the space of providing employees, our female colleagues care for. This is to look into our benefit plans and really make sure that there's no gaps in care and get that coverage for the perimenopause, and specifically in the pharmacy to the Hrt. And making sure that that's covered in the pharmacy program. So folks aren't paying so much out of pocket eaps. I mean, they have their place. But, like Dr. Jordan said, they're just not enough. There is definitely a mental health aspect to this phase of life. But it's not the root cause. So you know, the eap is a great supplement, I think. What's missing? There is the talk track to help direct women to the root cause care, and so getting the eaps to focus on.

You know, the possible hormone treatment and symptom could be a great start just to make sure that it's being a thorough in case they're called in first.st You know we you know the the Dyi or Diy. By Hr. You know if you're in Hr. You wear numerous hats throughout the day, and I suspect that putting together a plan for menopause care is probably not one of the on your high list of things to do, but without dedicated programs, you likely are, you're likely helping direct your coworkers who come into you for help. you know, raising their hand, saying, I I need something. I'm going crazy, and you know. So you find out how to you. You try and figure it out. So we wanna try and help mitigate that as well. And then the the harder part is that when the symptoms are unseen, so a lot of the symptoms are are misattributed, or they're they're not.

They're not cared for because of budget concerns. A lot of women are going through this in silence, because they're maybe ashamed, or don't really realize what's happening with their bodies. You know, if you don't have one of those hallmark symptoms, it may not trigger in your mind that it's perimenopause related. So you know, I, for one, didn't have hot flashes, so their doctors just brushed me off, as you know not having it so. These things, you know, symptoms go unseen, causes a lot more distress, and and declines in your confidence as well. Through that process.

Lauren Vetter: Yeah, I would say, Rachel, to that end we hear a lot of well, menopause isn't showing up in my claims right? Because so few women are going to a doctor who's saying, Yes, you have menopause. You have perimenopause. Let's figure out a way to help. Right? So they're not getting a perimenopause menopause diagnosis. Instead, they're getting this crazy constellation of symptoms right? That is, sending them from specialist to specialist. So, Rachel, you shared the stat that women go to 6 plus different specialists for menopause. We hear neurologists, endocrinologists sleep specialists, even, you know, like the holistic health practitioners, those are all the right. The many, many places our patients are going before they find Midi. And of course there's a cost to that right? This is unnecessary. Medical spend another thing. We hear a lot is a very common symptom of menopause we haven't talked about is heart palpitations, and that can be a really jarring symptoms, especially if they're like you, Rachel, and they didn't get the hot flashes. But all of a sudden I'm having heart palpitations. That's when women end up in urgent care er right saying, What's what's wrong with me? Right? Is this something really serious here? So that's where, when we think about cost a big chunk of the cost in menopause is this unnecessary medical spend about 25 billion dollars a year. One study found in unnecessary medical spend, and I know as business leaders, we hear all of these anecdotes about menopause, and we really want to do something to help. But it's these numbers that help us when we're, you know, thinking about making business decisions. And there really is a significant cost piece here on the medical side, but also on the productivity side. So we talked about the workforce challenges. You know that take place here. Women. you know, absenteeism, you know, missing work days from this, but then ultimately leaving the workforce as well. And so the productivity cost in all of this is a study found about 1.8 billion dollars in lost workdays.

And, Dr. Jordan, I don't know if you want to chime in here. But at Midi, what we're thinking about and the studies we're doing is, how are we able to impact this by putting a stop disrupting that poly shopping women are doing from specialist to specialist to the er to the right, to the specialty clinic. How can we disrupt that unnecessary medical spend by getting women the right care at the right time, so that we can prevent some of that. So I don't know, Dr. Jordan, if you want to chime in on some of the studies we're doing and what we're seeing.

Dr. Kathleen Jordan: Yeah. So I have been 100% confident that we are saving the healthcare system money really, by getting to good clinical outcomes and just giving good care. I think there's 2 ways we do it. So we have multidisciplinary care in one visit, so I will give you skin skin care. Help, talk about the hormonal changes to your hair loss save you from going to the dermatologists. We have ob-gyns. We have internists. We talk about cholesterol. We definitely are hormone. All the impacts that hormone we do bone health. We screen for thyroid. We treat thyroid right? So what we use is the telehealth platform to bring these multiple disciplines into one visit. So we stopped the poly shopping. So people are, we had 4% of our patients tell us they were seeing 11 providers. I mean. it's crazy.

Rachel Aleknavicius: And most of those aren't covered under in insurance, either. Right? So yeah, no. Some. They see them now. Naturally.

Dr. Kathleen Jordan: Yeah, yeah, they see some out of pocket, some in. It's a combination. But also they end up confused. They bring in their 11 care plans and say, like they don't know where to start.

So I think I think of many as a great place to start. Be the portal of entry into care. We do send a few people on, especially as we make 93% of our patients, we get sleeping better. And then the small percentage. We may actually send for sleep studies, but much reduced. But I was super excited. I have been working with some, and we've been working with some insurance companies with claims, data to see if we actually did. And I got results yesterday. So we did not make a slide.

But we did a matched cohort study with a major insurer, and we they looked at 1,200 of their insured patients that were enrolled with Midi and 1,200 of their insured patients of the same demographics that were not enrolled with Mini, and our group had spent 21% less over the year. So we'll be making that a report and formalize the report out. But it's it's a we. Also the care we give, I think, prevents visits. So an $8 tube of Estrace for vaginal cream prevents utis. Utis are days off work, fevers, er visits, antibiotics like doctor visits using Estrace twice a week was, I mean, it's literally an $8 tube of cream that every woman should have prevents utis. It also helps with continence and helps with vaginal dryness. It helps with things for the woman to have quality of life. But it does actually positively impact care costs. anyway. Sorry I could go on about this forever. So I'm gonna stop.

Rachel Aleknavicius: No, I love that slide every time I see it. I'm like, here we go again. Women are literally saving the world like we are, we're doing it. Yeah, like, that's a lot of money. We can put put back into our our system a lot of money. Yeah.

Lauren Vetter: Breaking News Dr.

Dr. Kathleen Jordan: I know I've been waiting for the study for a year and a half, so it's been good. Is that alright? Is this your slide?

Lauren Vetter: Turn it? Yeah. Well.

Rachel Aleknavicius: Okay? So yeah, so we're gonna talk about how we how we we close that that gap with with what? Without blowing up your benefit. Strategy? Right? We everyone has a budget. Everyone's plans are in place, you know. What? What do we do now? How do we move forward with this that we, now that we know it's an issue.

And so you know, for for us we work with virtual care quite a bit. I mean the days of Covid brought this front and center for a lot of us, and so I like the the openness, the easiness of the virtual care, like Dr. Jordan had said. You know you don't have to take half a day to see a clinician. It's you you carve out 30 min, or whatever it is. And it's all online. So employees can literally see a doctor and get care wherever they are. In the country the coverage is with insurance. And so it's going to be covered, likely, with your insurance. And so there's low out of pocket, and then you're getting a prescription through a provider as well. So it's just really seamless and easy, and you know.

I don't know. I think that's the the best thing about it is just that it's easy for employees to use and understand and get quality care. you know, Dr. Kathleen, is there anything else that you wanted to add.

Dr. Kathleen Jordan: No, I'm gonna say, I yeah, I love virtual care because I think people mistake it as a less than visit. Oh, it's like just like what you do in a visit minus the physical part.

So not true. You can actually get a lot more done with virtual virtual care. I actually use a lot of educational tools before and after the visit and during the visit I actually use it to bring in experts. So like, I had a patient in the. She was in the middle of the country.

I think, Kansas and she had a very complex genetic history, a very. She had a very complicated history. She had been trying to go through the system and look going to different providers flying to see experts. I had an expert from Mass general that we're contracted with, and someone from the Bay Area on her 2 different issues. We got on a call, and in 15 min we saved her so much time we created. A care plan was done. It was a $90 visit charge to her insurance.

So you can actually use it to bring expertise to the patient rather than making the patient travel and search and wait 9 months to get in. So we on the back end at Midi we use a lot of getting the expert into the visit with you. You see, one provider, and you have continuity of care, but that provider is going to drop in rooms seeing experts. And then, if you need to see an expert, we'll actually have the expert drop into.

Rachel Aleknavicius: Yeah. And I think for me, that was one of the biggest I wow! Was. I had done virtual care before, you know. But when I saw my clinician at at Midi it was such a different experience like it was very thorough, and the questions she were she was asking were direct, and she just she understood everything I was bringing to her. It was unlike anything else. It was very well received, and I felt so much better. Just after one conversation.

Dr. Kathleen Jordan: And she's supported by the tech tools. And also we, a lot of your intake is before the visit. So last time I went to an in-person doctor. They spent the whole time checking boxes and asking me questions. We do all of that before the visit, so by the time you come to the visit. I know a lot about you, because you've told me, and I can spend that time being in a conversation and actually having answering your questions and sort of creating a care plan. That's that you're part of.

Lauren Vetter: And I would just chime in. One more thing that you both said was insurance covered. Right? That's a big piece of this, too, is that this virtual care we're able to have it be insurance covered. So many women are getting this care today from concierge doctors. We talked about holistic doctors right? Midi's broadly covered with insurances. We're in network with about, it's almost 80% of commercial insurances were in network provider.

So being able to have that those visits covered by insurance is is a you know. It's inexpensive to virtual care is cost effective right? It's it's a way to to to expand access.

Dr. Kathleen Jordan: 8. Yeah, and most insurances don't cover naturopath doctors. We have a full-time naturopath that supports our clinicians and the evidence-based care. So if people have questions about it, or they have issues about supplements. So we sort of bring that expertise there on the back end. It's not charged. It's just part of the care solution.

Rachel Aleknavicius: Amazing. So as we, we kind of close up with, you know, some of the takeaways on, maybe what? As an employer, what we can do to kind of open up our workplaces, to be more menopause friendly if you will. Oh, can you go up to one more slide.

Lauren Vetter: Oh!

Rachel Aleknavicius: Yeah, thank you. So I think in a perfect world we would want to make sure that these checks are being hit on our health plans. So covering menopause on a health plan like the specific clinical care, making sure that employees know how to get that care. You know, I think, as an industry. We probably need to hold the medical carriers their feet to the fire a little bit more, and have specific menopause approved physicians easily accessible for women in my dream world. I see something like that happening and speak about it. Speak openly about it. I think a lot of women feel ashamed or frightened to bring this up, it might still be like a little bit of a taboo conversation, but I think also, the more we talk about it, then it's more commonplace, and you know it's a hard part of life, but if we're going through it together, holding hands and kind of laughing through it. it. It makes it much more manageable. Having a response for inappropriate comments or assumptions. You know. Really the education, not just the women, but the men, too, even children. And you know, making, I'm sure everyone understands that this phase of life is.

It's a real, it's a real change. And you know, we we grow up being educated about hormones and puberty, and then we hit this phase, and it's like, Oh, one day you just wake up and your cycle stopped. And it's you're in menopause. And you know, I, for one, didn't really know what perimenopause was 3 years ago. So just providing that education, providing resources for an employee. You know. Some employers might even want to have a champion or 2 internally to have conversations about this. I know within Nava. I kind of volunteered myself and started a little menopause chat section in our slack channel, so we can all vent to each other and share resources, because it's really that that sharing of information is incredibly helpful and just helping each other support healthy habits. You know the like everything Dr. Jordan had mentioned. Our lifestyles do take a change in this phase of life. So making sure that we are being more mindful about the way we're living our life to help us through this phase.

And then, as far as you know how we can additionally so, auditing our health plan, making sure that the benefits are there for employees. The virtual care, like putting Midi in, is like it would be an easy, simple way just to advertise that care for employees. Eap maybe re communicate it as a supplementary source, and not like a 1st call to action for employees who are in this perimenopause or menopause phase the communication plans again, just making those resources really available for folks and lean on your brokers like, you know, we have a whole communications team within Nava that we're happy to assist putting together custom communications and links to resources for folks. So it's not meant to be all on Hr. You know your your benefit partners will or should be able to help you with this.

And you know this is the pressure test, the vendors. This is where I say, in my dream world I have, you know, a specific network of menopause supported physicians. I guess that people can go to. I've seen them pop up more and more around locally, but but still it's just. It's just not enough.

And then just build in that flexibility. You know, women are going through a real struggle, and you know, the headaches, the lack of sleep. The mood swings so just having a little grace as an employer goes a long way, I think women are going to show their gratitude, and want to do more for you if you are giving them some grace and some flexibility as they navigate this phase of life.

Lauren Vetter: I I just wanna like reiterate 2 of the points you made Rachel about, you know, auditing your health plan and adding virtual care, and what I would say is what the Midi team has done is done, all of the back end contracting with the health plan. So nationally, we're in network with Aetna Cigna, Uhc blues. We're in network with about half the Blues plan. So I saw a lot of Californians. We got anthem and blue shield in California, you know. We can give you the list across the country.

But we're not a vendor. We're an in network provider. So we're probably already in network for your health plan. So where we could use your help is in letting your employees know right? That Midi's in network. So that's the auditing your health plan. Ask your broker to help you determine if Midy is covered on your plan, and then to your point about communications. Rachel, how can you weave that communications in to let let people know.

Dr. Kathleen Jordan: All right. I've been looking ahead at the Q. And A. There's some good questions I'm going to take the one on age. So hormone therapy. So there's I'm going to sub it out to 2 different questions. If you are on hormone therapy, you never need to stop right people just continue it into their seventies. Eighties. You get ongoing continued skin, hair, bone, health benefit, cardiovascular benefit. So there is a benefit, though, to starting hormone therapy as close to menopause as early as possible. As soon as the depletion starts the closer to menopause, you started the better health benefits you get.

If it's been more than 10 years since full menopause. So that we're talking about most people in their sixties.

You can still get some benefits, but the benefits are less. And then there is sort of a weird risk. Only if you only for starting new, if you're starting afresh in your sixties, there's a slight increase that as it relaxes your blood vessels, it can dislodge clots if you have a lot of atherosclerosis. So if you have a lot of atherosclerosis and heart disease. and you are in your sixties. We will talk to you about risk, and sometimes we don't start you on hormone therapy. If you are already on hormone therapy, and you've been on it since your fifties, and you're in your sixties. You just stay on it. You stay on it forever, because you don't have that risk, because it's really just in starting new.

Those guidelines change. And I think too many community clinicians tell women they can only take Hrt for 5 years, or they tell them to stop when their hot flashes are over. But we definitely know the bone. Health benefits, metabolic benefits, skin benefits, hair health benefits. Those are all those all continue decade after decade.

Another question about hair issues. Yes, hormone changes change hair. If you think about it. pregnancy. A lot of women will have hair changes with pregnancy. It's a high estrogen state, and then post pregnancy.

Your estrogen levels drop, and you'll see a lot of women postpartum losing hair. So if that was you, you are likely to have that happen again in menopause and perimenopause.

So hormone therapy itself can actually help with hair. The other underutilized sort of trick of the trade we have is check your ferritin levels. It's an iron levels, particularly with perimenopause. And those hormone changes. Your cycles get crazy, and it's over 90% of women will have some crazy, heavy period. So we see about a 3rd of women in perimenopause have significant anemia and have low ferritins. Your hair needs ferritin. So low. Ferritin negatively impacts your hair.

So you need Ferritin. And you need to. Also we also check for some other nutrients that help. Then the hormone changes themselves. You can take estrogen, it helps. And then there's some topical stuff you can do to combat.

Dht, which is basically a testosterone. As our hormones shift our estrogen levels come down our ratio to testosterone changes. So testosterone actually is starting to play a little more active role, and that can cause hair loss as well. So there's simple things you can use. Ketoconazole based shampoos that are over the counter. They can help. And then there's some other topical things as well that are prescription.

True that these are often not covered by insurance, we definitely optimize your insurance as much as we can. We send to Cvs. Walgreens wherever we can optimize insurance coverage for things that we know are not covered. We do work with some specialty pharmacies to get some economies of scale on price and cost. So, for instance, testosterone is not covered for women really on any plan anywhere.

So we've worked with a compounding pharmacy that create a solution that at least because they make it in large batches for us. We can get it a little bit more cost effective for our patients, but but there it is, cash pay, so.

Rachel Aleknavicius: And Dr. Kathleen just just to point out one thing that you mentioned the Ferritin. So that's different, you know. I'll go my Ferritin. I was one of the we had really low, but it's different than having your iron checked right like. If you go and ask for your iron to be checked. Some doctors won't go as deep to get the Ferritin checked. It's like a more thorough test or something, right? You have to specifically ask.

Dr. Kathleen Jordan: That's absolutely yeah. So Ferritin is a reflection of your iron stores, whereas iron, your blood, count, and your iron, so you can have a fairly normal blood, count, but your iron stores will be really depleted, but a low Ferritin is associated with hair loss. It's also associated with poor sleep.

So actually supplement making sure that your iron stories are great. That's a little bit less of a problem. Later in menopause, when your periods stop. But when you're having periods, especially if you're having crazy periods with that whole roller coaster I showed you of perimenopause.

You're vulnerable to it, for sure. What are your thoughts about? Glp-one S. Alongside Hrd. To help with heart and vein? Health I love. Glp-one. Si think we're actually going to make women live longer and better. So if you. They've already shown within 2 years that we reduced heart attack strokes and deaths with 2 years of use of glp, one s. So we're making people live longer.

There's that there's a reason that there, I think there's 14 currently going to be coming to market in the next few years. They are here to stay, and they can really be transformative for somebody's health as well as well as their confidence, too. Right? So obesity has been affecting 20 to 40% of Americans depending on your age and demographic, so you can use them alongside hormone replacement therapy midlife is actually, when you weigh the most. And, as I said, it's when your cardiovascular risks continue to build up. If you lose 10 pounds, your Ldl, your cholesterol actually will improve by 10 points. If you if you combat obesity, you actually risk of 7, you know, multiple breast cancers actually depletes right? Because fat is a pro-inflammatory, and it's linked to dementia. And it's linked to cancers. So we're going to see more and more of the long term benefits of these drugs and of people actually losing weight. And I think they're wonderful. There are some smaller studies that show you get a better bang for your buck. If you start hormone therapy first, st you actually get higher response rates with Glp one S.

There's lots of philosophy about. Why, that is, some of it is, you know, you generally sleeping better. You tend to be more active when you're sleeping. Better people engage in their diet and new regimen more robustly when they're energized. So typically if somebody's looking for both, we'll start hormone therapy and then we'll do the glp ones. Maybe a month or 2 later, because I don't like to start everything at once.

But I'm a believer. I could do a whole lecture on that separately are the supplements vitamins. Typically typically non-prescription items are not covered by insurance. If you have an Fsa or Hsa plan, they can be covered as long as we write a prescription which we do. So it really kind of depends on your plan for that, although I would say most are paying cash pay. So we also work to try and make them be affordable as well.

What advice do you give? Women who are not yet in perimenopause? Menopause come to lectures like this? I think, actually knowing what's coming, help you recognize when the symptoms start, because the symptoms can start at any any anytime. I also think, leaning into sort of healthy lifestyle. So we do a lot with alcohol reduction alcohol is linked to. The more you drink, the higher the it's it's not yes or no, like. The more you drink the higher your risk of 7 cancers.

So even just reducing, drinking, or eliminating drinking obviously is good for your health. So there's some lifestyle stuff. We do stuff with smoking cessation. Smoking is obviously positive impact, but also looking at your diet and optimizing your diet. It really kind of depends on your vulnerabilities, like, if you're a vegetarian, we might look at Creatine because it's hard to get creatine in your diet. So it really kind of depends on your genetics. your risk definitely get your cervical cancer screening. Get your skin cancer screening skincare starts at a young age. So there's lots you can do there, so we could talk to you about that. So anyway, lots you can do love that.

How about that for good timing? I want to thank you for sharing your story, too. Rachel, that was nice.

Rachel Aleknavicius: No, you all like I you all really did save me from yeah, a spiral it was. It was. It was a lot, but you know, and you know I so I am a like, I said, firm believer. And it's been amazing to have you being directing my care through this. So it's been making it a lot easier. Yeah, I'm the biggest fan and try and advocate as much as possible.

Dr. Kathleen Jordan: All right. So my next study coming out, I'm gonna show that we make women live longer.

Rachel Aleknavicius: Oh, that'd be great! Yes.

Lauren Vetter: There are some couple more years, Kathleen.

Dr. Kathleen Jordan: I just need a couple more years. But honestly, it's.

Rachel Aleknavicius: It's what keeps me coming.

Dr. Kathleen Jordan: No, I do think that you know midlife consumers of they're the largest consumers of health care. And what we do in midlife is going to impact how we are in our sixties, seventies and eighties we need to get. we need to optimize our bone health. Women are disproportionately affected by debility. We are 2 thirds of the residents of nursing homes. We are the largest consumers of health care because we have debility. We have twice as much dementia so like anything we can do to help our health helps us and helps us live long and vibrantly, because I don't. As I said, I don't see anybody coming to Midi, saying, Hey, I want to live longer in that memory. Care unit. Right? No. They want to live longer in their home, in their community and playing with their grandkids. but staying healthy in twenties and thirties was relatively easy. Now there's a little bit of work to it, and I think.

Rachel Aleknavicius: Sure.

Dr. Kathleen Jordan: Telehealth is a platform that can make that work easier, like accessible and friendly.

Rachel Aleknavicius: Yeah, I agree. I agree it. It makes it very easy. And so no more excuses. I guess.

Dr. Kathleen Jordan: Well, thank you for hosting.

Rachel Aleknavicius: No, thank you all for joining, and thank everybody for for dialing in. I I really appreciate the conversation. And I think it's it's a very important one to be had. So appreciate it.

Dr. Kathleen Jordan: Thank you, take care!

Rachel Aleknavicius: Yeah.

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