Episode Details

The American healthcare system is full of software. It is not always full of care.

That was one of the clearest lessons from my conversation with Melissa Hanna, the co-founder and CEO of Mahmee, a company that provides prenatal and postpartum support through doulas, lactation consultants, nurses, mental health providers, and nutritionists. The services are bundled together and, in many cases, covered by insurance. The support begins during pregnancy and continues through a child’s first year.

At first glance, Mahmee sounds like a healthcare startup built around coordination. In one sense it is. But Hanna’s story is really about something harder. She started with the belief, common in startups, that a broken system could be fixed by better software. Over time she found that software mattered, but it was not the thing standing in the way.

The original problem that pulled her in was simple and disturbing. The United States has some of the worst maternal and infant health outcomes in the developed world. For Black women, the numbers are far worse. Hanna said Black women face maternal mortality rates three to four times higher than peers with similar clinical and economic profiles who are not Black. Native American and Indigenous women also face sharply elevated risks. These are not small gaps at the margins. They are structural failures.

Hanna began by treating the issue as a data and communications problem. Why were patients falling through the cracks. Why were providers not sharing information. Why were systems not talking to one another. Those are reasonable questions, especially in American healthcare, where fragmentation is a defining feature. Patients move between doctors’ offices, hospitals, insurers, specialists, and community providers, often with little continuity between them.

So Mahmee’s first life was as a software company. For roughly five years, the company built tools to connect providers and surface information that was not being captured elsewhere. Hanna and her team focused on the providers who often sit outside the formal medical stack, doulas, lactation consultants, nutritionists, nurses, and mental health professionals working in communities, private practices, or local nonprofits.

Those providers often knew a great deal about what was happening with a patient. A doula might hear details a patient never shares with an OB-GYN. A lactation consultant might see warning signs that never make it into a medical record. A mental health provider might understand a patient’s risk in ways that do not show up in a standard clinical workflow. But much of that information was effectively invisible to the larger system.

Mahmee built software to change that. The company created electronic health record tools, care management systems, communications features, and scheduling and billing software aimed at these community based providers. In doing so, it found real demand. Thousands of providers signed up across 44 states. The footprint was broad. The product was useful.

But scale did not follow.

That was the hard part. Each provider might only serve dozens, or perhaps a hundred, clients a year. The software worked, but the market around it was too small and too fragmented to produce the kind of reach Hanna believed was necessary. She used an analogy from The Founder, the film about Ray Kroc and McDonald’s. You can have a very good milkshake machine, but if the burger stands are too small to use it at scale, the machine alone does not solve the problem.

That was the pivot.

Hanna realized the real barrier was not simply that community based maternal health providers lacked software. It was that they lacked a place inside the formal healthcare economy. Insurance often did not cover their services. Payment models were broken. The people wh