Unemployment, reduced hours, pay cuts. The reality of the COVID-19 Pandemic extends far beyond the pausing of fertility treatments. Over 60% of our country has been financially impacted by stay-at-home orders and social distancing. While clinics are working hard to keep patients in their funnels to start treatment once restrictions are limited, how are these patients going to afford the treatment? It’s not out of line to think that the demand for new financial resources will go up and the need for financing of treatments will increase. But, as we all know, discussing money can be sensitive, especially when it comes along with an infertility journey.
So, When do we talk about it with our patients? How do we talk about it with them? What can we do to help our patients afford proper care while the economy is in a downturn?
On this special episode of Inside Reproductive Health, Griffin talks to Dr. David Adamson of ARC Fertility and Andy Swan of Ally Lending. They discuss not only the changes we can expect in lending and patient decision-making post-pandemic, they also offer advice to financial counselors on approaching the sensitive topic of funding treatment.
This episode was recorded during a live webinar. As the COVID-19 Pandemic continues and new issues arise, we are putting out new information to help you and your fertility business. Follow us on social media for updates on upcoming webinars and how to join them live. Find this information helpful? We’d love it if you’d share with a friend or colleague in the fertility space.
Need help navigating marketing through this unprecedented time? Check out our COVID-19 Toolkit from Fertility Bridge.
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Welcome to the Coronavirus Business Response Series of Inside Reproductive Health. Here, you'll be updated on the latest insights on managing and owning a fertility business or IVF center during the COVID-19 pandemic. We put out free podcasts, webinars and articles as soon as new topics arise, so make sure to subscribe to stay updated. The best way to help us in return is to share this episode with someone in the fertility field that would find it useful. Now here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones
GRIFFIN JONES 0:53
Today, I have with me Andy Swan from Ally. And I have Dr. David Adamson from ARC Fertility, who is the founder of that who is a physician that you all know well. And I want to ask both of these gentlemen about the financial routes that patients are going to take now and how they might change in the next couple months. And what it will be like when this starts to settle because we're not sure if this is going to settle in one sort of spike and have a, you know, a quick economic recovery. This could roll for months and in peaks and valleys and the economic recovery could too and that impacts our patients’ affordability. So, Andy, Dr. Adamson, welcome to the program. Thank you for agreeing to come on and answer some questions and I look forward to exploring this with you.
DAVID ADAMSON 1:48 }
Great, it's nice to be here, Griffin.
JONES 1:50
}What type of changes has there been in the last month? I mean, we've seen most clinic stop treatments. How does that affect the financial side? I want to explore that, and then we can start to pull away some of the nuances from within it.
ADAMSON 2:08
So, you know, I think, Griffin, I'd probably start from the point that I really do think this is a, you know, an existential threat to society, such as none of us have ever seen. So in situations like this, I've always sort of felt you should look at the big picture first and then hone in on the narrow aspects of it. And I think the bigger aspects of the picture here are that society's really been changed, the employment situations’ been changed. medical care, and the clinical practice of medicine’s been really changed. And, and in fact, none of us really know what it's exactly going to look like we come out of it. So I think the most important thing to start with is for each individual, you know, a woman or man who's facing this kind of problem, first of all, to start with their own situation and say, you know, where am I at in my financial life right now? How secure are jobs? How much do we have in resources, cash and credit cards, and other resources? How much debt do we have? Are there ways that we can change our lifestyle right now to conserve cash? Are there ways that we can postpone payment of loans? Are there unnecessary expenses we can stop having? Are there big purchases we planned on, we won't do? Are there assets that we can borrow against such as a home, etc? So, trips that could be postponed… I think if an individual is looking at having fertility treatment now, and finances are going to be an issue, which clearly it is for probably 90% of people doing this. This is hard work to get the money. I think they need to start with their own situation, then I think they want to look at the clinic that they're going to and make sure that it's a cost effective clinic. They want to ask them about whether they're going to have any new programs that are coming along with the changed world out there. Will there be more telehealth? Will there be some reduction in expenses? I'm a firm believer, there's a lot of protocols in IVF, some of them cost more than others, but aren't necessarily proven to be better. I think it's really important in talking with your doctor and your clinic, to see if they have lower cost options that might be appropriate for you, to see if there are any protocols that might be cheaper for you because they use different kinds of drugs or less drugs. And if there are, you know, the proverbial “add-ons” that, you know, may not give value in a situation where you're really struggling to get enough money for it. So I think looking at that, and then I'm sure Andy’s going to talk about the programs out there--and I'll be happy to talk about it a bit too--but to look at the programs and what's going on with lenders to try to get more money, but I really think that dealing with this situation is is going to take a broad perspective, a broad approach with the patients, the clinics, obviously lending sources that are out there now. And we need to look at all of that in order to get the best possible outcome for everybody.
JONES 5:22
Do you think that some programs will have to change their pricing model, Dr. Adamson? You mentioned that you had some programs cost more, but aren't necessarily better in terms of success rates. And the converse of that would be that some programs cost less and aren't necessarily worse from a cost standpoint. And I think there's only a few programs that have really gone into lower cost IVF and I'm not talking about mini IVF, I'm not talking about InvoCell, but a much lower IVF base price. And look at some of those programs and their success rates are just as good as anywhere. They're at least as good as the average, some of them are a little bit better than the average. And so do you think that programs are going to have to start--are they going to have to cut their own costs? How would they adapt to this?
ADAMSON 6:11
Well, that's a great question. One thing that's been a certainty over the four decades since IVF really became established in the United States is that the clinics have been very responsive to market demands and market pressures. And I don't doubt that clinics will be making changes, I don't think it's really possible to know exactly what those will be. I don't think the demand for babies is going to go away. So I think they're going to be just as many patients and in fact, those should be, in theory, a little bit of a backlog after this. The people who couldn't have treatment are going to want to get back into treatment. So I don't think the patients are going to go away. But, you know, there's problems everywhere, right? I mean, a lot of the patients are worried if you read the numbers, so 60% of the households in the country have been affected by either unemployment or reduction in hours or concern about that by one or two people working in the family. I suspect it's not that high in the IVF population that gets treated, but it's probably still a very substantial amount. And even if people haven't been directly affected, everybody's worried about maybe a second wave of the virus in the fall or what have you, before we get a vaccine. It's an uncertain future for probably at least one to two years or so. So I think people are going to be more cautious. So in that end, they're going to be more careful about how they spend their money. On the other side of it, I mean, the clinics, of course, have been hammered by this. I mean, they still have rent to pay and personnel, and the embryo cryo tanks to keep up and they still have huge costs ongoing without getting revenue. So, you know, the clinics have problems that he won't be able to slash their prices completely because they're not in a position to do that. And at the same time, the lenders, you know, haven't had much business, so they've suffered from that. And as well, I think a really important factor here, which I'm sure to address a bit more later. But we don't know what the lending environment’s going to look like in a month or two or three months. I mean, we don't know what Federal Interest rates will look like, they'll probably be very low, but that doesn't mean that lenders are gonna want to lend unsecured money to people with infertility. And it doesn't mean that those patients are going to have the same credit scores, depending on what happened at their employment and with their income and what have you. So I think there's a huge amount of uncertainty. And I think that's why it's important for any patient who's listening to really take a holistic look, because this is an existential threat. It didn't affect one aspect of society. It's affected everybody in multiple ways. And I think they want to start with the fundamentals about conserving cash and trying to stay as liquid as they can, not getting more expenses and getting prepared. And then looking at their options within the clinics about how to get the care they need, but not spending any more than they need to spend to get it. And with the end lenders, I'm sure Andy's going to talk about that.
JONES 9:21
So Andy, before we talk about what this is going to do with the lending landscape, how does the lending landscape look now? What's changed in the last month or month and a half?
ANDY SWAN 9:33
Yeah, so I'm happy to touch on that. I think Dr. Adamson did a great job of initially talking about it where, you know, I would say in the middle of March where clinics were still trying to navigate this storm and, a lot of the mandates are coming from state governors on what is considered an essential business, the ASRM guidelines have been changing week in and week out. And in the middle of March, we still were seeing applications come in on a pretty regular basis. I think a lot of patients were actually trying to finalize their loans so they could make sure that they were getting on the fertility clinics’ calendars and getting their treatments scheduled. Now, in the past two weeks, we've seen the numbers drop significantly. We're seeing loans being finalized here and there as there are some clinics that are still continuing to operate as normal. It's a patient's--it hits back to what Dr. Adamson said, you know, patients are saying, I need to start looking at financing to break this down into affordable monthly payments, because, you know, there's economic uncertainty, I don't know how my job will be impacted. So the $15,000 to $20,000 ticket price now becomes, I don't want to just swallow that and be illiquid. And from the clinics that we've talked to, I think there's gonna be a demand when the doors are able to open up and the world normalizes a bit. And I think there's going to be a greater demand for financing. Now in terms of Ally Lending specifically, you know, we're lucky being a publicly traded company, having a strong balance sheet where we've been able to keep our interest rates as is. So where patients may look to go to a credit card where they're going to see really 14.99% APRs, we start at 3.99%. And in terms of what Ally is just doing a phenomenal job in terms of helping existing borrowers and new borrowers. So we've put in place a 120-day payment deferral program. It's putting your loan on pause, it's not, Hey, we're going to let you skip on a payment in those four months build up and then you get hit with a lump sum. It really puts it on pause, which I think is huge for these uncertain times, especially with fertility patients, not knowing when they are going to be able to start those cycles.
JONES 12:01
And how far back does that go? For patients that started when? I mean, somebody's paying that's paying a loan that cycled in May of 2019. Are they able to do the same thing?
SWAN 12:15
So it’s any borrower of ours.
JONES 12:29
So one question that we had, which was--and maybe both of you gentlemen can go over it--which is which loan programs are being used for IVF cycles is the question. So maybe both of you gentlemen can give an overview of just what programs are available for people. The question is which loan programs are being used for IVF cycles? Dr. Adamson, we'll start with you.
ADAMSON 12:40
Well, you know, I think there are very many sources of loans out there. I think the first thing for patients to do, frankly, is to talk with their clinic and ask the clinic if they have any programs. Some people go and start with a loan program, frankly, they go down the street to their own bank, and they see if they can borrow money on their house, you know, get a line of credit or a second mortgage on their house, the mortgage rates are very, very low.
JONES 13:06
This question was from an anonymous attendee, but almost everyone on here is either a clinician or someone that works at a clinic. So I think they're asking what programs can decline.
ADAMSON 13:15
Okay, so well, I still think it's reasonable for financial counselors in clinics to give patients a holistic answer. And I think that they should start looking at their own resources first, and then they should ask what the clinic has, and whether the clinic knows of any special programs, which there are. There's some programs with the drug companies and programs for cancer patients, etc. And I think it's important for people to look at all these. And certainly, when ARC clinics do a quarter of the cycles in the country and those patients call us and we work with a number of lenders and we try to get the best rates we can for each patient based on what their needs are. Patients have different needs. Some need more money, some need less money, some want a certain term, they can pay it off in a shorter time and others need a longer term. Some really are interested in an interest rate--that matters them. Most people, the most important thing is the affordability on a monthly basis, what's the monthly payment? So I think my answer would be that there are different lenders out there that have slightly different types of programs. And it's a good idea for the clinics to know which one is going to work best for them so that they can optimize it. At the end of the day, if it's not a good deal for the patient, it won't be a good deal for the clinic. Because if the patient doesn't get a loan or doesn't get what they need, they're not going to go forward in that clinic or they'll go to another clinic to get what they want. So I don't think there ought to be a difference in terms of what works well for the clinic. What works well for the patient, their interests clearly are aligned and I think need to be aligned in the presentation to the patients.
JONES 15:09
And I'm okay with both of you naming some of those programs by name. We’re not giving any one program commercial here, but we can name a few different programs. Andy, do you want to give an overview?
SWAN 15:21
Yeah, there's four or five typical specialty lenders within the fertility space. We see Lending Club, you see a United Medical Credit, Future Family is a newer name in there and CapexMD. So a lot of clinics are partnering with, say fertility specialty lenders and that's because it provides a lot more comfort to the patient and to the clinic because they're more familiar with the fertility process, because it can be complicated in terms of you know, a patient wants to take out a loan for multiple different services. So how do you ensure the loan amount is able to cover the medication side of things, genetic testing, if there's donor services used. Now, consumers are also looking to other avenues as Dr. Adamson had mentioned, which is going on, they're drawing on their 401k or a home equity line. In terms of Ally, we keep it pretty simple. And we do standard installment loan products. So we do 24 to 72 months in terms of terms, and I would say most patients are falling in the 48 to 72 month range. And the reason for that is that's going to break it down into much more manageable monthly payments. So seeing anywhere from $250 to $350. And there's no prepayment penalties if you're gonna pay off your loan early, so at least they keep the expenses manageable. They're not as impacted by the economy as they thought or they are a little more liquid and feel comfortable paying it off, they can do that early with no penalties to them. I think going back to what Dr. Adamson was saying, you know, I think this is a unique opportunity for clinics to engage with their patients and let them--you know, financing usually happens much further down in the conversation and in the fertility journey. The patient comes in, they have their initial consult, they're getting presented, their different treatment costs, what their treatment options will be, and what the cost may look like. And you know, that's a three hour consultation, and then financing is presented. And really that patient is overwhelmed at that point, and isn't really retaining much of that information. Where now, clinics really have a unique opportunity. They're having these telehealth or phone consults. They can talk about financing now and upfront and talk about how different lending programs that they can prequalify and see how much is available to me. You know, what are the interest rates going to look like? What is it monthly payment possibly going to look like the patients can then use this time to see what is the best option for them and their family? What is this going to look like if I fit it into my current budget? And if they don't prequalify, it's an opportunity for them to see if there's friends or family members that would apply for a loan on their behalf.
ADAMSON 18:17
Yeah, I'd really like to add to what, you know, what's just been said by Andy there. There's been a long history with IVF clinics of thinking that, you know, people come in the door, they can afford IVF. And the reality of it is that many of the patients that can't afford IVF don't ever approach it because they think it's too expensive. That's a perception they have. And of course, I don't feel IVF is too expensive. I certainly don't think IVF clinics overcharge or get paid too much for what they do. I think the services that are provided are extremely valuable. It's an issue of affordability, not of cost, and its affordability based on disposable income for an individual relative to how much income they have. And one of the big mistakes I think we've made and it's not just with us, it's everywhere, is assuming that when somebody calls up, that they're going to be able to afford it. And as Andy just said, I think many clinics take way too long to get into the conversation about finances and rather than finances coming up, sort of, you know, at the end, after you think the patient's committed to staying for treatment, and then you talk about you're gonna have to pay this for what you need. It should be brought up early on in the framework of We have a solution. We know this costs money, but obviously, having a baby is really, really important and it's very valuable and we want to make it affordable, and we have solutions for you. And this should be started early. It should be started when the patient first contacts the clinic and makes any kind of appointment because large numbers of patients drop out before the first appointment either finding out what it's going to cost--they have other reasons for dropping out, too--or they call another clinic and find out they have a solution for their financial need that wasn't mentioned to them when they made their first appointment. And then it's also true and there's really excellent evidence on this, it's not made up, that many, many patients drop out of care after they have their first consult, get told what they need, and then they decide they can't afford it or they won't go ahead. People drop out primarily over the money, they drop out over the emotional stress, they drop out over really poor prognosis, which, of course sometimes is an appropriate choice for the patient. But mostly, they drop out because they don't have money. And so I think it's important to present the solutions. The thing about ARC Fertility--so I will put my ARC hat on here for just a second--is that we work with Lending Club as a preferred lender simply because we’ve worked with them for 15 years, and they've been a terrific partner of ours and we really enjoy working with them. But we also work with Ally and they've got terrific goods and services, too. We really enjoy working with them and we have a third lender and sometimes even a fourth lender. So we work to try to get a solution because different patients have different needs and different lending companies have different criteria for whether someone gets approved or doesn't get approved, for how much, what the terms are. Again, Andy talked about that, but the terms can be anywhere from two to eight years, the amount lent can be, you know, under $10,000 to 50,000 or more. And the interest rates can be anywhere from you know, 4, 5% all the way up to 20%. And so these things are very different and different patients have different needs. And I think that a really intelligent approach up front matters. Now, frankly, again, I don't want to do a lot of advertising because I don't think that's the idea here. But one of the things about ARC Fertility, we take all that pain out of the clinic, people come to us and Andy will probably tell you, we have a 34% higher approval rate because we know where to go and what to do to get people the money they want. And that means that out of four patients that apply, three of them get a loan somewhere else, and one more gets a loan if they come to us, because we know how to put it all together. And sometimes we'll use a couple of lenders, we’ll use credit cards, we use cash, we use all sorts of ways to get that person the money. And that's a win not only for the patient, it's a win for the clinic. And I think far too many clinics have sort of left this in the side. And the reason is that nobody wants to talk about it. Doctors don't want to talk about this. The nurses don't want to talk about it. And so it gets left with a financial counselor, some of whom are well-trained, but I know because we deal with 85 clinics, that many clinics do not have very well-trained financial people just because of turnover and what have you. Nothing purposeful about it. It's just that it's a very problematic area. And nobody likes to talk to a patient who's emotionally upset or we're just finding out what their care has to be and what their prognosis is, and then how much money it is. Then they say, Oh, by the way, I don't have that much money. I mean, these patients’ sense of personhood and womanhood and you know, being a good wife and a potential mother are just absolutely devastated by these blows. And so it's very important, I think, to come in with early upfront solutions, as Andy has said. And so I do think that the demand, because of the change in economic times, in fact, is going to go up. The question is going to be will the lending resources be there to meet that need? And I don't think we know yet. I hope so. It's a, you know, very low interest rate environment right now. But people are still going to have to have a decent amount of credit to get an unsecured loan because the lenders have to know they have a pretty good probability of getting paid back or else they can't lend the money.
JONES 23:46
There's two directions I want to take that. Where I want to kind of go with this is one, I think we can do a little bit of an amateur, high-level training for financial counselors and provide some value for people. But I do want to beg the question, Andy is, will the lending resources be there if banks really have to tighten up across the board, not necessarily speaking for your institution, but just across the board?
SWAN 24:12
Personally, I mean, I can’t predict exactly what is gonna happen from my standpoint, and at least how Ally is reacting as a company and what we're doing--I've seen other competitors within the space or different industries having to raise their interest rates or increase requirements. And that's not something we've had to do. And we've been told that we're committed to this space and, you know, I think in terms of fertility, you do see a pretty high-quality borrower that is coming in the door. So I truly think there's going to be lending options available for these patients. And I think it's really a matter of getting in front of these conversations now. And Ally specifically, we're really just trying to be a resource out there for current clinics that we work with and prospects in terms of helping coach their financial counselors on how to present financing or if it's an office administrator, how do you go about implementing a financing program into your workflow? I mean, last year, we spent 200+ hours interviewing our patients, so borrowers of the fertility space, and then interviewing the financial counselors that we work with. And I can tell you, small clinics, large network clinics, they all have different processes. They all present financing in different ways. There's not one process that's going to work out there. But I think there's a lot of insights that, you know, we're able to share and I think a lot is what we heard from patients is what Dr. Adamson is saying, they're finding out about financing too far along in the process. You know, a patient may start with an IUI and financing may not make sense for that $1,000 charge to 1500 dollar charge. But if they really look at the holistic view and see, here's what my chances of success are on this and if I don't, here's the route, I may have to go with IVF. They may wish that they didn't spend all this money out of pocket on IUIs and had just started a credit line, essentially, with a lender. So I think what clinics really can be doing now is using the partners that they work with and leaning on them and seeing how do we retrain our financial counselors and talk to them.How do they position financing? Make sure that they understand the programs that they're offering, and invite partners like Ally to come and do webinars for their patients. So we can talk to them about patient financing and answer their questions.
ADAMSON 26:49
I think that's absolutely true, Andy. Yeah, I completely agree with you. And one of the things I’d like to point out that we've been facing is that patients call us up and they either, you know, been approved for a loan right now, we're just about through this phase that we were approved for, but they don't know whether they should take the loan or not. And then there are other people, you know, right now we're probably saying, well, I can't start treatment yet, but my clinic, maybe they're going to open up, maybe they're not. I think the patient should be calling the clinics. And I think the clinic should be calling the patients, especially the ones I think along I think with most people, nobody knows. But there's probably going to be a bit of a rolling start in the IVF as well, because it's going to be different. I think people are going to have to use PPE and they're going to have to screen patients beforehand on the phone to see if they're sick and maybe be doing antibody tests on the way in the door. I mean, I don't think we know exactly what it's going to look like, but it's almost for sure going to be different. There'll be fewer people in the waiting room and they'd be more prepping ahead of time. There’ll be more telemedicine. We've got a great telemedicine program. We've had a lot of uptake in that just in the last two weeks and going out the door like hotcakes. People have finally found telemedicine. But there's going to be telemedicine. There's going to be all this testing, a lot of PPE, a whole lot more cleaning, that's going to add cost, it's also going to slow down the process. And because I think that the general societal rules are going to be, you probably should only start with not the emergency patients because they're supposed to be taken care of now and the really urgent ones now, but most clinics are probably going to start up with their 40 and 41 and 42 year olds, and not the 31 year old has been infertile for 14 months and husband's sperm count is 12 million, and that's probably not where you're going to start on your first patient. So I think you should be calling the patients that you think are going to be the first ones back in the door, your older patients, you should be making treatment plans with them and you should be talking to them about their financial situation. And if they're in a position now where they both still have a job, they're still getting paid, but they're not sure how they're going to cover the costs, they should be applying for a loan now. Because as Andy pointed out, you know, Ally and Lending Club also have both put postpone payments on things. And if you get a loan now, that used to be that you had--you get a loan, you have 30 days to take it out, and then you start--you don't pay for another month or so after that, your first payment. So that gives you about two months of runway before you actually have to make a payment. And now they put in a waiver on that. So you can get another two to three months out of it! So most patients can get easily sort of like three to five months, they can put a loan in now, get the money, they both have a job, they know they really want to have a baby and she's 38, so they're not gonna wait a whole lot more time--they can get a loan now and have everything all tied up and the clinic knows they're going to come back in for care and you know what the plan is going to be and you get the most cost effective plan. So I think this is the kind of proactive work that both the clinics and the patients-- And look, we're in it together. You know, they have to do it together. So I would really suggest considering that for your high priority patients that you're going to, you know, be at the front of the line as soon as you can get open up, which I think it's going to start getting loosened up here. I don't know, I have no inside knowledge, honestly. But I think it's two to four weeks, I think we'll really be starting to see a little lightning up here.
**COMMERCIAL**
Hi everyone, it's Griffin. This is the break in the show where normally, I do a little commercial for our small engagement. And we do have a small engagement that's relevant to the COVID-19 business response. If you're cutting marketing. if you're trying to bring back your people as quickly as possible. If you're trying to build a cache of treatment ready patients. We do have that, but I would rather use this break to just ask if you find this useful if you would share it with a colleague, either via email or on social media. We're doing everything we can to put out as many webinars, articles, free podcasts, all free resources to include as many people from the field as we possibly can to give you resources on how to manage and operate a fertility business or an IVF center during this time. And it's changing so quickly.
So if you find this useful, I would really appreciate it if you would please share it with a colleague via email or via social media and help us grow the audience, but only if you find it valuable, and hopefully you are. Now, back to your program.
JONES 31:30
What we're talking about right now is how do we prepare patients as they come back, because everyone's going to have to make this decision for themselves, I believe. I think the next thing that ASRM is going to come back with is Okay, you all, here's the next round of guidelines, do what you think is best because you terrify us. I really think that that's what the next level is going to be. Many clinics are going to be deciding for themselves so that cache of treatment-ready patients is going to vary depending on what you decide to do. One of the things that will determine if they're ready for treatment is how they afford it. Dr. Adamson, you mentioned it's often an aside, and then you're also talking about this is how now is the time to start applying and educating. So taking it from being an aside to something that the financial counselors are educating on, is there something that financial counselors are often missing? Or do you think that they're not advocating strongly enough because it's so hard to talk about money?
ADAMSON 32:38
I think it's very hard to talk about money, especially for patients who are understandably very upset already, and very anxious. So I think it's a very, very difficult conversation. And the hard reality of it is not everybody gets approved. I mean, we wish everybody got approved, but that's just not true. And so it's not as though the financial counselor can say sign this form and you're going to get money. It doesn't work like that. So it's a very tough conversation, especially if they get turned down. And, you know, that's where I think if you have multiple lenders, which has worked well for us, that there are different ways in different places, different sources of money, different ways to go about it. And without sounding too difficult about this, I think it's really important for clinics to make sure that the services that are being provided to the patients are really evidence-based and clinically-indicated, and that the patients’ getting value for it. And, you know, I don't have to spend a lot of time on this, because if there's a lot of REIs, they all know what I'm talking about here, but it's very important not to spend $5 or $6,000 on something that may not help that much. If you could spend that money on another cycle or you could spend that money to buy a multi-cycle package instead of spending it on something that maybe has minimal benefit for the patient. I think this is very important. And I think the clinics, I think we'll be in a new era. And I think the clinics that know how to deal with-- And I think, this uncertainty and anxiety in society is not going to go away in July. I mean, I think it's really important for the clinics to get as many people in. There's lots of patients out there, but we have to make it possible for them. And that's by providing really quality, cost-effective care and dealing with this financial problem up front because it is the number one problem patients don't get care and we're all going to want more patients. So deal with it upfront, deal with it honestly, and look at the different options I think, try to encourage-- I think it's honestly too much for most clinics to have a financial counselor who knows all the ins-and-outs of this. It's too complicated, but they have a very important role to bring up the topic, discuss it and get the patient to go to a source where they have a chance of getting the funding they need.
JONES 35:10
Andy, it looked like you wanted to add to that--it looked like you were nodding.
SWAN 35:13
Yeah, no, it's, um, I just had to echo the comments of Dr. Adamson. And I mean, that's, again, referencing all the customer interviews that we've done. You know, as we spoke with financial counselors, they all feel like they're wearing seven different hats. You know, being a treatment coordinator, doing the financial counseling, just trying to be there and be empathetic with the patients who are going through an extremely difficult time. And a lot of it was difficult for them because they felt like they had the conversations about all these different financing programs, and they'd hand over the brochures and patient packet and the next day, the patient's calling and asking all the same questions that the financial counselor already covered. And so that's why at least with us, Ally, that's how we built our team. We reshaped our team so that our customer support team basically does the job of the financial counselor. So in terms of their team is only dedicated to fertility. So every time that patient calls in, they're getting their same support specialists, they're having a continued, ongoing dialogue. So they get the personalized caring touch and they feel, Hey, this person is an advocate for me and trying to help me along this process. They know fertility treatment, they know what I'm going through, so they're empathetic. And it really takes a huge burden off the financial counselor where it's Okay, I have a trusted partner. I know if I send them over to Ally Lending, that patient is going to get taken care of, the right amount of money is going to get sent to the right places, and I'm not going to have to do extra work. And so I think we put such a focus on that because it frees up so much time for the clinic and a lot of clinics are going through difficult times now and having to furlough or let employees go. So, they're going to be leaner shops when doors do reopen, and the demand is still gonna--we think the demand’s still gonna be there. So how do you efficiently move patients through the door and feel comfortable about getting them through the process?
JONES 37:22
So fair enough, I mean, send them to us and we'll take care of it, I can see that there's some merit to that. But there still needs to be some level of education or rapport built from the financial counselor at the practice and what does that need to be before you can even get to the “Here's some partners that we've worked with, they're gonna walk you through it, they're really experienced.” But there needs to be some rapport, even if often it is you're explaining everything to them, and then they're calling back with the same questions because they just can't receive it. What do they need to be doing?
ADAMSON 37:57
So and you know, I think Andy made a great point, and I really agree with him. I think the answer to that question, Griffin is, first of all, that there should be a program in place where the financial issues are addressed with a patients, I would say at the time they're making an appointment, literally, the patient should be told that we have financial solutions that we offer to all patients. And so number one, it should be early, and then the material can be sent out even before a patient comes in. They can read it at home, they won't be emotionally upset, just having had a consultation about the treatment and just be overwhelmed with information and maybe emotional, you know, anxiety, appropriately because of what they've been told. So you send it out early. And the number two thing is you send it to everybody. The person who drove up in the Mercedes might have leased that car and it's going to be reclaimed next week and the person driving the Volkswagen had shares in Google when it started. The evidence is out there. You cannot predict who is going to need financing or not. So the first big mistake is not doing it early enough at the very beginning and the second mistake is not doing it for everybody. Don't try to guess who can afford it or not. And don't wait until they ask if you have a program. Because the other advantage is that if you start this up front, and they know that you have packages of services like two cycle or three cycle packages, that we have, the patient might decide to spend (and I’ll just make the numbers up), but instead of spending $18,000 for one cycle, they might decide to spend $27 or $28,000 per two cycle package, or $31,000 for a three cycle package. And you just sold a whole lot more services to somebody because you've approached it upfront and you solved the problem. So you want to present it as a solution. You also want your financial counselor to be very empathetic, which I know they are, but they have hard days, too. But if they start this early, and they start it with everybody, they can really come across saying, We understand that this can be something that's not affordable for many people. In fact, we know it's not affordable for any people, we are here to solve your problem and make this affordable. And you start with a dialog like that, before the patient comes out just emotionally distraught from her consultation and the plan for her IVF treatment and by the way, you know, it's $16,500 plus drugs or what have you. That's all. So start early, deal with everyone, and train your financial counselor to do it. And then if they send them out to one of the lenders, certainly with us, you know, we have half a dozen concierge fertility specialists. All they do is day-in, day-out, all day, they know how to talk with people about the financial aspects of this and how to solve the problem. So there is expertise out there to solve the problem. I think the clinic's role is do it early, do it for everybody, and do it with somebody who has empathy and can refer them to resources that have a high chance of success for the patient. That's what the clinic should be doing.
JONES 41:11
Okay, so I can see where we're getting caught.
SWAN 41:15
The other piece for financial counselors, you know, I think it is incredibly important for them to establish rapport with the patient, right? Because they are, in a way, helping guide them through this process. But if a patient is able to be empowered and armed with that information upfront on what financing programs are available to them, once that patient comes in for an initial consult, there can be a much more productive and efficient conversation that's able to happen because a financial counselor can then see, you know, John and Mary Smith, they actually prequalified I can see that in my lender portal, so I know they're actually interested, at least, in financing. We can talk about, you're approved for XYZ, with that, here's these different packages that really fit within your loan options. Or here's how much would be your out of pocket expense on top of the loan, you're really able to have a more constructive conversation based on that.
JONES 42:19
So I think this is where I see people getting caught up. And I love how you listed out these examples of where people get--mistakes that people are making Dr. Adamson, which is they're not having this conversation early enough, they're not doing it for everyone, and maybe it's not the right people doing it-- maybe there's someone else with empathy, that should be more empathy, that you're doing or they just don't know if they can refer to the resources. But this point of not doing it early enough, is coming from they are waiting very often until someone asks, and the one of the reasons why I see that happening is because it is they perceive it as they'll lose someone if they feel like they start to talk about finance too early. And indeed you will lose people if you talk about finance in the wrong way too early. And so we sometimes listen to phone calls of clients because our job is to get them there, then we see what's happening. And very often what we hear is, Hey, I'm just calling to see how much does IVF cost and very often, the person gives them some sort of range or a number and then maybe a couple other questions about How much does PGT cost and these sorts of questions, and then, Okay, well, I'll talk about it with my partner, I'll think about it, we'll think about it. And then nothing happens. And there's no way of really telling us this ever become a patient? And so, I guess, how should this work to where when these people are calling you are talking about it early, but still getting them to the point that matters most, which is the initial consult. Because we don't know, we don't know how much it's going to cost until they come in and the testing has been done and they've been evaluated and there's been a plan prescribed. Because someone might need a gestational carrier, another person might need donor gametes, and someone really might need PGT. And then someone else might just need timed intercourse, right? So there's this huge range. So how do you have the conversation early and answer this question that comes up so frequently?
ADAMSON 44:38
I think it's always good to tell the truth. And I think the reality is, Griffin, as you pointed out, there's a big range. But I think it's easy to say--I think if the person who calls doesn't bring up any questions about finance, I think it would be reasonable for the person who's the scheduler to say we know that for a lot of people we know that IVF is an affordability issue. We have lots of programs to help people with that. And we usually send a package about our programs that makes IVF affordable to everyone. Would you like to have one of these packages? And they can say yes or no if they're, you know, they're worth 100 million dollars, they’ll probably say no. So that's fine. If they bring up questions and say, well, what's it going to cost? You can say well, you know, some of the treatments we do, you can have, you can write this all out so the scheduler doesn't have to make it up as they go, you know IUI costs 1500 dollars a month or something like that. And then an IVF cycle is about $12 or 14, plus drugs or this and this, but we don't know exactly what services you will need. But because we know some of these treatments are not affordable for some people, we have programs to make them affordable and we have a lot of different programs and I'd like to send you this information so you can read about the way we're going to make the care you need affordable. And we understand. So you want to have the scheduler emphasize empathy, that they understand it's a problem. And you want to give them some information, but not too much, don't say we'll send a price list. I'm joking, but you know, don't send them more than necessary. But then very importantly, tell them you care, and you have a solution for them. And you'll send the solution to them, and you will work with them on it. And so I think that's how to approach it and that’s before you've ever seen the patient.
JONES 46:39
So one person asked with respect to that, not everyone will need IVF at the start. They're concerned that discussing IVF costs and financing comes off as that prior to the first visit, and that it could cause a lack of trust with patients that we're only concerned--we're an IVF factory. We're not--
ADAMSON 46:59
That’s a great question, I totally agree. And that's where I see if the patient, you know, I think sending the information to everyone is reasonable, because, hey, who's kidding? Three cycles of IUI can cost $4 or $5,000 easily by the time you get in and have a consultant, and it costs more than that at some places--I know what things cost around the country. And it's a lot more than that some places. And not everybody has $4 or $5,000, either. And you can also, again, you write the pitter patter up that the person is going to give. You can also say, you know, often some of this is covered by insurance. And you can put that in and we will check your insurance, your benefits, make sure you can get the most benefits you can. And there can be some special plans to cut some costs down if you have those. And, you know, you can emphasize that not everybody's going to need IVF. So you can sort of block out the conversation in five or six modules that the scheduler has based on what the person's asking. But the primary message is that we empathize with the fact that this costs money, that is often not covered by insurance, but we have programs to solve these problems for those people who are interested. And I think, you know, those are the principal messages. And then Andy will help you guys with the training of the staff. We train the staff at five ARC clinics, and we do staff training all the time for the financial counselors, schedulers and things like that--we do webinars and help train the staff so that they don't have to do it in house.
JONES 48:37
So, Andy, maybe want to talk a little bit about what sort of training you suggest--that was a question Vivian had.
SWAN 48:44
Yeah, so I think with, you know, one is working with clinics in terms of understanding really where financing fits into their current workflow. So if it is happening later on in the process, and it's happening at that initial consultation, helping coach them and in terms of how they can present our program. And through the customer interviews that we've done, we really know--we've developed a lot of materials for financial counselors that hit on the typical questions that patients have about programs: how long is it going to take for--how long does it take to finalize a loan? Am I able to cover multiple services? Things of that sort. And then working with clinics in terms of you know, it is moving financing further up in the process. It's trying to help them craft welcome kit materials, so they can send it to the patient and not say be invasive or pushing it, but at least, here's materials you can review prior to your consult. And you put in financing and the different programs they offer. And a point you can stress on is you can prequalify with no impact to your credit and that's really a huge selling point to patients because if you can prequalify, you can see the amount that's available to you, you're able to know what fits within your budget in terms of treatment and what you can afford. It's really weird for patients--it's a sense of relief, knowing prior to getting in the door that you can do that. I mean, we have dedicated fertility account managers that work with clinics on an ongoing basis to help train them on programs, or how to present our financing program, how to implement one. Right now, we're doing a lot of retraining for financial counselors just because it can get confusing if they're managing three different lenders because they may each have their little nuances. So I think there's turnover in that space as well. So it's really just constantly staying in contact with the clinic and making sure they're comfortable with our program and seeing what questions and issues they're running into.
JONES 50:57
So I want to conclude with a question and another program that was mentioned is BBVA, who I assume is a lender through Unify--so for those that use Unify to predict outcomes and present patients with that data, that is a program, they also make loans for IVF treatments, so that's another one for folks to consider. But gentlemen, as we wrap up, because I want to keep us mostly on time, and a lot of people have said, thank you. So thank you for the thank yous for everyone that has mentioned that in the comments. What's the biggest takeaway that you feel like centers should be doing with their financial counselors for their patients right now, during this downtime over the next one to three months? What are the top 1-3 things that they should be doing? Maybe we use that to conclude.
ADAMSON 51:43
I'd encourage the clinics to reach out to their patients now. Make a plan for their treatment, and make a plan for them having the financial resources to go forward. And it's not necessarily a bad idea to apply for loans now if you think they'll be into treatment in the next two, three, even four months, so do it now!
SWAN 52:06
Yeah, I would reiterate that and I think about how you're positioning financing today, and what opportunities you have to move that further up into the process in terms of getting patients educated and really leaning on your lending partners. I know at Ally, hey, reach out to me if you have questions about a lot of research and we're just here to help clinics, to help patients because once the doors open up, patients are going to be ready to move forward and the clinics need to be ready.
ADAMSON 52:39
And certainly contact me, contact ARC Fertility if anybody has any questions and we can help you, we'd be happy to do that. And thank everybody for attending and thank you Griffin!
JONES 52:52
Mr. Andy Swan of Ally and Dr. David Adamson of ARC, thank you both for coming on and as people have follow up questions I'll direct them to you. Thanks so much for helping us.
ADAMSON 53:03
Appreciate it, Griffin.
SWAN
Thank you.
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