Episode 6
· 32:00
It's not just a heterosexual couple that may need support on their family building journey. It's not just a couple, right, that needs a family building support system in place. It could be single parents by choice, same sex couples. And casing point, seeing how that movement, I think, helped foster really meaningful change at the medical clinical diagnosis level to the extent that our professional organizations, American Society of Rubberative Medicine, actually expanded the definition for medical need for fertility support services to include anyone who needs medical support.
Jennifer Sargent:Welcome to Maternity Reimagined, a podcast exploring the future of maternal health care through the lens of innovation and human connection. I'm Jennifer Sargent, and each episode I'll be speaking with health care leaders, providers and changemakers who are working to transform how we support expecting parents and families. From hybrid care models and emerging technologies to policy shifts and real world solutions, we'll uncover insights that are shaping a more connected, accessible future for maternal care. Whether you're a healthcare leader, provider, or just passionate about advancing maternal health, this podcast is for you. Join me as we reimagine what maternal healthcare can and should be.
Jennifer Sargent:Doctor. Janet Choi is a double board certified reproductive endocrinologist and OBGYN and the chief medical officer at Progyny, where she brings over twenty five years of clinical expertise to advance access to comprehensive women's health care. As both a practicing physician and health care executive, she's dedicated to eliminating the fragmentation in maternal care and ensuring the technology amplifies rather than replaces the essential human connections that power excellent outcomes. Whether it's advocating for equitable family billing benefits, advancing integrated care from preconception through menopause, or rethinking how we coordinate support across the entire maternal health journey, Doctor. Choi has been at the forefront of transforming women's health care to be more inclusive, comprehensive, and truly centered around what families need.
Jennifer Sargent:Doctor Choi, welcome. I'm so looking forward to this conversation.
Dr. Janet Choi:Thanks so much, Jennifer, and thank you for that introduction.
Jennifer Sargent:You've had such a fascinating career evolution from practicing reproductive endocrinology at Columbia for over a decade to now leading clinical strategy at Progyny. Maybe answer a couple questions there. What initially drew your focus of your career on women's health, and then what ultimately led you to transition from direct patient care to helping transform care at scale?
Dr. Janet Choi:Thanks. So I've always had an a strong interest in women's health. Starting in my my college and and med school years, I had some great mentors. So I was learning by example at the clinician, at the general OBGYN level as well as the subspecialty reproductive endocrin level. So I had a lot of support and guidance there and kind of helped sort of through lucky circumstances into the program, you know, after I graduated fellowship back on the faculty at Columbia and was really fortunate to be able to team up with some wonderful clinicians, researchers, well as nursing and lab staff there.
Dr. Janet Choi:Really had this great opportunity there to deliver care to a whole swath and variety of patient populations in, Upper Manhattan. Also had the, you know, really good fortune in addition to delivering patient care to team up with one of my now friends and also colleagues here at Progyny, Lissa Klein, who's our SVP of member services to actually help start, way back when at Columbia, our oncofertility program. And so try to think about even back then with my teammates. And then, again, I I'm a little humbled by the introduction because it definitely wasn't all my doing. I think I was lucky to be able to team up with some very productive, forward thinking individuals and organizations, but being able to offer services for oncofertility.
Dr. Janet Choi:So in terms of how my kind of career path went, I moved into private practice because one of the gaps that I saw when it came to reproductive endocrine, now infertility care was that it's well studied and well known that mental health needs really kind of ratchet up, especially for people who are suffering from loss and infertility. The rates of depression and anxiety are much higher than the general population, and PTSD has also been studied. And it you know, we're trying to be able to navigate that system with my patients. I thought required a little bit more time. And so being able to, in a private practice setting, be able to spend if necessary forty five minutes, an hour, even ninety minutes per patient to really help them understand their personal needs and choices, I think went a long way in terms of delivering excellent clinical care.
Dr. Janet Choi:And as I was thinking more and more about the process, I felt that I was able to, as a clinician, impact, you know, individuals one to one, two to one when I was helping couples. But what I was also realizing, not just from private practice, but also my experience in academia was that there were still a lot of, people who are falling through the cracks and the gaps because they weren't getting coverage or when they did, they weren't getting adequate coverage. Then in between the doctor's visits, even if they were getting coverage or taking out a second or a third job to be able to afford the care they needed to build their family, there's still so many unanswered questions where they could fall through the wayside. And so learning from the patient experiences in my office, seeing the difference in in how having really comprehensive care from a benefit perspective that was really equitable, honoring all the different family building journeys that people can experience, seeing the impact having a a benefit like Progyny supporting the patient and the difference it made on themselves, their partners, and their families made me sit back and think, alright.
Dr. Janet Choi:I want to be able to have even a larger impact. And so it actually wasn't so quirky. It kinda made a lot of sense to me at a certain point to say, let me just take this out of the office setting, and let me sort of move it to an organizational network to be able to have and scale the impact that I really wanna have along with my teammates and colleagues who are incredibly mission and, passion driven at Progyny's. I feel very lucky to be with this team. And that's where we are today, and that's where we also continue to look at other ways to address gaps in not just maternal health, but in women and family health.
Jennifer Sargent:That's great. As someone who went through my own personal fertility journey without support or a benefit like someone from Progyny, it's just the amount of, to your point, stress and confusion around navigation, like, the support that you all provide is so important. Across your career, you've probably witnessed tremendous amount of change in reproductive medicine. And as you think about where we are today in supporting families through the entire maternal journey, not just fertility, but sort of preconception through beyond, what excites you most about this time and what you're doing?
Dr. Janet Choi:I actually think there's a lot for us to be excited about as a population, as as organizations trying to foster really positive change. And so starting first at the fertility level and family building, sort of this, like, understanding awareness and acknowledgement that is expanding and increasing is understanding that it's not just a heterosexual couple that may need support on their family building journey. It's not just a couple, right, that needs a family building support system in place. It could be single parents by choice, same sex couples. And casing point, seeing how that movement, I think, helped foster really meaningful change at the medical clinical diagnosis level to the extent that our professional organizations, American Society of Rebootable Medicine, actually expanded the definition for medical need for fertility support services to include anyone who needs medical support.
Dr. Janet Choi:So single parents by choice, same sex couples who might need medical tools and treatments to help build their families. And then looking at a larger lens, what really excites me is as terrible, for instance, as COVID was for the entire world, I think some of the takeaways that we realized really quickly, because I think in general, medicine can be a little bit slow to change, is understanding that there was value in having virtual health providership and also care navigation integrated into the medical system to help optimize a patient's journey through preconception, pregnancy, and postpartum and beyond. I think that was incredibly exciting. I also find very exciting, although I think we have to be very judicious and educated in how we use it and integrate them, are the tools available through AR guided by human expertise to try to optimize care.
Jennifer Sargent:That's great. Definitely an exciting time. Maybe we'll touch on a couple of points that you brought up there. You've been such a strong advocate for nontraditional families and making sure they have the right benefits and which is, you know, something that Pacify that we certainly support and believe in with the support we provide for doula and lactation. What advice would you give to somebody who's building a family in a non traditional way about advocating for themselves in the health care system?
Dr. Janet Choi:So I think one, for those who are employers provide benefits, a lot of folks may not realize the wealth of benefits that might be available to them. So instead of casting about feeling frustrated, first going to HR, really kind of getting guidance in terms of understanding what's actually available. And if you find that you're not getting the appropriate benefit support, it may not be due to a lack of interest or concern from their HR team. This is something that we really encourage our members, but that may be a lack of awareness and education. So speaking up can actually go a long way to try to move the needle, to try to implement and integrate more robust, rich preconception pregnancy, fertility, family building support that is covered by your employer.
Dr. Janet Choi:What I also appreciate is making sure that you're properly educated about what your needs may be. I think a lot of people don't realize some of the basic measures they can implement at home before they even consult with a physician or if they never have to is, you know, things that one can do or a couple can engage in to try to optimize the chances of a healthy pregnancy and postprimary period.
Jennifer Sargent:One of the things that is a personal passion for me, and I know it's something that Progyny has focused on, is how do we deal with and make a positive impact on fragmentation in care and not have solutions add to that? Maybe paint us a picture of what fragmented care looks like from a patient's perspective that you've seen both either in direct care or work in progeny. Like, how would someone experience fragmented care if they're trying to conceive or have reproductive challenges?
Dr. Janet Choi:I think fragmented care, there are different ways that that care can be broken about. Actually, life can be more difficult and arduous than it already is for somebody struggling with, for instance, fertility and family building issues. And so one of the issues is somebody who might have, for instance, a gynecologist who's a fantastic women's health care provider, but may not have the interest or the focus for their patient population or the bandwidth because they're time constraints to handle some of the infertility days or even some of the basic fertility workups or tests that a person might benefit from to get them onto the proper pathway for their family building needs. And so then the the member is kind of sometimes, if they are motivated, will, like, look at the Internet or look at, you know, social media for medical guidance and then get led down various warrants and and rabbit holes that may not actually lead to optimized medically appropriate services and then not know which kind of clinician to be able to turn to for their fertility needs. And so looking at that, again, looking at the most simple cases of somebody with infertility, baseline, pretty healthy medical history, uncomplicated past, having a resource at the outset.
Dr. Janet Choi:And so with Progyny, what we have is is our Progyny care advocates where the minute a member onboards, even if they say, I'm not really interested in seeing a provider yet, a position, I just want some basic advice. Where do I turn to? They turn to their PCA. And even though we have, for instance, a digital wraparound to help support that member, what remains at front and center and, again, one of the things that we also value about Pacify as well, because I know your motto is kind of the same, the mission or the focal point, is that high touch human interaction, that consistent continuity of care navigation support with one person to be able to say what I need to do at home now to optimize my chances of having a healthy baby. And what point should I be trying to find a physician to help me if I'm struggling at home?
Dr. Janet Choi:Who should I turn to, right, if I need medical support versus surveying three or four different doctors just because, you know, the Internet search kind of kind of coughed up these results for me, and I'm having a very difficult experience. Now I have to go back to score one and find a different physician. Right? So having a trusted coach care navigator who is not just, you know, your aunt Sally or your mom or your mother-in-law trying to give you advice, but someone that you can call, email, reach out to whenever necessary for touch points to be able to say, how do I stay on track for my needs?
Jennifer Sargent:You know, one of the things that we continue to focus on in our services too is how do we reinforce our member or patient's relationship with their provider, OB GYN or advanced practitioner, and how do we create better connections between our doulas and providers to help with this fragmentation of care? What do you think, you know, should happen, or how do you think about kind of broader health care and opportunities for us to better connect all the different individuals, whether it's a reproductive endocrinologist, an OBGYN, a doula, a care advocate? Like, how do you think we could help solve connecting some of that service data? Like, how are you guys thinking about that?
Dr. Janet Choi:So I think being able to have a cohesive, you know, women's family health organization system where there is constant bidirectional dialogue and awareness of what kind of care the member is getting along the way. From our fertility family building perspective, for instance, our members are constantly in contact with their PCA along with their fertility provider, whether it's the reproductive endocrinologist, reproductive urologist, and getting real time feedback as well in terms of, hey. I had a question after I was visiting my provider. Can you kind of help me, you know, further understand the dialogue that I had with my physician? And then also understanding that in between those physician visits, there may be some additional needs where the member might say, can you kind of help me understand my test results for the treatments that are being advised for me so I can see if they better if they suit my optimal needs as I grow my family.
Dr. Janet Choi:From a pregnancy, postpartum perspective, in terms of having an integrated karamata, it's also not just ensuring that the member is connected to OBGYN or nurse midwife, but also having that additional support of a member of patient advocacy and awareness and education with doula support. And what I also really appreciate, what our team really appreciates about the partnership with Pacifi is that they're available twenty four seven after the doctor's offices are closed. When a member might have a middle of the night con you know, question, how do I help my new in bed latch? I have this issue. Do I need to go to the emergency room or not?
Dr. Janet Choi:And so having that constant round the cloth support, I think helps go a long way to minimize a fragmentation of care.
Jennifer Sargent:Agreed. We spent a lot of time talking about the fertility and maternal journey. Let's maybe broaden that. I know you're focused at not just on fertility. You're sort of looking at the antidote continuum, a preconception of your menopause.
Jennifer Sargent:How are you thinking about connecting these different life stages into one sort of cohesive care experience?
Dr. Janet Choi:So I think foundationally is having each member develop a trusted relationship, again, from the moment that they onboard with their PCA who can actually flex and support them as their needs evolve. And being well aware, for instance, that there are actually many individuals who opt not to pursue fertility and family building pathways or joiners. But every single definitely, every single person born with Everest is going to go through, for instance, mood like changes. And so being respectful of each person's personal health journey and be able to provide that professional education and guidance for each member comes through the door. And oftentimes, what can happen is is we'll have members who, again, might just want reassurance, might want to flesh out some of the symptoms, for instance, in menopause they may be experiencing, but the primary care provider that they consulted with or the GYN said, you know, try to muster your efforts and try to just kind of endure, and it'll end at some point.
Dr. Janet Choi:And the reality is there is is because there is so much to learn, especially as an OBGYN, and even also as a family practitioner or primary care provider in your residency program, very little time, if any, is devoted to midlife care. And so having a trusted resource who is knowledgeable about that aspect of life, who is knowledgeable about some of the common symptoms within UpNormalize, and also connect people to proper resources, whether it's through lifestyle management. Sometimes people might say, I don't want an SOAC doctor. I don't want a prescription, but I would love to get some advice on how to optimize my nutritional needs and my movement needs. So connecting somebody who specializes in midlife nutritional support.
Dr. Janet Choi:And then for those who actually might want to look at or or contemplate prescriptive measures, pharmaceutical measures to support their symptoms or needs during midlife, connecting them to the right skilled, educated, and trained providers, whether a women's health nurse practitioner or GYN specifically specializing menopause care and getting them not only connected to those providers, but getting them connected in a in a timely fashion to help support their needs. And so I think at the heart of the program is because, you know, particularly as we think about women's health needs, anyone's health needs, they're gonna evolve throughout a person's adulthood, being able to have that consistent trusted resource as a touchpoint to be able to guide and help you navigate to the resources that you need at this appropriate time. The other thing, is really important, by the way, is the focus on, or the need, further need on looking at patient education from a preventative healthcare standpoint. I think a lot of people don't realize that things that might engage in in their twenties or thirties can actually have an impact, not only on their fertility, if they decide to pursue fertility issues, but pregnancy and ostomyelitis, and how can we try to anticipate future problems, lower the risk there by having our our members be more well educated about, what they can kinda take advantage of lifestyle wise now in terms of changes.
Jennifer Sargent:I love that. I think one of the things I love about the sort of time we're in is this focus on menopause and talking about it and being open about it and accepting it. And I love your comments and how really thinking about engaging younger women in education to prepare them for this. I also think we're at an interesting time, my own experience, where actually my maternal journey almost blended right with my perimenopause journey. Right?
Jennifer Sargent:And so you have this, you know, group of women potentially thinking about both at the same time. How are you thinking about navigating through that?
Dr. Janet Choi:So, again, I think and that's actually I'd be curious to hear more about your story only if you're comfortable sharing. But, again, that is not an infrequent issue that comes up, particularly as the age of first pregnancy and beyond has increased in this country over the, for the past decade. But it's not uncommon for, for instance, people who've had fertility issues go from hopefully successful fertility interventions, pregnancy, postpartum, assume that some of the menstrual irregularity, mood changes are just due to new parenthood, and then realize all of a sudden, oh my goodness, I'm in perimenopause for menopause, what do I do now? And so, again, being able to frankly and honestly share some of the symptoms and concerns with someone who has a knowledge base to be able to connect that member with the right resources is incredibly important. And so what we found not uncommonly is we might have members who enter the boor in our program at Progyny and our product at preconception seeking advice, find after some time, many of them will go on to conceive without assistance happily, but those who actually need fertility support will get connected to the right subspecialist providers, again, with their PC along the way, and then hopefully successfully go on to conceive.
Dr. Janet Choi:And then they'll also come back to our program for further pregnancy dietsuform and postpartum support, which also includes, you know, that proactive management and program as well as that sort of integrated care with doula support with, you know, our partnership with you, as well as benefit navigation and leave navigation because that's a full tangled and oftentimes overwhelming to have to piece out for people who are expecting and new parents as well. And then also having the member be able to say, you know what? I am now eighteen months postpartum. I haven't got a period in about three months. And even though my toddler is sleeping most nights, I am really busy and having some other mood issues I thought these should have resolved by now.
Dr. Janet Choi:What should I do? So then being able to have them reach out again to their PCA and say, you know, what do you think of the situation? Are there resources you connect to me with? And then because their PCA has the knowledge base, be able to educate and then sort of validate their symptoms and say, you know what? This could be heroin policy changes everywhere.
Dr. Janet Choi:We consider that. Can I connect you with a resource if your, drug and motor position is unavailable right now? And so that's how the cleaning of care clinic. Further integrated is for those who might have the special plus delivery, some pelvic floor issues. So there are a lot of women, whether they deliver via vaginal delivery or cesaremaline sectionaliva, just the trauma of pregnancy itself on the body in the pelvic floor might find that they have some pelvic floor nades, so connecting them to the right, you know, credential resources on the pelvic PT side.
Dr. Janet Choi:So that's all integrated there as opposed to having that member kind of cast about having to do their own provider shopping.
Jennifer Sargent:That's so great. I think this concept of having the PCA be with the members through that journey potentially as they're transitioning in a different phase is is so powerful because you have this person who knows all of your history and can connect it versus, you know, my experience of I had my second baby, you know, mid forties and then started to go through my perimenopause journey. And I'm sort of like, when I go to this right. I don't really have one person who's sort of been along with me to say, like, yes. This might be normal.
Jennifer Sargent:Oh, this is a tiny. Right? So I just think there's such incredible power in that longitudinal relationship that you can have with somebody like that to see you through those multiple journeys that we don't often get.
Dr. Janet Choi:And I agree. And, you know, you also might have a fantastic gynecologist OB GYN that you love and trust and or a primary care doctor. But, you know, if the next available I know my experience has been, you know, here in Manhattan is is unless I have an acute health issue, if I wanna see my gynecologist, it's gonna be about a four to six month wait. So then being able to sort of reach out to somebody sooner like today or tomorrow and just say, just, you know, wanna run this by you even though I have this appointment set up and then have that PC be able to say, can I also connect you with some resources that are available within the next two weeks?
Jennifer Sargent:Maybe shifting gears and kind of on this same topic of continuum of care and how do we better care for the member throughout the journey. You know, we spend a lot of time talking about mental health during both maternal, perimenopause, menopause. Talk to us about how you're thinking about combining, you know, that sort of support into your solution, connecting members to the right resources, or what are you seeing there?
Dr. Janet Choi:Yeah. I mean, so as you're very well aware of, mental health issues are a major concern and need. I think for a large part of the population, not just those going through pregnancy or infertility, but definitely a need there. And it's actually one of the leading causes of maternal morbidity and mortality. And the other concern, and then we'll kind of go over some of the solutions we're working on is in the midlife era too, mental health needs, depression, anxiety, whether a person has experienced them in the past or new onset also spikes.
Dr. Janet Choi:And what I find very concerning is from talking to a colleague is the increased rate of suicidality too around that time. So the needs are great. It's still, I think, unfortunate that some people view it as a stigmatized area of health care that sometimes members might be patients that be reluctant to bring up unless they're actually actively asked. And so although we don't provide under Progyny at this point, you know, mental health providers, we're the front door in terms of our PCAs do offer and deliver the appropriate mental health assessments as from the lens of members sort of understanding and self awareness to say, hey. On this, you know, PHQ screen or GADS or GADS seventh screen or GADH screen that we did or the Edinburgh postpartum, the postpartum, The score, it kind of suggests that you might actually benefit from some extra resources and needs.
Dr. Janet Choi:Can do you have a mental health provider? And if not, can we actually help you connect with some of the mental health resources that are actually readily available through your employer benefits as well. So I think we're kind of the the front line in trying to ensure that people are not falling through the gaps, that they're being asked the right questions, again, because I think sometimes people may be suffering quietly and not not even know how to ask the questions or ask for.
Jennifer Sargent:So true. And I think, again, back to this, like, having that PCA that's sort of been with you on your journey, it's a great way to to identify needs and get people access to such impactful care. As you think about, you know, the broader support for nontraditional families and all the people involved in the maternal journey, talk to us a little bit about how you're thinking about supporting birth partners and particularly men in the pet sort of family building journey.
Dr. Janet Choi:I'll start off with an anecdote. We are basically agnostic in terms of who we support in terms of the member. And so one of my favorite more recent stories was a Progyny pregnancy member who was in active labor and had been in regular contact communication with her p three nurse then went into active labor. And the p three nurse actually had an outreach call and conversation not with the actual, expected mother, but with her partner who needed some guidance because it was their first pregnancy, was rushing to the hospital to meet his partner there and support, but was a little bit at sea in terms of what else in a panic, what else should I be thinking about and thinking about doing to best support her in the labor room. And so, our P3 nurse actually was able to offer guidance and education and some tips, and most importantly, trying to minimize some of the stress and anxiety that that male partner was experiencing as he was heading over to a hospital.
Dr. Janet Choi:And so we are making sure that we're trying to not just help the expectant parent, but if there's a partnership, making sure that the that the partner is also supported. This also starts even in the preconception phase, so even prepregnancy. We think about some of the male members who call into our preconception team asking about what can they be doing to try to promote the health of their partnership and minimize any future medical needs? We also offer testing for those members who wanna do home testing as well. We're working on that so that they can actually be more proactive in that partnership as they're thinking about family building from that perspective.
Dr. Janet Choi:Again, back to the whole integration with leave and benefit navigation, which can be, again, incredibly stress inducing and overwhelming, providing support for both partners along that way to make sure that they can sort of understand the benefits that they have available, how they might be able to stagger parental leave to make the most of each of their benefits into the postpartum period as well.
Jennifer Sargent:That's great. What gives you the most hope about where we're headed in terms of supporting families through their journey?
Dr. Janet Choi:I think programs like ours and yours, right, and how we can work together. I think what gives me a lot of hope and optimism is the fact that there are so many organizations as well as individuals who are really working proactively to really study out and intervene and improve on maternal health through solutions that they're building or developing or through partnerships. I also appreciate the fact that there seems to be more of a drive now for proactive engagement of members of patients trying to anticipate and hopefully prevent problems early on in life. My experience has been that there are more and more younger aged adults who are trying to take their health in their home hands in a proactive manner to sort of say, what can I do now to minimize the chances of having a fertility complication or having a pregnancy complication? You give me some advice?
Dr. Janet Choi:Can you give me some education? Whether it is through dietary adjustments. So I'm thinking about, for instance, people who might have, you know, women who might have polycystic ovarian syndrome coming in, whether they've frozen eggs recently or they've had a new diagnosis and they want some better information on what they can do from a a movement, dietary, and preventative sort of medication care model to optimize their health and potentially even reduce their need for medical interventions.
Jennifer Sargent:Agree. I think it's a really great time, and I have a lot of hope and optimism as well. As we wrap up, what's the most important thing you want our listeners, whether they're providers, expectant families, or just advocates for better maternal health to take away from our conversation today?
Dr. Janet Choi:I'm actually very hopeful about the changes that we made. I think there's still a lot of room for all of us to improve and grow on. And I think that recognizing that there are sort of comprehensive solutions at hand to help address the individualized needs of the patient population. Again, looking for instance at the integration of doula care, looking at specifically maternal health, there are now studies that suggest that you know, doula support, both predelivery and post delivery, can go a long way to mitigating some of the complications associated with pregnancy and particularly for populations that frequently feel and are marginalized. And I think taking a bigger picture look at how health and medical care can be delivered and supported, I think, you know, it's an exciting time.
Jennifer Sargent:Doctor Troy, thank you so much for joining us on Maternity Reimagined. The work that you're doing at Progyny to eliminate fragmentation and increase access really aligns with our mission to reimagine what maternal care can look like when we put human connection and comprehensive support at the center. Molly's so grateful for leaders like you who are working to transform women's health from the inside out.
Dr. Janet Choi:Jennifer, thank you so much for the opportunity. I really enjoyed the conversation.
Jennifer Sargent:Thank you for listening to Maternity Reimagined. I'm your host, Jennifer Sargent. If today's conversation resonated with you, please subscribe and listen wherever you get your podcasts. And be sure to share this episode with those who, like us, are passionate about reshaping the future of maternal health. Until next time, as we continue to build bridges and transform maternal care together.
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