Fertility equality - Tammy Sun

Tammy Sun, CEO and Co-founder of Carrot, discusses the link between fertility and equal pay as well as what drove her to create a solution.

Referenced in the conversation:

• Equal pay is impossible without equal fertility benefits

This episode brought to you by:

FULL TRANSCRIPT

​Nate Randall:       I'm pleased to welcome CEO and co-founder of Carrot fertility Tammy Sun to the show. Thanks for joining me Tammy.

Tammy Sun:          Thank you for having me. I appreciate it.

Nate Randall:       To orient ourselves, high level, what is Carrot, and what have you guys been up to?

Tammy Sun:          At a high level, Carrot is a global fertility solution for employers. We have the most inclusive, equal platform that allows employees, whom we call members, to access flexible fertility spending, as well as white glove care navigation. And so we've made the product customizable for companies of any size. Really if you're fully insured or self-funded. So you customize it financially, and then everyone has access to flexible fertility spending for everything from fertility testing for men and women, to egg freezing in vitro fertilization, or IVF, as well as adoption and third party reproduction that includes donor eggs, donor sperm, and gestational carrier services, or more commonly called, surrogacy.

Tammy Sun:          And so we manage the full financial and claims processing system, that's built on our own stack at Carrot, and then Carrot also provides all members with expert care navigation, so matching at the Clinic, information, education, emotional support, injection support through video at night, in the US, as well as 40 other countries.

Tammy Sun:          So we're super proud. You know at this point we're over three years old. We've been global since day one. We launched with five countries, and today we cover 40 countries across AMEA and Asia, as well as North America, including the US of course.

Nate Randall:       And you recently secured Series A funding, so congratulations on that.

Tammy Sun:          Thank you. Yeah, it's a part of the growth process. I think we're really excited that employers have really led the charger around the fertility space, and I really believe that. Our customers, you know, are really at the forefront of reshaping not just the future of fertility, but the future of work. So we're super excited to have fantastic investors. To date, we've raised over 15 million dollars. So, we'll be using that capital to do whatever we can to provide better experiences and create simpler, better experiences for HR leaders, as well as employees.

Nate Randall:       I was just having a similar conversation with another person, more on the investor side, who was just talking about the importance of HR people adopting and really testing out some of these new solutions. You know, you wouldn't have gotten funding if it weren't for the support of those early champions, and you wouldn't be able to use these funds to expand this great service to hopefully millions of families across the world.

Tammy Sun:          That's a hundred percent right. I mean, when you think about the people function in America, they have a really unique place in the US, that's very differentiated from other countries around the world. Employer-sponsored health plans and benefits cover over 150 million lives in the US. That's more than Medicare and Medicaid combined. And together, CHROs and people leaders direct the spending of trillions of dollars in healthcare benefit spending. And they are our most valued stakeholder, because they have the ability to shape the future, and really create the future of work, and the future of fertility.

Tammy Sun:          We believe that fertility is a fundamental part of human health, and our customers share this value. When you look at it from that perspective, where everybody is equal, and everyone belongs when it comes to fertility care, then it becomes the standard part of what people expect when they go to work. So it's medical, it's dental, it's vision, and it's fertility. And us and our partners in the HR space are creating that future together.

Nate Randall:       Yeah, and I want to go backwards a little bit, because when I hopped on LinkedIn here to take a look, you've got quite a work history with the White House, Clinton Foundation, the FCC. Now you're a CEO and co-founder. I love asking about the founder journey. So, how did you come about to create Carrot in the first place?

Tammy Sun:          I think to your question about the work history, I think if you think about government as a platform, and technology as a platform, they're the two strongest platforms that you could influence, if you have an opportunity to influence them, to create change at scale. So I think people who work in both of those categories, have actually more in common than they might think, and certainly more in common than they have differences.

Tammy Sun:          I never intended to start a company. I never aspired to necessarily be an entrepreneur. I had a personal experience with my own fertility where I did three rounds of egg freezing, found a clinic after much late-night googling, walked into the clinic, put down my insurance card. They ran it, it was rejected, swapped it out for my credit card. And 40 thousand dollars later, I have 12 frozen eggs in the basement of UCSF.

Tammy Sun:          It became a problem that completely consumed me. I didn't really know what a solution was, and to be honest, when I first began to think about the space, I was quite convinced that we would do something in the direct-to-consumer space. And what we learned is that employers really have the most power to solve the existential central problem for employees. Which is that not enough people who need access to fertility care, and valued fertility care is a fundamental part of human health, can afford it. It's very basic. It's just too expensive. And so most people pay thousands of dollars out of pocket, to access this type of benefit.

Tammy Sun:          And so, our solution is really two-fold. There is a solution that benefits the employer by helping them find, and retain, and nurture the best workers, and the best talent, while also creating a managed care environment that helps reduce healthcare claims and costs. But on the flip side, it also addresses the central, critical pinpoint for millions of people around fertility, which is that it's too expensive. They can't afford it.

Tammy Sun:          And so, that's the crux of how we partner with employers.

Nate Randall:       Right. And I think there is definitely a growing recognition among employers that fertility is an issue that's not adequately covered by your health plan, typically. There are other issues as well. So maybe talk me through the main talking points of what the issues are. I know we've got issues with coverage. I know we've got issues with when you dive into coverage, who is covered, and what types of relationships are allowed, and some of these things. So what are the main talking points and issues that I need to know if I'm interested in exploring whether fertility benefits or something for me?

Tammy Sun:          There's really two. And the first is simplicity, and the second is equality. On the equality front, this has been the driving point of view that governs how we build products, how we build programs, and how we build this company. Everybody is equal. It doesn't matter whether or not you have an infertility diagnosis. You don't have to prove to people that you have an infertility problem, before you were able to access IVF. Folks that are interested in egg freezing are not excluded.

Tammy Sun:          Carrot is a unified fertility solution that is available to everybody regardless of age, sexual orientation, gender identity expression, as well as geography. And so equality across geography has been one of the defining propositions of Carrot, when it comes to customers. The ability to deliver a roughly equal benefit, and a similar and high-quality member experience for an employee in Singapore, similar between Singapore and Seattle, is something that we are very proud that we have the ability to deliver.

Tammy Sun:          And then on the other side, in terms of what you alluded to, there's so much complexity that has existed in this space, that has only been augmented by the opacity and the difficultedness of navigating a carrier, an insurance-based system, that Carrot essentially intervenes to simplify the experience for both the HR leader, as well as the employee.

Tammy Sun:          On the HR side, when they deploy Carrot, they create a plan design, they plug in the data of their preference, in terms of their budget, and then we take care of the rest. On the employee side, we take a very complex experience, and we navigate them through each stage of the journey in a way that helps them save time, and stress, and in many cases, a lot of money.

Nate Randall:       Yeah, and this is an important and fundamental shift in employee benefits in HR. And there's a lot of this going on right now. And some of it could be because of cultural changes, and more recognition and acceptance in our culture, generally. Some of it could be because of generational differences in work, and when to decide to have a family, and all that sort of stuff. But for somebody who's been in HR for, let's say, forever, 10, 15 years ago, infertility and fertility benefits were really looked at as something that was pretty quiet, not talked about very much. It generally was considered something for maybe a lady who's getting to the age where she's trying to have the decision of whether she's ever going to be able to have kids.

Nate Randall:       And now it's a lot different than that, isn't it? It's not just for that very specific use case, it's pretty broad. And the benefit is extremely valued.

Tammy Sun:          It is. I mean, 70 percent of both men and women say that they would consider switching jobs, moving to a different company, in order to access a fertility benefit that covers freezing, and IVF, and surrogacy. I think your point gets to a very significant structural change that has happened, and accelerated over the last five years, which is... There was a time when infertility benefits was considered a luxury good. And there was only infertility. Today, what we've seen is the evolution and the emerging fertility care ecosystem. And fertility form a proactive perspective, is very differentiated from an infertility experience.

Tammy Sun:          And for the first time ever, in this country, according to the CDC, the Center for Disease Control, there are more women above the age of 30 having children, than women below the age of 30. For same sex couples who are interested in planning for or preserving, or building families through having children, there is an existential need for access to IVF, and other aspects of fertility care, as well as adoption, and surrogacy, specifically for male/male couples.

Tammy Sun:          And so this is the modern way that human beings think about fertility care. And as you suggested, the legacy systems that are supported by carriers today, have not caught up, and my prediction is, is that may never catch up. They're not really built to solve these types of problems.

Tammy Sun:          Carrot is. And so from the equality perspective, I think it's equality between fertility and infertility. It's equality between age and sexual orientation, and gender identity, and marital status, and geography. It's build on a fundamental value that everybody should have equal access to fertility care, because it is a fundamental part of our human health. It is not a luxury good anymore.

Nate Randall:       I want to touch on an article that you wrote recently entitled, Equal Pay Is Impossible Without Equal Fertility Benefits. It's a great piece, really eye-opening for me. I'm wondering if you could walk through the basic premise of that statement, and maybe highlight where your thoughts are on the subject, because I did think it was just a really well thought out argument, if you will.

Tammy Sun:          Sure. I'll take myself just as a personal example, and walk you through it. As I mentioned, I spent 40 thousand dollars on my own egg freezing. That was money that I took from my own savings account, and purchased a healthcare service that I deemed at least that much in value, at least the 40 thousand dollars in value. That was 40 thousand present day dollars. And I, as an employee, as a millennial worker, pay into a healthcare system every day, every month, every week, every year. And I'm participating in that healthcare system, but at that moment when I needed healthcare coverage for something that I considered fundamental to my health, it was absent.

Tammy Sun:          And so I paid 40 thousand dollars. And that was 40 thousand present day dollars, but it was hundreds of thousand of dollars 40 years into the future, for my retirement. You could imagine that 40 thousand dollars being invested in any sort of investment vehicle that would have produced non-trivial returns for my financial future.

Tammy Sun:          When you think about it like that from the fertility benefits perspective, same-sex couples who will need access to IVF, women who need access to fertility preservation and egg freezing, for whatever reason, because this is not part of their healthcare benefits at work, like medical, dental, and vision, they are going into their own pockets to pay for this out-of-pocket, pay for this in cash. And there is the short-term hit, in terms of... That 40 thousand dollars decimated my own savings account. But I consider myself lucky that I would even have access to those financial resources to pay for egg freezing. Most people don't.

Tammy Sun:          And so the disproportionate financial burden of the absence of fertility benefits at work, rests on women and on same-sex couples, as well as couples who don't want to wait a year before having an infertility diagnosis, before they can access an important benefit.

Tammy Sun:          And so it just exacerbates wage issues that are already present, from a variety of other very structural and deeply ingrained social, cultural, economic factors that have built up over decades, if not centuries. And our point of view is that it is very important for this to become a standard part of what people expect when they come to work, not because it's the right thing to do, even though it is, but because it is an important step towards equality.

Tammy Sun:          It's the same reason why we don't sell loans for instance, for medical coverage. When women, young, female graduates who are coming out of college, they carry more than 50 percent of the student loan debt in this country. They're already being paid 70 some odd cents on the dollar starting out, and placing a burden on them to say if you want to freeze your eggs, you're going to have to take out a loan. I think most people would look at that, and on the face of it, and say that's wrong.

Nate Randall:       Yeah. And we're getting to a place where we are starting to have much more sophisticated conversations like you're having right now, around equal pay, diversity, and inclusion, all those sorts of things, which have been sort of buzz words for a long time. But I think the consciousness is finally rising a little bit, where we're seeing some movement. And you're on the front lines of this movement, and I'm really excited to see where you guys go with it.

Tammy Sun:          Thank you. It's such an exciting time to be working with folks like you, and partners like Lumity, and others. We have an opportunity. This is the moment to imagine, and to make decisions that can shape the future of work. And obviously, it's our point of view that fertility has a big part of that.

Nate Randall:       Well, great. Thank you so much for taking the time today.

Tammy Sun:          Thank you for having me.