Investors are opening their wallets to fund startups that promise to tackle the healthcare disparities endured by the growing population of people who identify as LGBTQ.
In the first half of this year, funding for LGBTQ-focused digital health tools already more than tripled compared to investments in all of 2020, according to digital health consultancy Rock Health. As the LGBTQ digital health space is relatively new, most companies in this category have received only seed investment and Series A rounds.
Companies such as Denver-based Plume, Boston-based Folx, New York-based Included Health and others say their missions are to empower marginalized individuals by offering care from culturally competent staff, as opposed to forcing LGBTQ individuals to meet with providers who may not understand—or may be openly hostile—to their care needs.
The demand for LGBTQ-centric healthcare is growing. Six percent of U.S. adults now identify as LGBTQ, according to a Gallup poll conducted last year. A clear generational divide suggests that share may grow over time: 16% of respondents from Generation Z identify as LGBTQ compared to 2% of Baby Boomers.
"It's not that we're having more queer children, it's just from a societal and generational perspective, people are feeling more comfortable being out," said Included Health CEO Colin Quinn.
As the potential need for healthcare services for LGBTQ people grows, their struggle to access care persists. More than one-third of LGBTQ people said providers either blamed them for their health problems, dismissed their concerns, made false assumptions or did not believe they were telling the truth about their medical conditions, according to a Kaiser Family Foundation report published last month.
LGBTQ people are more likely to have chronic health issues than cisgender heterosexuals, and the COVID-19 pandemic disproportionately impacted their health due to foregone care, the report documents. Quinn, who identifies as a gay man, said he started Included Health, in part, because of the barriers he and other LGBTQ individuals face in accessing compassionate, accurate care.
"2020 was really a year of cultural awakening," Quinn said. "Employers had this opportunity to reassess their benefits and say, 'Actually, this one-size-fits-all approach to healthcare and benefits doesn't work for our employees.'"
There is more of a desire to offer curated care navigation and telehealth designed for specific subpopulations, which is important for engagement and meeting individual health needs, said Rock Health COO Megan Zweig.
But the go-to-market strategy and prices of these startups have raised the eyebrows of some in the LGBTQ community, who say the mostly heterosexual, white, cisgender male venture capitalist community is doing nothing more than cashing in on rising awareness of the plight of these underserved patients.
"It feels like venture capitalists are like, 'You know, trans issues, they're in right now and so we want to get in on that,'" said Chris Barcelos, a professor of women's, gender and sexuality studies at the University of Massachusetts Boston.
"That's, to me, pretty gross, that trans people are a trendy topic or something that you can make money off of," Barcelos said. "On the other hand, and this is a long-standing debate in social movement work: Do we take money from people whose politics we dislike if it enables us to do the work in our communities that we need to do?"
The most effective and sustainable organizations will be those that look at the LGBTQ community as people with specific healthcare needs instead of as a potential market, said Scott Nass, president of GLMA: Health Professionals Advancing LGBTQ Equality.
"In the long run, if the care being provided is culturally competent, if the environment being created is one of mutual trust and if the patients are benefiting in a cost-effective way, I think generally wherever the funding comes from would be irrelevant," Nass said.
In May, Grand Rounds and Doctor on Demand paid an undisclosed sum to acquire Quinn's one-year-old startup, Included Health, which provides care navigation services for LGBTQ people through their job-based health benefits. Although the combined company provides direct-to-consumer services, the startup is currently focusing on employer clients because that's where the demand is, Quinn said.
Eighty percent of employers plan to promote diversity, equity and inclusion through their benefits programs in the next three years, according to a 2021 survey by Willis Towers Watson. Approximately 45% of employers have added services addressing transgender care to their benefits packages, such as hormone replacement therapy, counseling and surgery, and another 30% plan to do so during the next two years, the survey found.
Included Health has 270 clients and is partnering with more to provide services at no cost to individuals, Quinn said.
The key to providing care to LGBTQ individuals is to be able to refer them to staff who understand their concerns, Quinn said. The company has identified thousands of providers trained in hormone replacement therapy and PrEP for HIV prevention who understand LGBTQ people's unique health needs.
Doctor on Demand also employs a diverse workforce of more than 1,000 clinicians. More than 40% of the company's providers identify as Black, Indigenous or people of color, 20% identify as LGBTQ and more than 60% are women, said Dr. Ian Tong, the company's chief medical officer.
"When you already have that representative foundation, then you can actually say, 'Providing care for marginalized groups...can be part of everything we do,'" Tong said.
Companies specifically targeting LGBTQ patients often start with a single specialized service offering, such as hormone replacement therapy, and broaden their benefits as they build trust and engagement with the community, said Adriana Krasniansky, a research associate at Rock Health.
"For many of these organizations, especially those that are started by providers or queer founders who are serving their communities, there are often really interesting avenues for expansion or the way they might pursue the evolution and maturity of their business," Krasniansky said.
During a February founding round, Plume raised $14 million to grow its direct-to-consumer offerings and add partners through employer assistance programs. The Trevor Project, which provides free crisis and suicide-prevention services to LGBTQ people, added Plume's specialized telehealth and on-demand hormone replacement therapy as part of its benefits package this year.
Plume currently has more than 6,000 members across 33 states, giving the organization access to 95% of the country's transgender population, said Jerrica Kirkley, chief medical officer and co-founder of Plume.
"Our mission is to provide gender-affirming care services that are available to all trans people in the U.S. at the convenience of a smartphone, that specifically meet the needs of trans folks, and that address a lot of the barriers in the healthcare system," Kirkley said.
Once a patient is registered, they are assigned a clinician and can schedule phone or video appointments or text questions through the Plume app that are answered regularly, Kirkley said.
In addition hormone replacement therapy, Plume provides lab monitoring services, prescriptions, and letters of support needed for gender-affirming surgeries and name changes. Plume also connects patients to local providers and organizations. Plume uses a subscription-based model, where patients pay $99 per month for unlimited access to care coordinators, clinicians and counseling.
Because costs can be a barrier to care, especially for LGBTQ people, Plume seeks ways to subsidize payment and provide financial aid through partnerships with local not-for-profit organizations. Since its founding last year, Plume and the not-profit-profit Point of Pride has provided 24 Black, transgender patients with grants for a free year of services, medications and hormone therapies.
"There've been so many amazing individuals that have come before and done work in the gender-affirming care space and the more global trans rights space," Kirkley said. "What we're doing is not completely novel, it's just taking a process and trying to refine it."
(Correction: Included Health has 270 clients. The story originally misstated how many customers the company has