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Welcome, everyone. I'm your host, Caroline Schillaci, and today I'm speaking with Tara Raffi, founder and CEO of Almond ObGyn. Almond is a female-founded venture-backed startup aiming to revolutionize obstetrics and gynecology care, supporting women and birthing people on their health journeys as of 2022. Almond's core vision is simple, provide top-tier ObGyn services, both in-person and via telehealth to build women up and help them realize their health goals more quickly and efficiently. Founded by Tara Raffi and Carly Allen, Almond has quickly become a trusted partner in pregnancy planning, birth control, counseling, vaginal infections, general wellness, period management, and sexual health services for its members. In 2024, the duo made Ink Magazine's Prestigious Female Founders list for launching a full-service ObGyn service that aims to make it easier for women to take care of their reproductive health. Thank you so much for joining us today. I am so excited to dig into this conversation.
I'm so excited to be here.
Amazing. Let's kick things off with the primary inspiration for creating Almond. Can you walk us through that a little bit and then also share what you see for its future?
Yes. So the story starts in a really small room in the back bowels of a hospital system somewhere in Colorado. I was a management consultant and I was taking a break from the really challenging financial services work that I had been doing in New York to do an easy project. So I was like, "Okay, what's the easiest, most boring project so I can just relax?" And everybody said, "Oh, go work in a hospital." And I had never wanted to work in healthcare. A lot of my family's in healthcare, and I thought, "That's just not for me." And I went to go to this dimly lit room to work, and it just totally changed my life. It was the most interesting work by far that I had done my entire time at McKinsey.
And the reason for that was healthcare is so, so important and the challenges that we were working on solving in healthcare felt so basic and elementary. And that combination really captured my attention and it actually made me pretty angry, especially as a woman because there's a personal aspect to this story. I was actually sitting in this room working 18 plus hours a day. I guess it wasn't that easy after all. And I had a urinary tract infection and I couldn't get a prescription.
Oh my goodness.
And I [inaudible 00:03:10], "Wait, how is this possible? I am sitting in a hospital and I can't get a prescription for this terrible feeling." It was a moment for me where it just really all became very clear, this is really broken. And then we know as women, we sit around and we talk about our healthcare experiences, and it's a very common complaint that we have, that we all know is sort of a norm, that we're not getting the kind of healthcare that we want as women. And it's even worse now that we are working so much and expected to, and that we want to have full-time careers, and we have a very heavy healthcare burden to maintain and care for our reproductive health and our primary healthcare. So it just seemed obvious that this needs to be worked on.
And then when you look at the market, you see, okay, well there's One Medical and there's Tia, and there's all these companies doing incredible things in the primary care space. They're making primary care so much better and we're so thankful for those companies. But who's doing that in ObGyn? Which is the second biggest specialty after only primary care. It's not some small subspecialty off in the corner. This is one of our primary ways of interacting with our health system and one of the most important, one of the most emotionally and physically impactful of our lives. And there wasn't a modern alternative. And so it seemed like a no-brainer. So left my job consulting and went out and started Almond, and just here we are making it easy to get better basic ObGyn care.
I love that. That's so inspiring. I think you touched on something that probably every woman goes through at some point, but just the anger of the obstacles or the challenges that you face when you're either trying to do a regular appointment or to find care for an issue that you're facing, it can be so difficult, whether that's reaching out and actually getting an appointment, messaging a doctor in an archaic system. So I completely understand, and I love how that anger that got channeled into the creation of Almond.
Right? Why do you have to leave your desk multiple times when you're working to call your doctor's office to hope you get somebody not on their lunch break, so you can just wait so you can get an appointment? It's bonkers.
Yeah. So we started to touch on some of the challenges that women face, but what do you feel are the most pressing challenges that women are facing in healthcare today?
So there are a few. One big one is just this norm that we hear all the time that women are told, "Just deal with it." There's this perception that, "Oh, well, women are complaining or they're making this a bigger deal than it is." And that's a really paternalistic view of women and women's healthcare. Actually, John Oliver does a really great segment on bias in healthcare, and he talks in particular about bias against women in healthcare. And we see the reason for it. I mean, we have grown up, our health system has evolved in a way that is largely led and informed and structured by men. So it's not a surprise that it's that way. We're not blaming people for that. We're just saying, let's acknowledge that we need a more female-centric focus on healthcare because women have different needs. We have a different complexity to our bodies and to the way that our hormones interact with our reproductive needs earlier on in life. And we need that to be acknowledged.
So the, "just deal with it," mentality affects us throughout our lives from early on. When people say, "Period pain? Just deal with it. Just stop complaining. Just keep working. It's going to be fine." Or people who have PCOS, which is 8 to 13% of women, and they're told, "Discomfort, weight gain? Just deal with it, or, "Take this birth control pill, that's the best we can do." And then it comes to pregnancy and expectation is there are these really uncomfortable things that happen to your body. "Oh, well, it's normal." And then don't even get me started on menopause. I mean, on the other end of the spectrum, menopause, there's a generation of women who are working more through perimenopause and menopause and they're being told to deal with it. And they're angry. "This is not acceptable that I'm feeling like this, and there is no answer."
And Miranda July actually just came out with a really good book called All Fours. It's a very spicy read for anybody who is looking for something uniquely entertaining. And if you have not come across Miranda July, unique, is a very watered down word to describe her. It's one of the first books that I've come across that even talks about perimenopause and menopause in a socially relevant way. So I think that the, "just deal with it," mindset is really toxic to women. There are a couple of other things from a more structural perspective, this affects not just women, but also men, as a healthcare system are not doing enough to bring preventative care into our standard of medical treatment. We are using a lot of old research when there is new research that can really support better, richer, more productive preventative healthcare.
And there is a growing movement around actually, interestingly, wellness industry that has maybe played a hand in moving preventative care more into the spotlight. And that's so important because we do have chronic disease epidemic in this country, it's a very serious problem. There are many Americans who are spending the last decades of their life with chronic disease, and we can do things earlier on in our lives to prevent or to lessen the burden of chronic disease, but our medical institutions are not as focused on that as they should be. And so that's really focusing on diet, exercise, sleep, stress. That's number two. And that affects women in unique ways.
And then I think number three is just there needs to be more research, medical research on women, and in particular involving pregnant women. And that's been a structurally difficult endeavor in some ways because people who are running studies have some requirements for statistical significance. And so perhaps sometimes it's easier to leave out women or pregnant women complicate the quality of the results. And it's more expensive to test on men and women and pregnant women and to really explore the differences and outcomes, but that's something we need to invest in.
Yeah, you touched on so many important things. I think back to what you were saying, "Just deal with it." I think that's the biggest complaint out of all my girlfriends is that they're typically told, "Oh, it's so common. It's normal to have this level of discomfort. Don't worry about it. It's no big deal." And I think that can be really isolating too, because it's also such a vulnerable part of your body too. And health is not something that people normally talk about. It's not the first thing or part of conversation.
So I love that transition, like you're saying, to focus more too on bringing more awareness and then also focusing on preventative care. I mean, that makes me think too of that research that just came out about how they were saying eight hours of sleep that was only studied on men, and now they're looking at, "Oh, what is needed for women?" So I completely agree there definitely needs to be more research done. We talked a little bit about how healthcare systems can be improved to address the needs of women. Anything else that you feel in your mind can really move this conversation forward?
I think the other thing that's actually uniquely relevant to women is community. It's one of those things that can be brushed aside, like, "Okay, this is like science. Let's be serious here." But there is research behind how creating community for women does improve healthcare outcomes, in particular in pregnancy. And actually we just at Almond released a different model of pregnancy care called group pregnancy care. And it's something that we very proudly did not invent at Almond. It is a model that has been tested for decades and that has shown better outcomes.
And the way it works is it moves away from the traditional model of 15 or so prenatal visits one-on-one with an OB to a group model where you're in a cohort of other women, you stay with that cohort the whole time. Your visits, you have about 11 visits, 90 minutes each led by a midwife and a few visits solo with an OB. And those group visits, you get much deeper education and understanding of what your body is going through and how to make your own decisions instead of just relying on a five or 10 minute visit with your OB to be given the instructions from up above and just to go execute on them like a computer. That model doesn't work. You're making hundreds of thousands of decisions. You need the information so that you can operate with agency.
But group care is not only good because of the education, it is also good simply because it is a group. You build connections with people, you understand what they're going through, you don't feel alone. And that has shown in studies to have an impact, a reduction on postpartum depression and anxiety. And that's a really big deal because not a lot of people know this, but suicide is a second leading cause of death for women postpartum. That is a medical issue. And so when we see that that's a medical issue are we continuing to give women medical treatment for pregnancy in these fast, siloed, isolating, abandoning models? And women are huddled at home alone feeling like, "Well, I'm broken. My body's broken. My mind is broken. Why am I going through this? Yeah, maybe I'll spend a little time talking to my friend who gave birth a year ago or maybe hasn't given birth," but that's not enough. So community can be really powerful in women's health as well.
Yeah, I mean, I think that shouldn't be understated. It's so important just from personal experience, I was just telling you, I was just at my ObGyn and I had all these questions and he was busy typing on the computer, and I just was like, "Are you listening to me?" And so after I went and asked Reddit, I spent five hours deep diving and my husband was like, "What is wrong with you?" And I was like, "I just need to be able to relate to someone, to see someone else asking the same questions. I want more information. I want to feel heard." So I think that community aspect and what you're doing with the group care is so significant to people.
I mean, we're human. We're not computers. And doctors talk about this too on the other side. My sisters are doctors, and I was having a conversation with one of them. She was like, "Had this patients came in and read this thing on Reddit. And how do I tell her that that's just fake. This is not real." This is our conversation at dinner. And it's like, okay, well first of all, I feel for her in that case. And also the big picture, people have this need to go to Reddit. So let's solve that problem.
Yes.
Instead of complaining about patients going on Reddit, let's give an alternative to Reddit. That's actually better instead of just being like, "Don't go on Reddit." Well, there's a need there.
It's so true. I completely agree. And then what about the design of healthcare spaces? How can they better support women's health?
Oh, well, where do I even start? I mean, we all know that the feeling of like was this bought in a yard sale in the '80s and when has this been replaced? And I think the question is why can't medical spaces be beautiful? It's not that hard. It doesn't have to be that hard or that expensive to create a beautiful space. It just needs a little bit of love and care and attention and just an acknowledgement that the space that we're in affect our perception of an experience and the experience itself. And in a world in medicine, when we have up to 70% non adherence to treatment plans when treatment gets complex, there is a lot of psychology behind medical adherence and getting patients to connect to their doctors and their healthcare teams so that they actually follow their recommendations and the space that you're in and the message that sends plays a part in that.
So when we started Almond, we set out to just build something very different with our space. We built out our first location in LA is about 1,000 square feet. We built it out from scratch, and we had a couple design principles in mind. One was just, and I'm not a designer, I'll probably misuse the official words, but we wanted the space to feel full of light and airy. We wanted the space to feel natural, so to use natural woods and natural feeling fabric. The idea was we're so lucky to be given these bodies and to be able to experience the joy of living in this beautiful garden, why shouldn't engaging in your healthcare feel like the epitome of worshiping and celebrating that bounty?
I love that.
So there's a lot of fruit kind of tones, and we have fruit stickers that are at the front.
Cute.
And we built out this space for $75,000. It wasn't a $2 million build out, doesn't have to be a $2 million build out. Less is more. We have concrete floors. But people walk into the space and they look around and they're like, "This is my gynecologist?" Or they walk out and they're like-
Yeah, I've seen the photos. It's so welcoming. It just immediately puts you at ease.
Thanks. Yeah, that was what we were going for.
Yeah, and I think it takes away all of the preconceived notions too about the scary doctor's office visit as well, right? The very brightly lit fluorescent, like you said, chairs from gosh knows how long ago. It's a total change in the way people experience healthcare.
Yeah, exactly.
And then what about the role of access to reproductive health services? How does that play into overall women's health?
So it's interesting because a lot of our most intense engagement with health care in our teens, in our twenties and our thirties happens at the ObGyn, happens in this reproductive first lens, for whatever reason. Maybe it's you want birth control or you want STI testing or want to start preparing your body for pregnancy or going through pregnancy yourself. And because of that acute need for reproductive healthcare, this ends up being the gateway to healthcare in general for a lot of women. And so there's actually a responsibility on ObGyns to be offering a welcoming place for people to get a broader spectrum of their needs met, because they can so often be that face. People have a bad experience getting their reproductive healthcare at their ObGyn or at Planned Parenthood or wherever people are getting reproductive healthcare, it makes it that much harder to engage in just general primary preventative healthcare.
Yeah, I think that makes absolute sense. It's more of a hindrance too to them continuing to seek out the care that they need.
Yeah.
And then how do you see the future of women's healthcare evolving over the next decade?
This is, I think, such a good question and I think something that all Americans should have a perspective on, because our healthcare system has a lot of challenges. Big picture, I think the first set of changes needs to come on a system level. We have some unfortunate aspects to our healthcare system design. I think we should have a single payer system, which means one single entity that is the health insurance provider for the country, which allows us to set prices centrally. And the reason why that's important is it reduces a lot of inefficiency that comes from having prices being set by many different insurers, and it creates so much work just to maintain a competitive environment where prices are being set by different entities.
I guess taking a step back, I'm a capitalist. I believe in capitalism in so many ways. I do not believe in capitalism in healthcare. I believe it breaks in healthcare. Because in a capitalistic model, the prices are set according to need. That's what determines need, and supply and demand triangulate to determine prices. But in healthcare need is infinite. What would you not pay to not be sick, to not die 10 years earlier? Infinite, your money doesn't matter. We're not taking our money to the grave. So capitalism does not work in healthcare. And what it does is it creates messed up incentives where ultimately the person who has the least power, which in our model ends up being the individual consumer loses.
So I think we should have a single payer system. I think payers, insurers should be public. We should not have private companies who are returning a 20% or whatever percent profit margin to their investors. Again, like why pay $1.20 for a service that you can pay $1 for when it has to do with your healthcare? Last I checked, Kaiser Family Foundation reported that a million people were going bankrupt from medical debt a year in the US. I mean our healthcare is too expensive.
Wow. Yeah.
There's actually a really good book for anybody who's interested in this. It's called The Healing of America by T.R. Reid. He's a reporter, it's not overly medical or complicated, and he tells the story of eight different countries and how their healthcare system evolved. And it's fascinating. Because we like to think, our American centric view is, "We're the best, we're the most advanced." And in some ways we are, in some ways our health system is the most advanced. But in a lot of ways it is backwards and wasteful. So that's on the system side.
On the other side of things, I mean tech is bringing such great things to healthcare. I was actually having a conversation with a CTO of a non-healthcare company. We were talking about ChatGPT, and he was moved to literal tears talking about the impact that ChatGPT, that large language models broadly are going to have on our healthcare. It was a totally wild experience seeing a little bit into that lens. And I think big picture there is so much research and science that is going to be progressed by large language models and GenAI more generally. But even before that, tech is bringing so much benefit to healthcare. We have more telehealth which improves access. We have more personalized healthcare, and we don't have to be sending the same 40 page PDFs on IUD insertions to every single person. You can actually give more relevant, targeted advice. And we have more testing and more access to better data on our individual health. So lots of great things are happening in the future.
Yeah, that's great. I feel like a lot of progress has been made, so it is exciting to see what the future could hold. A lot of challenges to still overcome. And speaking of, what about other barriers that still exist for women, particularly in rural or underserved communities accessing healthcare?
Yeah, I mean, the big one is there's a shortage of ObGyns, and that's only worsening. We're projected to have 5,000 too few ObGyns by 2030, out of a total of 50,000 OBs in the country. So that's 10%. So imagine one in 10 or 11 of your visits you can't do. And that's on top of an already constrained supply of ObGyns in rural areas, but also even in urban areas. I mean, the average wait time to see an ObGyn in Los Angeles is 26 days.
In New York it's a couple of months. It's crazy.
Yeah, that's crazy for primary care. And then this is just getting worse, we don't maybe see this as much in California or New York, but this is worse because of Dobbs. Obs are afraid. I have actually interviewed multiple OBs from states that are affected by really draconian abortion restrictions. They're leaving those states. They don't want to go to jail. And also, it's not even about going to jail. It's also emotional. Their patient population's telling them, "We don't ideologically align with you. We don't care. We don't value this service that you're doing." And so just aside from the fear, a couple of these women that I've spoken to have left. They're like, "I'm not welcome there." So pushing doctors out of communities in those ways is also a really serious risk.
Yeah, it's scary. Huge emotional toll, I'm sure. And then what were some of the challenges you faced with starting Almond? And how did you overcome them?
Well, running an early stage company, actually one of our advisors at YC puts it this way, running an early stage company, you wake up and you ask yourself, "What's going to be the big slap in the face this day?" And I think that's very true. I think it's early stage companies are hard. There are always some pretty big challenges. But you do it. Well, I should say, I shouldn't leave it there. That's kind of depressing. You do it because you really care about what you're creating, what you're bringing into the world. And at the end of the day, it's still a no-brainer to go to sleep and do it again the next day. Despite the impending slap in the face, it is the most rewarding, exciting, interesting work I've ever done, and I'm really grateful to get to wake up and do this every day.
There have been some really big challenges. I think the earliest one was just raising money for this business. I left consulting and thought, "This is a slam dunk. This is a huge market. Nobody's offering this service. Women are asking for this. We want this, we need this." And so I put all that in my pitch deck and I went out and talked to a bunch of VCs. I was like, "We're going to raise X million of dollars." And it didn't work. And we got pretty close, but we ended up not closing that round that we wanted to when we went out the first time.
And we ended up doing a much smaller round. We got friends and family who knew us personally, who believed in us to bring together the very first small micro-round of funding. And ultimately, it took over 180 investor pitches before we got a big yes. And just to put that in context, some of the really successful male founders talking about their fundraising experience, and they're like, "Yeah, you need to expect that you're going to get a lot of no's. Like you might get like 30 no's before you get a yes." That's what we were going into it with 30.
Wow.
It wasn't 30, it was a lot more than 30. And that was challenging, but also we just knew that they're wrong. We knew that they're wrong. We knew that the numbers are stacked against us. We're pitching to mostly male VCs who despite... It's not a sexist thing that they don't want to fund women. They do want to fund women. They really want to. But in order to fund a company, it's so personal, it has to really make sense in the core fiber of your being. And how can we expect a man in the fiber of his being to understand what it feels like when you're pregnant and your doctor tells you, "That's just not a big deal."
Yeah, exactly.
Or, "I can't take your phone call." You can't put that feeling into words. It sucks. It's scary. It's infuriating. But listening to me say those things, if you haven't been there, it's only going to go so deep. And so we ultimately persisted until we found people who understood the type of business that we were in. So we found great investors, Brit Morin at Offline Ventures, Tony Conrad at True Ventures, Surbhi Sarna at Y Combinator, some founders, Caesar Javaherian, the founder of Carbon Health, Steve Eidelman, the founder of Modern Animal. I mean, just truly smart, thoughtful, really extraordinary people who also understood this market, and that was a big break for us.
That's amazing. I think that leads into my next question too, because obviously there were challenges that you overcome, but you persevered. So advice you would give to others seeking to improve, whether that's the healthcare industry or any industry, if they feel like they might be stuck in those early phases?
I think the big one is people say, "Do what you love," which makes sense. I think the big one that comes before that is have a point of view. This was advice given to me. I think this was, I don't even remember, I must have been like 24 and I was considering a job at a VC. And I met with somebody with a VC in San Francisco, this big office. And I was basically trying to convince him to give me a job. And I was like, "I love analysis of all kinds. Any problem, give me any hard problem." I'm so grateful for him because he was so brutally honest. He was like, "That's just not that convincing. I don't care that you want to work on every hard problem. I want to know what you really care about, which problem you really want to solve. What is keeping you up at night? And think about that, and then let's talk."
And I was kind of embarrassed. It was like, "I just met this person and he is telling me that I'm full of shit." But I'm so indebted to him because it wasn't even about getting a job in a VC. I didn't even ultimately want to work in a VC. But it was just a good advice. Why spend your time spreading your brain energy across all these different things just without focus? It was really about focus. And I spent a lot of time thinking about that, and I thought, "Yeah, what is a thing that just I care about that makes me crazy that something doesn't exist that way?" I think it was Brad Feld, who's an influential VC, who said... I might be misquoting this, somebody should correct me, but he looks for VC, he looks for founders, to fund founders who are delusionally optimistic to the point of obsession.
I love that.
And what is that thing for you? So I think that's the first one. Find that for yourself. And then all the other things like do what you love and never give up. It's so much easier to never give up if you're doing something that you're delusionally optimistic about. And then the second one is just classic, but so true is surround yourself with great people.
Yeah.
The great people will pull up a struggling product or service or any kind of challenge to their caliber every time.
Yeah, I love that. I also think those people being delusionally optimistic as well helps to fuel that passion and push things forward too.
Yeah, exactly.
Amazing. This has been so inspiring. I appreciate the time to chat through everything, and thank you again for being with us on The Design Board.
This was so fun. Thanks for having me.
Thank you so much for listening in with us today. We hope you leave inspired by the ideas in today's episode. For more, follow UpSpring on LinkedIn and Instagram, and don't forget to check out the amazing lineup of shows brought to you by the SURROUND Podcast Network at SURROUNDPodcast.com.
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