It's no secret the U.S. healthcare system is frequently hard to navigate, even for industry experts. 

Finding doctors, figuring out insurance and accessing care can be a particular challenge for young people who are doing it for the first time, said Lori Evans Bernstein, CEO and cofounder of Caraway. Young women and others assigned female at birth also face a complex landscape of abortion restrictions as well as a growing need for mental healthcare in the wake of the COVID-19 pandemic.

Caraway, which offers virtual mental and physical healthcare geared toward women ages 18 to 27, has been expanding into new states, most recently adding services in Ohio and North Carolina. The startup emerged from stealth over the summer with $10.5 million in seed funding.

Bernstein sat down with MobiHealthNews to discuss Caraway's rollout in new states and what the startup has learned since its launch in September.

MobiHealthNews: What are some of the needs that have come up in the population that you're serving: young, college-age women? Is there anything that's surprised you? 

Lori Evans Bernstein: There's a lot of questions about birth control. There's a lot of questions about ADHD. That's an interesting one, because we have a lot of expertise in the company on ADHD, but we're not prescribing stimulants, we're not diagnosing ADHD, we're not refilling a prescription. But we do have incredible expertise with our chief health officer, with another psychologist, and so we're able to answer questions about it. And our plan around ADHD – down the road, next year – is to start with a lot of executive functioning coaching and then to see what our path is to begin supporting patients with existing diagnoses. And then new diagnoses. So we're committed to it, but we're getting a lot of questions there. 

A lot of nutrition, a lot of supplement questions, which is sort of interesting. The way that members asked about mental health, they may be feeling a lot of stress and discomfort. We were seeing a pattern with a lot of really significant stress and anxiety. So we were quickly able to develop a toolkit for stress tolerance skills. It's an audio clip that walks through the steps to do that, that members can listen to all the time in the app. 

One of the plans we have for later this year is to release a mental health wellness program that is in the spirit of teaching skills. They're digital tools that the member interacts with, that the care team can comment on and engage with the member around, and then therapy can be dialed up or dialed down in the context of what's going on for that individual member. And so we are almost ready to roll the first piece of that out. But we were seeing so much stress tolerance issues in the beginning that we were quickly able to get something out there.

MHN: Why did you see this as an important group to focus on for Caraway?

Bernstein: The short answer is the tsunami of need. We were seeing access to care being really, really limited. The mental health crisis that was brewing before COVID really escalated during COVID, and in particular, for women.

In our view, you can't treat mental health effectively without treating physical health. The mind is connected to the body; we see them as inseparable. So we were seeing this in the data, in the headlines. I personally have a lot of friends and family in this age group that I was seeing firsthand the suffering that they were going through. And then when the Dobbs decision happened, we, of course, had another crisis happening. The higher ed press was immediately talking about the Dobbs decision being another crisis on college campuses. 

So this tsunami of need combined with just inadequate options for 18- to 27-year-olds. Whether it's student health or urgent care, trying to find physicians, trying to get appointments, having just a really hard time navigating our system and navigating insurance. Our model is to be as proactive and personalized as we can. We want to teach our members health as a life skill. We want them to really understand and engage in that journey, gain independence and gain agency around decision-making.

MHN: You recently announced plans to expand in North Carolina and Ohio. Ohio has restricted access to abortion, while the situation is precarious in North Carolina. What's your strategy for reproductive care there?

Bernstein: We have to take a state-by-state approach and really examine all the implications, the legal implications, the medical malpractice implications, the privacy implications, any advertising or employment. 

We feel the answer in restricted states is contraception and education – and being able to, to the best of our ability, help women understand their bodies, understand their menstrual cycles, talk about contraception and advise on choices. 

There's a lot of choices these days. We have an adolescent medicine physician on our care team who was just at an American Academy of Pediatrics meeting, and there was a lot of discussion about long-acting reversible contraception, which are the IUDs, and then, there's now an implant. They're not prone to user error, and they last a long time. We initially will look to refer women to get those if that's what they want to get. Next year, we're hoping that we'll be able to do some of that from an in-person care perspective. But we really want to educate, and we really want to lay out the options for contraception and help advise on what's best for young women. 

MHN: You've had an established career in healthcare and health tech, both private sector and public sector. How has that affected the development of Caraway?

Bernstein: It's been a long time in different aspects of the system and trying to drive change, and everybody is working hard and using their best efforts to drive improvements. But we're not doing a very good job, like the collective "we," right? Costs are going up, and quality is going down. 

When you think about Gen Z and everything that we know about this generation and wanting to initiate a proactive approach to care, showing a different experience for the system – given the tremendous need at this age already – and really setting the tone for systemic change that needs to happen over the longer term. I think if we're showing this generation a different experience, hopefully, that will inspire continued change to the system.