Investing in Pomelo Care

“In the United States of America, in the 21st century, being pregnant and giving birth should not carry such great risk. But the truth is…before, during, and after childbirth, women in our nation are dying at a higher rate than any other developed nation in our world. And we know that, for some women, the risk is much higher. When we know that…we need to do something about it.”

— Vice President Kamala Harris, at the Maternal Day of Action Summit

A personal story

I am personally alive thanks to heroic maternal care. My mother was astutely diagnosed with severe preeclampsia, necessitating an emergency airlift and delivery at 29 weeks gestation at an academic medical center in rural Pennsylvania. My entry into the world started with a harrowing 12-week NICU stay. A smart care team and medical innovation like surfactant (discovered just a few years prior for use in preterm babies!) saved my life–and my mother’s life.

Fast forward a few decades later–and in a full circle moment, I was diagnosed with preeclampsia during my own first pregnancy. Even as a physician myself, with outstanding obstetric care, my journey as a new mom felt bewildering, fragmented, and seemingly devoid of modern technology. I tapered off blood pressure medications myself. The postpartum depression survey felt so cold and impersonal that just the act of filling it out made me upset. I couldn’t stop thinking what a mom with less support would do–what about single moms, moms with multiple kids at home, moms without a blood pressure cuff at home, moms without a PCP, or moms lacking resources for transportation to their OB’s office? I started paying attention to every startup, every non-profit and government initiative, and every innovator in the maternal health space.

Pomelo, like the fruit: Extra layers of protection

A few years later, in early 2021, I got a call from Marta, with whom I had previously worked closely at Flatiron Health. She was widely known as a “get stuff done” business development leader and key member of the Flatiron executive leadership team. She was now a mom, too. And, she was about to jump in and become a startup founder/CEO. “I’m thinking about value-based maternity and neonatal care. Want to hear more?”

By this point, I hardly needed to hear more to be ecstatic. I couldn’t imagine a more effective and purpose-driven operator than Marta for any business–but especially this one. It was also painfully clear that too many growing families in America struggle–and as VP Harris recently highlighted, the maternal mortality rate in the US exceeds that of other high-income countries worldwide by a significant margin. That’s despite spending twice as much–an irony that is begging for new technology, care model innovation, and value-based payment rail redesign.

“We’re calling it Pomelo,” Marta said. “Like the fruit. It’s a reference to the super thick protective peel that protects the fruit inside.” I loved the idea of a company that paid homage every day to moms (aren’t we all courageous human pomelos!). I also loved that in Marta’s vision, the company would in some sense be a pomelo to our existing healthcare system–a protective care model that wraps around existing obstetrics providers, NICUs and labor & delivery wards, Medicaid plans, commercial insurance plans, and employers–to continuously improve the maternal and neonatal care journey for patients, provide always-on triage, and lower the catastrophic suffering and cost associated with poor outcomes.

Our early conversations all took place during the early part of the pandemic, while Marta was actually running a 9-month long customer empathy exercise while pregnant herself with her second child in rural Georgia, over an hour away from an OB! Unable to meet in-person, we sent Marta a crate of grapefruits via Instacart, emailed her a recipe for a pomelo basil mocktail, and got together over “Zoom drinks” to shake hands on co-leading the company’s Seed financing alongside fantastic partners at First Round Capital.

So we need to “do something” about maternal health–but what?

Value-based care models are proliferating across healthcare, but maternity presents some particularly unique opportunities–and unique challenges. Unlike primary care, and unlike chronic disease management, the maternity care journey has a very clear, near-term endpoint, with a clear definition of success: Healthy delivery for mom and baby! This creates the opportunity for nimble care model iteration, innovative adoption of technology (e.g., from risk prediction to remote monitoring to symptom management), and relatively rapid ROI demonstration for payor and employer partners.

However, it also necessitates a deep commitment to integrate with our existing healthcare fabric: Obstetricians practicing all over the country, hospitals, health systems, labor & delivery wards, NICUs, and existing maternal care programs. These represent an expensive and valuable care delivery infrastructure without which nearly 4 million babies simply cannot be safely born every year in the US. Especially for high-risk pregnancies and high-risk moms, this infrastructure is essential.

As we have seen the Pomelo team build out their virtual clinic, care model, and software platform, they are dedicated to a few key principles which we believe are absolutely critical to building a scalable company in this space.

• Deliver 24/7 care for both mom AND baby. Maternal and neonatal care go hand-in-hand, and a trusted relationship with patient families can and should serve both patients. Cost savings from better maternal care are also often realized in neonatal care.
• Enable rather than replace existing OB providers. For those who have read my prior investment blog posts, you know that I love enablement business models. They allow a company like Pomelo to empower capable physicians already embedded in their communities, avoid the cost structure of becoming the obstetrics office/birthing center, and drive savings with an efficient wrapper care model.
• Build a solution that pays for itself (via savings to payors and employers), and remains free to patients and individual providers. Socioeconomic inequality and the inability to pay for appropriate care is a driver of the maternal health crisis, and adding out-of-pocket costs to patients is not a sustainable path forward.
• Use cutting edge software and technology to do all of the above. Look for every opportunity available to make our care more available, more accurate, more actionable, and ultimately more impactful. Use data to understand what is working, and what is not.

We are delighted to see the Pomelo team scale their offering towards serving thousands and even millions of moms, babies, and growing families across the country, across every part of our diverse society. It is a privilege to lead Pomelo’s Series A and serve on the company’s board. Join us!