Why is healthcare so siloed, and what can we do to fix it?

I’ve been dealing with a string of recurrent urinary tract infections (UTIs) for the past 6 months. They are the worst, and the pain, discomfort, and anxiety they bring has undeniably taken a toll on not just my physical but emotional wellbeing.

While I’ve finally made progress in getting to the root cause of why these infections keep happening, this has been a time consuming and expensive process full of different doctor appointments, urinalyses, microbiome tests, learning all about supplements that promote bladder health, and pelvic floor therapy.

This is all in an attempt to avoid a low dose, long-term antibiotic as well as the full-dose courses I’ve needed on an almost-monthly basis. But while I fully believe that there is much that can be done to prevent and even treat less-advanced infections, holistic remedies can take a long time to see an impact. And the 50% of menstruating people who have had a UTI know that it is hard (and dangerous) to wait things out.

While I’ve never had bladder problems before, this experience has unfortunately felt like an extended period of d​​éjà vu.

In summer 2011, I first started experiencing symptoms of polycystic ovary syndrome (PCOS). It took nearly a year to receive my diagnosis, and while I was ultimately able to learn how to manage my hormonal health, the difficulties I experienced during this time eerily mirror what I have observed the past few months:

• With PCOS, I was told by multiple doctors to try different birth control pills before any mention of labs. With the UTIs, I was encouraged to use prophylactic antibiotics with no discussion of more advanced testing even though standard urine cultures have been around since the 1950s and are known to be inadequate for recurrent infections.
• With PCOS, I was told that the acne, hair loss, and insomnia I was experiencing were “normal” parts of experiencing a life transition like going to college, despite the fact that I had never had such physical manifestations to stressors before. With the UTIs, I’ve been told bladder infections are “normal” when you start to date someone new, without any acknowledgement that this has not been a problem with past partners.

It has been disheartening and downright infuriating to see the same flavor of problems appear over ten years later, even when my own knowledge, privilege, and ability to advocate for myself has grown exponentially.

One of the most resounding parallels, though? The worlds of conventional and holistic care do not work together, and patients are suffering as a result.

Enter the (systemic) problem of finding providers who are open to approaches that differ from their own.

While I made the personal decision years ago to manage my own PCOS sans drugs, I was a student with endless flexibility and had the privileges of both
(1) time and (2) parental financial support.

(Read: (1) I was okay with symptoms taking a longer time to improve since I was not trying to start a family anytime soon and (2) my parents were paying for my healthcare.)

But, it was important to find a doctor who supported this decision and was willing to let more functional providers take the lead.

This took a long time.

The process of finding providers to help with my current health issue has not been any easier than it was in 2011. I am currently working with both a urogynecologist and naturopathic doctor who have taken a thorough-yet-flexible approach to finding the root cause of this issue, but I had to sift through several providers before finding them:

• The conventional doctors I initially saw for my UTIs were focused on immediate symptom relief and not long-term prevention through identifying a root cause. I did my own research and learned about more advanced urine tests like MicroGenDX, for which a Denver OBGYN office refused to sign the requisition form because they had not heard of it. I also tried discussing preventative measures like D-mannose, berberine, and N-Acetylcysteine (NAC), which have shown early evidence (emphasis on early) of helping prevent recurrent infections. These suggestions were largely brushed off, elucidating not any individual physician’s inadequacy but rather a systemic failure to include non-pharmaceutical options in both schooling and clinical guidelines.
• I also did several discovery calls with more holistic providers whose practices centered around prevention of bladder and vaginal infections. But their hesitance toward antibiotics did not jive with me; I had developed fevers and mild back pain for several of my UTIs which was a sign things were headed toward my kidneys and I needed more powerful medication than herbs. I wanted support from someone who respected my boundary when it came to not risking a trip to the ER.

These black and white approaches resurfaced an existential and demoralizing frustration I had experienced while going through my PCOS journey, as well as one we have heard from dozens of beta users and hundreds of community members at Pollie.

Why are the worlds of conventional and holistic healthcare so siloed?

Both holistic and conventional medicine can be powerful, but they’re most powerful together.

My experience from a decade ago was a major catalyst behind why my co-founder Sabrina and I started Pollie to redefine the PCOS patient experience.

We deeply believe that an interdisciplinary approach to PCOS, or one that combines conventional and more holistic, lifestyle-based treatment, is the most effective from an outcomes-perspective. And the research backs this up.

Holistic care strategies can provide effective tools, particularly for people who want to fix the “root cause” of their health issue.

Today, the scope of Polle’s PCOS Program is limited to lifestyle-based changes because we believe learning health-supporting habits is the most core part of living with a chronic condition. However, if applicable we still encourage our members to continue their regimen of pharmaceuticals like birth control, metformin, and spironolactone based on conversations with their doctor

We are taking an evidence-based approach to doing this. All care pathways are personalized for each member based on their specific labs, life stage, and goals, and intended to help each individual tackle the “root cause” of their PCOS.

And, despite my openness to experimenting with treatments limited to anecdotal clinical evidence for my own personal health, that is not what we are doing at Pollie. As mentioned earlier, all of our recommendations are supported by research; we are bringing best practices into one space, not currently* innovating on any new treatment methodologies.

The fact that more nuanced nutrition, exercise, stress, and supplement changes can improve PCOS severity is old news, and yet the standard of care does not incorporate these options. We hope our work can influence the clinical guidelines for PCOS on a national level, but that will take time to accomplish.

While nearly 85% of our pilot members felt better after 2 months of Pollie’s behavior change program, in many cases tackling the root cause of a chronic health issue can admittedly take more time to see an improvement in symptoms compared to using pharmaceuticals. This is true particularly for more severe cases.

But in many situations, the power and speed of conventional care is the best option.

I’ve been on antibiotics more times than I’d care to admit since my UTIs started, and anyone close to me knows I’ve been bugging out about gut health and antibiotic resistance.

While my goal is to cease the cycle of infections that requires these prescriptions, for the past several months they have been a necessary tool when an infection flares up.

Have antibiotics fixed the true issue behind my UTIs? No, because they keep coming back. But do they provide me almost immediate relief and keep me out of the ER with a kidney infection? You bet they do.

On a day-to-day level PCOS may not cause the same acute pain and discomfort as a UTI, but there are still elements of having a hormone imbalance that may require medication, either for symptom management reasons or just a patient’s preference. We plan to support this at Pollie through physician partnerships and expanding our scope to include medication in the future.

Also, something that cannot go unsaid is the inherent privilege that looking for the “root cause” of a health issue necessitates. If someone has too many other stressors in their life — whether they be financial, relational, physical security, or something else — the time it takes to see improvement from behavior changes and experimenting with more holistic strategies is hard, if not impossible.

This seems like it should be easy. Why don’t the two sides just come together?

There are a few reasons for this:

1. Reimbursement is a hellscape. Payers have notoriously provided little to no coverage for providers on the more holistic end of the spectrum. Even nutritionists and health coaches, who have been shown repeatedly to help patients change lifestyle and behavior in a way that reduces severity or even reverses chronic conditions, are not billable by all plans. While this dynamic is thankfully beginning to shift, what has resulted from years of said reimbursement dynamic is many holistic-minded providers have turned away from the traditional healthcare system and created their own out-of-pocket pay practices. Since we live in a world where in-network referrals are common, this reimbursement dynamic has added to the divide between conventional and holistic healthcare.
2. Politics. Ah yes, politics. While all medical providers can generally get behind some universal truths (Masks are good! More veggies can’t hurt! Prioritize sleep!) there are perhaps more issues that they take radically-opposing sides to. In Pollie’s world, debates center largely about the use of medication versus not to manage symptoms of imbalanced hormones. What’s more, in the advent of brand building, many physicians and other types of providers have developed large followings on social media. This is great from an education and awareness perspective, but like any news source, the information one consumes easily becomes an echo chamber. It seems more common for these providers to take sides than work together.
3. For reasons 1 and 2 above, lots of innovative solutions are deciding to start from scratch and do things their own way. This is great in lots of ways, but also limiting, particularly for purely consumer players who have made the strategic play to not touch insurance. More on that below.

Since our healthcare system has effectively encouraged these silos to develop, the onus of bringing together conventional and holistic care is oftentimes left to the patient. And it’s a privilege to straddle both worlds.

Seeing an OBGYN, endocrinologist, therapist, acupuncturist, and nutritionist regularly is nearly impossible, both from a time and financial perspective. And yet, many people with PCOS and other chronic health issues find that this hypothetical multifaceted team is ultimately what is needed to kickstart their health journey.

Unless someone has access to a clinic that brings all of these resources together (and the medical coverage or disposable income necessary to cover these visits) or a virtual program like Pollie, it is a significant strain to pursue both conventional and holistic care, and completely impossible to even fathom for many.

We have seen some convergence, of course. Some traditional physicians offices are now adding functional MDs and nutritionists to their roster. Healthcare upstarts like Tia and Parsley are starting to disrupt this with more integrative models.

But these efforts are outnumbered by the majority of legacy health systems and physician offices that take a more conventional-only approach. And these incumbents still have an undeniably strong market share, one that is unlikely to dissipate anytime soon.

This “silo” issue is systemic and deep, and it is hard to imagine venture-backed startups or more innovative medical practices making much of a dent without the participation from healthcare giants who own the status quo.

And so still today, finding providers that truly embrace an integrative approach (or respect the benefits a different approach may bring, with the willingness to work with a different provider type) can be hard to come by. It is not the norm, but it should be.

Startups like Pollie are building solutions to bridge these two worlds.

One of the main benefits of Pollie’s product is our programmatic approach. We strongly believe that taking an approach similar to what Livongo did for diabetes care 10 years ago is not only the most cost effective way to solve for PCOS, but also the best patient experience.

We have made the active decision to not be another virtual clinic with quick appointments or prescriptions as our core offering. We have conviction that an approach like ours is ultimately what is needed to create sustainable behavior change that enables long-term symptom management. By packaging things into a program-based model, we are ultimately able to provide our members with more diverse tools that become integrated in their day-to-day routines.

That is part of the problem we see with the explosion of virtual clinics that are built on the premise of on-demand care and prescriptions. If healthcare is broken to begin with, why are we just trying to make it remote?

Virtual care helps with convenience and access no doubt, particularly for urgent care-related issues, but it does not fix the underlying problem of abhorrent patient experiences if it is confined to one-time appointments for quick prescriptions. Especially when it comes to chronic issues, this model just virtualizes something that was already broken to begin with.

This aside, there are also many startups taking an integrative, more programmatic approach similar to Pollie’s. This is exciting to see, and these companies are making an impact similar to the aforementioned Tia and Parsley. But when you consider that many of these options are still serving just thousands of patients despite raising tens of millions of dollars, it becomes clear that we still have a way to go.

We need to have higher expectations of influential payer and provider institutions, and must challenge consumer-first health startups to work with, not separate from, the existing system.

We are building Pollie to fix a problem we feel strongly about, but if our current healthcare system were doing its job there would not be a Pollie to build. And yet here we are.

My experience with a female health issue a decade ago was just as shockingly inadequate as my experience with a female health issue today. The past few months have only reinforced my belief that conventional and holistic healthcare are siloed, the payment landscape fuels this divide, and this harms the quality of care for patients.

So at last, my plea to existing providers, especially those who have an influence at the institutional level or who are involved with developing clinical guidelines: please create forums that allow for collaboration between the different “sides” of medicine.

It should not be up to individual practitioners who are overworking in a system that does not support them, and certainly not up to patients, to bring together different treatment methodologies themselves.

There is a need for this to be more of an institutional push, and not just at the provider level. If payers do not continue to move in the direction of covering more holistic resources like health coaching, nutritionist visits, and functional medicine resources, it will be impossible for any convergence to occur that is accessible by non-wealthy populations.

And to consumer health companies who are filling gaps in the existing system: collaboration with incumbents is still important, even for those who are taking a more interdisciplinary approach. Recall we have been talking about the consumerization of healthcare for over a decade, and we are still dealing with a largely siloed healthcare system today.

Plus, while DtC healthcare is exciting for those who can afford it, this business model necessitates that some people are excluded from having those gaps filled. If consumer health offerings do not work toward becoming more integrated with our existing healthcare infrastructure, it does not matter how better of a patient experience a vertical offering may provide: we are not truly disrupting for the people who need it most.

Our definition of success at Pollie includes ultimately selling into payers and also working with existing providers to better support their PCOS patients. These goals may slow initial growth, but they are necessary if we want to be anything more than a standalone solution.

Because at the end of the day, conventional and holistic care should always be easy to find in a context where they’re being leveraged together. The silos within healthcare have developed alongside systemic flaws, not because such split worlds provide a superior patient experience. But if systemic issues pervade and if healthcare startups continue to disrupt from the outside only, healthcare will remain siloed and patients will suffer as a result.

*As we amass more data over the next few years, we certainly hope to contribute to new innovations through real-world evidence.