DISCLAIMER: Today’s Advertiser helped make the production and delivery of this episode possible, for free, to you! But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, and the guest’s appearance is not an endorsement of the Advertiser.
How does someone go from CCRM to one of the big fertility networks in Australia?
What can fertility executives in the US and other countries learn from the consolidation that happened earlier in Australia? How does the Australian fertility market compare to the US?
Find out on this week’s podcast as Scott Portnoy, COO of Genea Fertility, gives an in-depth look at the current climate of the Australian fertility space.
Tune in as Scott discusses the Australian perspective about:
Where Australia is ahead of the US with Fertility (And where it’s behind)
Fellowship & training practices (And how it's impacting their doctor shortage)
Donor and surrogacy regulations in the fertility market
Fertility Networks going public (And why that may have happened sooner in Australia)
The private equity backed consolidation in fertility (Foreshadowing what may happen in the States)
Scott Portnoy
LinkedIn
Genea Fertility
Website
LinkedIn
Facebook
Instagram
Twitter: @geneafertility
Transcript
[00:00:00] Scott Portnoy: What's different is that the consolidation period happened so much sooner. And so what you had was the, what, the big wave of consolidation of practices in the U S has been probably. The last 10 years. So take Verdis and Monash, who were the two who have been public here in Australia, they both went public and call it 2013, 2014.
So they had already done that consolidation. Now it wasn't finished, but a lot of that consolidation before the U S really even started to do so. And what you're now seeing because of that is the doctors who were part of founding those original practices, and then were maybe part of these consolidation efforts have subsequently retired and moved on.
And you now seek the second iteration or maturity of. of those networks.
[00:00:53] Sponsor: This episode was brought to you by AIVF. Maximize your clinic's potential with EMA by AIVF. Slash end to end embryo evaluation time by a staggering 97. 8%. Freeing your staff to focus on what truly matters. Curious how this reduction in evaluation time could affect your bottom line?
Visit aivf.co/precalc and use our free calculator to uncover the cost saving benefits of EMA by AIVF.
Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
[00:01:51] Griffin Jones: Are U. S. fertility clinics looking into their own future by looking at Australian fertility clinics, or are Australian fertility clinics looking at their future by looking at what's happening in the U. S.? Who's to say maybe our guest today is to say he was the COO of CCRM, and now he's the COO of Genea fertility in Australia.
We get an intro to the Australian IBF market. What's their payer system like? What's their self-paced system like? What's happening with employer sponsored benefits over there? Do they let their OBGYNs do egg retrievals and transfers? What's their fellowship in training like? And how does that impact their doc shortage?
Scott Portnoy educates us on what's happening with donor and surrogacy IVF in Australia. We talk about what's happening with private equity back consolidation and fertility clinic networks going public. We talk about why that may have happened sooner in Australia and what might that foreshadow what's going to happen with fertility consolidation in the U S.
We talk about consolidation and then fragmentation. What's happening with new fertility clinics. Thanks. And I talked to Scott about where he sees the U. S. being behind and ahead and where he sees Australia being behind and ahead in the assisted reproductive technology space. I think it's useful for U. S.
and Australian audience members to peek into each other's landscapes. And if you're from another country, how does each situation compare to your own? Discuss amongst yourselves. Enjoy this episode with Scott Portnoy, former COO of CCRM, now COO of Genea Fertility. Mr. Portnoy Scott, welcome to Inside Reproductive Health.
[00:03:32] Scott Portnoy: Thanks, Griffin. Glad to be on.
[00:03:33] Griffin Jones: I've had a lot of people on over 200 plus episodes. Don't. Think of anyone off the top of my head that was in a leadership position on one continent, and then at another leadership position in another continent. Maybe there's somebody, but you're the first one that I'm thinking of.
So for those that are a little bit familiar with your bio, you were chief operating officer at CCRM for a number of years. Now you are at Genea Fertility in Australia. And I believe in the same role. Is that right? That's right. So I'm just curious at a personal level, like you're too young to have a midlife crisis.
So tell me about what brought you from Colorado to Australia.
[00:04:16] Scott Portnoy: My, my hairline would say differently, Griffin, but yeah, my, it was really more family driven than it was work driven. My wife was originally Kiwi by birth. It's been part of her childhood here in Sydney. And so we always looked at this part of the world as a place to come back to at some point.
And. We're on a bit of a career sabbatical, both of us, and got a call from Janaya right in the middle of that. Timing is everything. That's what brought us down.
[00:04:38] Griffin Jones: Was it during COVID that you did the move? Was it during?
[00:04:42] Scott Portnoy: No, no. It was in January of this year, so it's been just under a year we've been doing it.
[00:04:47] Griffin Jones: Okay. So you're on a little bit of a career sabbatical. You got a call from what is now local to you. What was your first impression of that? Were you thinking, Oh, sure. Like this is pretty cool. Or was it like, there's, I don't know what I'm going to have to learn being in a totally new market.
[00:05:05] Scott Portnoy: Certainly both.
We're actually on, on a little vacation in Maine and I turned to my wife and I was like, Hey, is this one I should take? Would you take direction from the wife? That's always a smart call. And she's on vacation. Especially on vacation. And she said, yeah, go ahead. That sounds interesting. And so started having some chats and as I learned more, it was became clear.
It was interesting. Alexis, my wife had grown up here in Sydney, so very familiar territory and the growth story and the quality story of Genea. And what we were trying to do reflected pretty well with me, especially given my CCRM experience. And so it became a, Hey, I could think I could see like I'd add some value here type situation.
[00:05:41] Griffin Jones: I'm very interested in this unique perspective, because I'm curious as to what the similarities are in the two continents, in the two countries, uh, what the differences are, and I'll try to get. specific side of you, cause I'm sure there's general differences and general similarities, but what was, as you started, what was the first thing that you noticed that, Oh, this is very similar.
This is very similar to what I'm used to.
[00:06:04] Scott Portnoy: The similarities have been the, what I'll call the patient care side of the spectrum. First outcomes really quite similar to those that we see in the U S. Australia has been alongside the U S at the forefront of a lot of change. CSERM itself had folks from Australia working there way back in the day.
And so, there's a lot of overlap from an outcomes and quality standpoint. The patient experience, the patient journey, how hard that is, no matter where you are. has been quite consistent and man, embryologists, right? Doesn't matter if you're in Australia or the US trying to find the right ones or is the tough problem.
I think the biggest difference, probably a couple things, the funding environment as to how to access care for patients and then the doctor component. And great doctors in both places. But just how the model operates certainly differs.
[00:06:51] Griffin Jones: I want to dig into each of those. When you say funding, right? You're talking about patient payor side, or are you talking like venture capital, private equity stuff?
[00:07:00] Scott Portnoy: No, well, those are both be fun to talk about, but the, I'm talking about the first of the two, which is the system here in Australia covers a large portion of costs for patients. Going through fertility treatment, and that increases utilization probably threefold in Australia over the US on a per capita basis, obviously.
[00:07:20] Griffin Jones: Is that true for each state? Is it at a national level, or does it depend on if you're in Western Australia, or if you're in New South Wales, or?
[00:07:30] Scott Portnoy: That is on a national level. There may occasionally be a rebate that'll occur just here in New South Wales, for instance, but broadly speaking, doesn't matter which coast you're on.
You're getting the same coverage.
[00:07:40] Griffin Jones: I think you're my first guest from Australia. I still wasn't able to get the accent, but because you are the first person, maybe it bears a little bit of necessity just to paint the picture of what that public payer system is when you in the UK, for example, it's very different than in Canada and even in Canada, it's very different from Ontario to get back to other provinces where sometimes you have a lot of refunding in the UK.
It's based on certain locations of how much self NHS funding is there. Correct. Give us a little bit of one on one on what that payer system is like in Australia.
[00:08:13] Scott Portnoy: Yeah. System here is called Medicare. It's the system across Australia for all healthcare needs. Everybody has it. And for fertility services, it covers 50%, but call it 5, 000 to 6, 000 per cycle.
And there is no cap on cycles. So you come through fertility treatment. Whether you are 30 years old, and it's your first cycle, or 45 and it's your 10th, if it is medically necessitated, so diagnosed as Infertility, you come through with that kind of funding. Patients look at it, obviously it's still expensive.
People see it as expensive. And we're constantly trying to figure out how to make, how to enable more access, but broadly speaking, it reduces costs significantly. And that's from really consult, through all the way through treatment. What it doesn't cover the actual call it, if we're talking PGTI testing, but what it will cover is PGTM testing.
[00:09:11] Griffin Jones: What's the rationale behind that?
[00:09:13] Scott Portnoy: I'm not sure. I know that the BGTM is a quite an interesting one, and this is probably going a little bit deeper, but as of what is two weeks ago now, at the beginning of November, the government actually began funding for a three gene carrier screening test. And there's a real awareness of funding for things that could cause, obviously, patient problems, but also massive costs to the healthcare system over the life of a patient from start to finish.
And that, uh, carrier screening is covered. You've got the funding for the fertility treatment. You've got the funding for the PGTM, and now you've got actual funding for the storage of those embryos post PGTM. And so there's a real kind of end to end coverage for treatment there.
[00:09:55] Griffin Jones: Is there a requirement for a certain number of IUIs or time to intercourse or anything like that before IVF?
[00:10:03] Scott Portnoy: There's none. And so it's really specialist driven. Specialist sees you. They feel like you are validated as a, as an infertile patient and that this is the best course of treatment. Off you go. There's no preauthorization, so there's nothing to submit to the government before you proceed. Obviously a specialist could be audited by Medicare at any point, but broadly speaking, it's specialist driven and it doesn't become an issue.
And so from a patient standpoint, that's great funding. Obviously it's costly to the system because inevitably there's patients who. I'm not sure what always be appropriate to go through, who end up going through, whether their request or specials request, but on the whole really good program.
[00:10:40] Griffin Jones: If I'm not mistaken, the NHS in UK was either this year or last year, if I'm remembering and have my details correct, expanded the definition of, or at least the coverage of fertility treatment to same sex couples.
Has that happened yet in Australia?
[00:10:58] Scott Portnoy: That's a great question. It is a little bit undefined. And so, again, back to the what is infertile in the eyes of the specialist, if you are a same sex couple and therefore cannot medically conceive a child on your own, if a specialist considers that to be infertile, they would validate that as having, as submitting for Medicare coverage.
And I think I would find it hard for the The system at any point to go, Hey, I'm not going to cover that. Right. I, you're walking into a whole storm. If you were to do that, I think.
[00:11:33] Griffin Jones: Does that lead? So of 1500 or so REIs in the U S there's probably, Oh, 30, 50, 60, somewhere around there, docs that have, A really high percentage of same sex couples, or particularly same sex male couples.
Do you find that there's some kind of Prado's distribution in Australia where there's a few docs that are well known for being specialists for same sex male couples?
[00:12:01] Scott Portnoy: I think there's a little bit of that, but I think there's a broader reason why that probably hasn't been the case as much as it has in the U. S., which is around the regulatory environment for Donor and surrogacy services in Australia versus the U S it's an interesting one. And depending on your, your ethical views, it gets gray, obviously U S depending a little bit, state regulation, dependent commercial surrogacy or donor services are allowed.
That's not the case in Australia. So, for either surrogacy or donor, there is no compensation that can be paid. There's some reimbursement that can be paid, but no compensation. And so, it's gotta be altruistic. So how do you go about that? Obviously, the wait lists for those services grow, and patients end up going outside of Australia at times, or there's probably a market outside of regulated fertility centers between patients that pops up for those services.
And it probably pushes less patients towards specific clinicians who do a lot of
[00:13:04] Griffin Jones: As far as you can tell, is there any thing on the horizon for that changing? Because that's been the case for at least as long as I've been in the field. And I remember 2014, 2015, 2016, helping some U. S. clinics market. to Australian and New Zealand patients for third party because of the shortage of egg donors and the shortage of gestational carriers.
So people would come from Australia and New Zealand and travel that, that long distance because whatever market there is in between folks and whatever's coming from people who are only donating altruistically without any kind of compensation is just insufficient. Is there any kind of, is there anything on the horizon to revise that?
[00:13:49] Scott Portnoy: Yeah, there, there's certainly discussions, especially within the industry as to what can we do to better enable access, whether or not that will make it to the level in government where things would change is another question. And that's where you do have some States do differ compared to funding where it's ubiquitous across Australia, depending on the state you're in, that legislation changes slightly.
Victoria being the most conservative, if you will, oftentimes. And it's not just a national conversation. It's a state level conversation. And it's therefore not exactly an easy one, but it's something we're aware of and trying to solve it for no other reason than we have patients that we need to serve.
And we've got to find a way to help those patients achieve their family dreams and it's a tough situation for folks.
[00:14:29] Griffin Jones: Tell us a little bit more about the, what is the differences between doctors? You mentioned that you, there's great doctors in each country on each continent, but you noticed some differences, what in the way they're organized or the workload they have.
What differences do you notice?
[00:14:49] Scott Portnoy: Two or three main things. The first is. In the U. S., at least historically speaking, fertility doctors are REIs that completed their fellowship and all they do is fertility. That may start to change, but that's been the historical. And first thing I noticed walking into Australia is that's not the case.
There's obviously that group of specialists who all have what we call here a CREI. It's like completing your fellowship, an REI in the U. S. And all they do is fertility. And maybe all they do is private fertility. Here you've got folks who are also maybe doing gyne, doing obs, and doing fertility because it's a full service offering for their patients.
And I think that's just how Australia's traditionally done it. So it creates a slightly different dynamic in that way.
[00:15:34] Griffin Jones: What are the pros and cons of having the model set up that way?
[00:15:37] Scott Portnoy: I think the pro is, and this is why I think you're starting to see it happen in the US, It enables a broader population of specialists to help people with fertility issues.
And we know whether it's embryologists or doctors in the U S that is a real supply constraint and opening up the supply with non REI specialists. Is it can be a real positive way. And there's different ways to do that. That that could be individuals managing an entire cycle and doing the retrieval. For instance, it could be just procedural related specialists.
Yeah. There's variations. The potential con is obviously quality has always got to be paramount. And so how can we ensure that the same level of quality is being driven to our patients, regardless of whether it's somebody who does nothing but fertility or somebody who does other things on the side as well.
And so that's a mechanism that we're constantly thinking about is as we grow or anybody grows and you bring on additional specialists, one, what is the training mechanism? How do we validate it? How do we support to the extent that the specialist wants that? And then how do we retroactively. review data and provide additional support as needed.
[00:16:52] Griffin Jones: There's so many different sub rabbit holes I want to go down. So I keep writing them down to make sure it's if we jump back and forth, it's because I want to cover them. And each time you say something, it's, Oh, that's an interesting topic. And so you started talking about OBGYNs as part of the practice group, being able to offer a broader supply of physicians, able to provide fertility treatment.
That's a debate that is still raging on in the US. I feel like it's one, but it will be more years before the war is over with regard to that debate. But I feel like we have passed a turning point. Maybe that's just my own perception. But I was recently at ASRM where There was an REI, and I don't even think they call them that in the UK, but a fertility specialist from the UK.
I want to give them credit because it was very funny. And this person said, where I come from, if you can deliver a baby, you can suck an egg. Is that the case in Australia?
[00:17:50] Scott Portnoy: I'm not sure I would've put it so crudely ,
[00:17:53] Griffin Jones: it's very British, right? ,
[00:17:55] Scott Portnoy: yeah. Yeah. That's the other thing I've learned being in Australia, I would say, speaking for Genea and I, I haven't worked extensively with specialists from other networks here in Australia, so I don't wanna speak for them.
Jena organizationally has been focused on quality and research and outcomes since the mid 1980s, and so that's in the DNA of the organization, if you will. Therefore, we're acutely aware of the specialists that we have joining us, and how do we ensure that if they're not only sucking eggs, as your contact there put it, they're doing it at a level that's synonymous with everybody else.
As to whether there's a difference in outcomes, I think it'll depend on the specialist, just like anything else. As the space continues to mature, I just have to assume we're going to see more and more of it. And if we can do it in the right way. We, we've got specialists who have better outcomes as non CREIs than CREIs.
And again, I think it comes down to the doctor, obviously having a CREI is the kind of most mature version of your training, but I don't think it's, you don't have to be successful as a fertility doctor and provide fantastic outcomes. It's certainly not a 100 percent requirement. We see both.
[00:19:01] Griffin Jones: CREI, is that an Australian term?
Does that mean certified reproductive It is, sorry, yeah, that's your, that's your
[00:19:07] Scott Portnoy: Exactly. That's your, that's having completed your fellowship.
[00:19:10] Griffin Jones: Yeah. Okay. So tell us about that credentialing in Australia. There are fellowships like in the U S and Canada because in, I don't think in the UK maybe, but in certainly in, in many places in Europe, there's not a fellowship.
So tell us about what fellowship or REI credentialing is like in
[00:19:27] Scott Portnoy: Australia. Everybody completes their kind of O and G training, if you will. And then you can choose to complete further training in infertility as a subspecialty, if you will, kind of happens in a few different forms. There's the other thing we didn't talk about earlier around how the doctor mechanism differs is there's also public programs.
And so those public programs are publicly funded hospitals and provide publicly funded fertility treatment to patients. Those are. Places where audit subspecialty training happens for specialists, and they may or may not continue to provide services in that environment kind of post having completed their CREI.
And in addition to doctors who may be due part of the time and fertility in part doing gyne and ops, they may also be doing part of the time and fertility in a private setting. And then part of the time in a public setting. From an access standpoint, enables greater access for patients more broadly. It means you don't always have the doctors full attention at the private environment.
And so that's a something that operationally differs from the U. S. in terms of how do we best partner with specialists to make sure when they're not here 24, not 24, 7, 5 days a week, that we're still maintaining the best experience for their patients.
[00:20:46] Sponsor: Boost your IVF clinic success with EMA by AIVF. With our suite of AI modules, analyze embryo viability with precision, considering visual quality, morphokinetics, and genetic integrity.
Enjoy seamless clinic management with advanced IVF analytics. Integrated EMR connectivity and a centralized communication hub. Ensure 24/7 access from any device and connect to multiple time lapse systems simultaneously. Using our platform, our partners have experienced a 10 percent rise in implantation rates and a 30 percent increase in capacity.
Don't just take our word for it, see the actual impact on your bottom line. Visit aivf.co/precalc, Input your clinic's data, And get a personalized report on how EMA by AIVF can revolutionize your operations and financial performance. That's aivf.co/precalc.
[00:21:51] Griffin Jones: So in order to understand more about the REI practice structure, I probably need to understand a little bit more.
of the very basics of the Australian healthcare system. So in the U S you've got multiple payer, multiple provider in the UK. You have single payer, single provider in Canada. You have single payer, multiple provider. What is it like in Australia? Is it like Canada or the UK or neither?
[00:22:18] Scott Portnoy: I'd been, I can't say I'm an expert in either the Canadian or the UK medical systems as it comes to being an expert, but.
It's probably a little bit more like the Canadian model in that you've got a single payer in Medicare. Everybody has it, but what's happened is that over time specialists, especially those that are more in demand, will charge what we call a gap. So above the rate that they would receive from Medicare, there may be a gap as to what they bill a patient.
And that's, that gap is what the patient's responsible for. And there's now a number of private insurance Options that would sit on top of that Medicare funding to help patients cover that gap, if you will, in coverage, and broadly speaking, those private insurance options do not cover fertility services, they may cover components of it.
Like the day surgery, for instance, but the basic fertility component they don't cover in that if you want another rabbit hole that we could go down that opens up the entire conversation around alternative payers direct to employer models, which because of the funding mechanisms here haven't yet really become all that present, if you will.
[00:23:34] Griffin Jones: Oh yeah, I've got that in my notes here. What percentage of. IVF patients in Australia are self pay.
[00:23:42] Scott Portnoy: Outside of the Medicare funding, really everybody, right? Unless, at least in my nine months here, unless you are a patient that has come through one of the few employers that is maybe a multinational, And therefore has alternative payer coverage from a, one of our big alternative payers in the U. S. You're going to be paying out of pocket for the services that Medicare does not cover.
[00:24:09] Griffin Jones: Okay. I then, I must have fundamentally glossed over something you said earlier. I thought that Medicare pays for most fertility treatments. Not a hundred percent. Maybe the audience doesn't need the recap, but I guess I do.
Tell us again what Medicare pays for and doesn't pay for.
[00:24:26] Scott Portnoy: Medicare will cover. At least in the instance of most private fertility, non low cost providers, roughly what is 50 percent about five to 6, 000 of a fertility treatment. Got it. Okay. Yeah. Sorry. If I glazed over that earlier, that's the rough math.
And so if you, if the average. Cycle costs 12, 000 here, 5 or 6 is covered by Medicare, the rest is covered by the patient.
[00:24:52] Griffin Jones: So is that 5 to 6 exhausted after one cycle or is it 5 to 6 for each cycle?
[00:24:58] Scott Portnoy: Each cycle, no limit. Nope, that is, obviously at some point hopefully the patient or the specialist is going, Hey, this doesn't make any sense anymore.
But from a Medicare standpoint, there's no limit.
[00:25:08] Griffin Jones: Okay. All right. So it was probably me that, that glossed over, but that makes things a lot clearer. So is there any progeny in Australia?
[00:25:17] Scott Portnoy: What you have is those multinationals based in the U S your Googles, your Ubers, whoever it is that offer alternative benefits, alternative maven, a carrot, a progeny, whoever, when they've got international employees based here, those benefits typically extend in some way to the employees.
And so we will see a subset of patients who have that, but obviously it's limited to the portion of the population that works for one of those us based multinationals. So it's pretty
[00:25:50] Griffin Jones: limited. So it's only the multinationals, like, I think one of the big media companies in Australia is ABC. Like, they don't have fertility provider benefits for their, or fertility benefits for their employees?
No. Is there any kind of Push because if the multinationals are there, that means they're taking some of the talent from the domestic Australian companies. And so if it's, I could go work for ABC or I could go work for Metta. I guess I'll work for Metta because they have these extra benefits. Is that starting to put pressure on Australian companies or is the conversation not even happening yet?
[00:26:27] Scott Portnoy: I think because the existence of the. Medicare system that has broadly provided what has been relatively comprehensive coverage for people for any sort of healthcare need. Historically, there's been a less of a just mindset about employers stepping into that space, because as an employer, you probably have nothing to do with your employees, healthcare coverage, whereas that's such a different thought in the U S where it's a huge component of evaluating who you may go to work for, and that ongoing employee, employer relationship, whether it's It's really not a part of the conversation here at all.
I think that as these gaps I referenced, this cost above and beyond what Medicare covers continue to grow in the future. There may be more of a place for employers to fill those gaps, if you will. With additional coverage, but I think it's just at the beginning stages in my sense
[00:27:21] Griffin Jones: So then talk to us about how private practice had been structured you have public programs Then it sounds that you also have private settings And so was it the same sort of dynamic in the US where you had?
The program's mostly being affiliated with hospitals in the eighties. And then by the mid nineties, you started to see the RAIs leave the academic center, start their own private practices. Was that what happened in Australia? Was there something different?
[00:27:51] Scott Portnoy: No, I don't think the origins like you just went through are relatively similar.
I think what's different is that the consolidation period happened so much What you had was, you know, what the big wave of consolidation of practices in the U. S. has been probably the last 10 years, right? Especially 2015 to 2020. If you were to look at Virtus and Monash, who were the two who have been public here in Australia, they both went public in, call it, 2013 2014.
So they had already done that consolidation, now it wasn't finished, but a lot of that consolidation before the U. S. really even started to do so. And what you're now seeing because of that is the doctors who were part of founding those original practices and then were maybe part of these consolidation efforts have subsequently retired and moved on.
And you now see the second state of the second iteration or maturity of.
[00:28:55] Griffin Jones: When did that consolidation start to happen? I'm guessing it happened much earlier than when they went public. Was there a private equity phase prior to that?
[00:29:04] Scott Portnoy: I don't know the exact years, but in my mind it was probably three, four, five years prior.
It depended on the network, there was private equity involvement, certainly in the case of Virtus before it went public. Those were then both public, Monash continues to be public, Virtus was recently taken private again by private equity.
[00:29:21] Griffin Jones: Any speculation as to why that worked out earlier? Because it did happen, that was still happening in the US, it just didn't seem to take off, at least the consolidation until, mas o menos, 2015. But. You had IntegraMed, you had, Dr. Gleicher was on the show previously, and he said that he attempted that in the mid nineties, and you had some attempts in the US with very mixed success at best. Any speculation as to why it worked out in Australia earlier?
[00:29:52] Scott Portnoy: At least part of it's probably driven by market size.
Obviously Australia's population of 25 million people. There's a more limited number of markets to consolidate and much easier, therefore, to reach that kind of network scale. I think that's probably part of it.
[00:30:11] Griffin Jones: I know zilch about the Australian stock market, but is it, is there a lower barrier to entry to going to being listed on the Australian stock market than on NASDAQ?
[00:30:23] Scott Portnoy: That's pro that's probably true as well. I don't necessarily envy living in that sphere, if you will, just personal style, not wanting to be short term focused always or needing to be from a. Market visibility standpoint, obviously it was a, it was an event that led to funding capacity for those organizations and good for them.
Right. That no problem there.
[00:30:40] Griffin Jones: How did your organization differ in their approach?
[00:30:43] Scott Portnoy: First of all, I don't mean to say anything that if you're a publicly listed company and you're not doing great things by patients, that's not at all what I'm implying. I'll answer your question. In the, how's my experience differed, which is, and I know you've talked about this on prior shows.
So I'm, I'm sure the question is going to come at some point here, which is the presence or role of private equity in all things, fertility and healthcare more broadly. And that's just by happenstance, the path that. Organizations I've been a part of have gone down both at CCRM and here at Genea as well.
And I think it all comes down to the people you work with.
[00:31:14] Griffin Jones: There's Genea Fertility, there's Genea Biomedics. Tell us more about that corporate
[00:31:18] Scott Portnoy: structure. So Genea, founded by Professor Robert Janssen back in the 80s, always focused on quality outcomes, research, trying to be at the forefront of that, which has driven a huge amount of value for patients in the organization.
So it's the only reason I'm here is because of all that work. Part of that effort was. What became Janaya biomedics Janaya biomedics produces things like the Jerry incubator time lapse incubator and other call it products and technology media, etc. Again, helped us to differentiate from an outcome standpoint, but obviously there's a different cadence to running a products and technology company from a service company.
And it was determined that the best thing for the organization was to split those two pieces separately. And so, Genea Biomedics was separated from Genea, Genea retains the exclusivity, so we're the only ones in Australia using Genea Biomedics products. Which is fantastic for us, but we operate a little bit more independently today than we used to.
Is there a private equity partner? There is. Yep. It's a Liverpool partners based here in Sydney.
[00:32:20] Griffin Jones: And so where does Genea fertility rank in the size of groups in the country in terms of clinic providers? Are you all the third largest in terms of cycles and docs?
[00:32:31] Scott Portnoy: No, you got it. That's right. Third largest from a cycle market share standpoint.
Historically, Genea, because it was so focused on the outcomes, the products and the technology wasn't as focused on the, I'll call it patient access side. And that's, I think manifests itself both in geographic expansion and enabling patients not to have to come to Sydney for care, but to be able to access that and say, Brisbane and Melbourne, third largest markets in Australia, uh, as well as just call it, called marketing and ease of patients accessing.
specialists in care. And so that's a lot of place where we figure if we can combine the outcomes leadership that we have with leadership from an access standpoint. It creates a lot of value for patients and ultimately the organization hopefully.
[00:33:20] Griffin Jones: Are there still lone wolves in Australia in terms of private independently owned fertility clinic providers?
[00:33:27] Scott Portnoy: Yeah, it's probably, oh, 30, 35 percent of the market, something like that, who operate outside of the big kind of three or four networks. And what's interesting is because you've seen the consolidation exist for longer, You actually have instances where you now have breakaway doctor groups going to form their own practices again.
So we've begun the next cycle and I've got to assume that eventually those individuals will decide it's best in their interest to join a network again. And they may become part of that network or different network. Time will tell, but we've just started that.
[00:34:01] Griffin Jones: I say that all the time. And we are seeing that in the U S as well, but it's the same thing that happened with banks.
Every town had their own bank and then they conglomerated into regional banks. And then they got bought by larger national banks who then got bought by. by a city and chase and HSBC. And we saw the same thing with breweries where a hundred years ago or so, every city Scott had their own brewery. And then by the mid 20th century, it was all Miller Coors and Heizer Bush.
Then by the early two thousands, it was SAB Miller Coors and, and has a Bush merging globally with in Bev. And, but then. Guess what? Every city has their own breweries again. And, and the middle guys are gobbling up the little guys and the big guys are gobbling up the middle guy and the circle of life continues.
[00:34:49] Scott Portnoy: Completely. And I think look for any network organization at this point, that creates both certainly a threat, but also an opportunity. depending on where you sit and frankly, depending on how do you partner with specialists. And that's what we're constantly thinking about. Not just how do we serve our patients best, but frankly, it really is as customers of the organization, as partners, how do we serve our specialists best?
And if we can do that, I think both in how do you partner just as individuals and partners and relationships, but also from a incentive and economic structure standpoint, you can hopefully find the right balance. to make everybody happy and keep folks around. And that's where we're obviously spending a lot of our time at this point, as we look to grow.
[00:35:35] Griffin Jones: Is that kind of like the Google approach from 20 years ago, where they're losing some of their best devs and talent to create their own startups. And they said, listen, we want to create an ecosystem here where you can start your own thing at Google and you can be entrepreneurial, but that way they're retaining their talent.
Is that what you're alluding to or something else?
[00:35:56] Scott Portnoy: Yeah, I'm not sure we're as cool as Google, but I think certainly finding ways to align incentive and for those that want to feel like owners or be owners, make that the case. There's obviously a million ways to do that, as I just think that's incredibly important.
Now, not everybody wants that, and that's fine, but if we have the ability for you to, if you want that to slide into that appropriately, while still making sure we maintain a standardized network where you can go to any JANEA location and expect the same level of care, the same level of outcomes, We've hit a really good point.
And so how specifically are you doing that? It depends on the market, depends on the doctor as to what they want. I will say, and we're still at the early stages, right? It's been nine months or something like that, but broadly speaking, there's local level ownership. There's parent level ownership. There's other ways to incent doctors.
And again, those are conversations you have to have with each specialist and it's going to depend on each market. This isn't necessarily Janaya specific. This is just broadly speaking, how I think about the world. If we're entering a new market, that may be a very different conversation than an existing market and no different than how those organizations in the U S have dealt with it.
So a lot of the same dynamics need to be dealt with here. Although I think there's more opportunity for creative structuring. In Australia, then I think the U S may be a little bit further ahead.
[00:37:17] Griffin Jones: There are the top three networks in Australia. Are they all in the top five to let's say top 10 biggest cities in Australia, or are there some where we're in Adelaide and Melbourne and.
Sydney, but we don't have a place in Perth or we're in Perth, but we don't have a place in Sydney. Is it, what's that like?
[00:37:35] Scott Portnoy: The top two are in all those markets already. There's maybe extenuating circumstance somewhere, but Genea has been the one that hasn't had that level of geographic access, and so we recently entered the Adelaide market via partnership with an existing practice there.
We opened a location in Brisbane, which was a greenfield about a year ago, and just opened a location in Melbourne. Again, a greenfield all of about a month ago. And that for us is such a big opportunity, whereas you've got the other players who are largely already in those markets.
[00:38:06] Griffin Jones: I was going to ask you what your mandate was when you were hired and maybe, maybe I've stumbled upon it.
Was that, was it that expansion? Tell us about what was your mandate to the degree of detail that you're able to share and comfortable sharing? What was it that like Scott do this?
[00:38:23] Scott Portnoy: One outcomes in patient care are non negotiable. That's what's led Genea historically. Cannot change and so continue to sort that one out, right?
Whether that's maintaining and growing our quality outcomes to his patient care and patient access and then Specialist partnership and growth how I think about the world and if we can do those things that obviously sounds like a very simple list There's obviously a lot that goes into making that happen But if we do that, we're adding value to all the places that seem to matter in my mind And our group's mind, and I think that'll drive success ultimately.
And obviously geographic expansion is a big part of that, right? Enter and grow in those markets. And what comes beyond that, who knows you've seen the groups from Australia expand into Asia, primarily in order to continue their growth. Whether we do that or not to be determined, what we don't want to do is miss the, the great opportunity in Australia.
[00:39:23] Griffin Jones: First and foremost. So then to understand what the need is across the board for, or the difficulty in recruiting providers. I need to understand a little bit more about how OB GYNs work in the fertility center. In Australia, can OB GYNs do retrievals and transfers? I can. Does that make it easier to meet provider talent than it was in the US?
[00:39:47] Scott Portnoy: It makes it easier to meet provider talent. That doesn't mean. It's always easier or as likely to bring them on again back to the quality component always have to be Selective and who you bring on to ensure you're not sacrificing quality just to expand access to care and added add another specialist That's the big catch.
[00:40:06] Griffin Jones: I think got it. What about advanced practice providers? Can it does that exist in Australia their nurse practitioners physician assistants or some equivalent?
[00:40:16] Scott Portnoy: It's newer And I think there's opportunity there for us to use more of those individuals. Here it's what we call a GP, a general practitioner. And those individuals may sit somewhere in the early part of the care process.
They're not really an extender as much as they are another part of the care system that can help complete things like a patient's workup. Are they physicians? Yes, they're physicians. I went to medical school. If you think about the Medicare system here in Australia, in order to go get that Medicare funding as a given patient, you have to have a referral.
Those referrals. Come from GPs. And so they are very much the gateway to specialist care throughout the system. And those GPs can order tests. So oftentimes you may see a GP to get your workup done as a fertility patient before you get to a specialist.
[00:41:03] Griffin Jones: So there's no in between a physician and a nurse, like what used to be called mid level provider.
There's no nurse practitioner, physician assistant, mid level provider.
[00:41:14] Scott Portnoy: Nurse practitioners is just becoming a thing. Yeah. And so I think there's opportunity for us there. We haven't quite cracked it yet, but I think it'll get there.
[00:41:22] Griffin Jones: Where do you feel like the U. S. was ahead in certain areas of the field?
And where do you feel like the U. S. is behind from what you've seen?
[00:41:32] Scott Portnoy: The U. S. is certainly ahead on creativity around ways for patients to access care because of price. That is Employer sponsored benefits, and that is pricing creativity, things like multi cycle programs. And that iteration of pricing is much less present in Australia because the costs are less to the patient out of pocket.
Where it's behind is obviously that has had to happen because there's so much less funding. So just from a expanding access to care standpoint, if that's our ultimate goal is to help more patients, there's obviously an issue with the U S system from a funding standpoint. And then secondarily is leveraging those non REI specialists.
If you can do it in the right way, the U S may be caught behind. On that. Cause I think that's been going on for longer here in Australia and it's certainly more utilized.
[00:42:23] Griffin Jones: How about on the technology side, like workflow, software, automating workflow, automation for patient consents and patient education, and then an AI on the lab side and all of that.
Where has each country implemented more or less?
[00:42:39] Scott Portnoy: I think you're in a largely similar place. AI sits in that same place of, Hey, what's the, those are great two letters, but what does it actually mean? And how do we best use it to add value? Not just to say we have it. I think that both countries are in similar places.
They're the lab technology. We, we, for instance, because of the Janaya biomedics history are a 100 percent time lapse incubator organization and have been for a number of years. So whether it's lab technology or workflow technology, we're largely similar where I think the U. S. is maybe out in front of things a little bit is from a patient acquisition standpoint and the direct consumer marketing and using digital Marketing and technology to acquire a new patient volume.
Whereas in Australia, it's been a little bit more doctor driven historically. I think that will shift a bit as the ways in which we all reach the world via technology and all things digital. Becomes more and more prevalent. That makes sense.
[00:43:41] Griffin Jones: It does. And I'm going to give you the concluding thoughts.
There's a whole bunch of other things that I want to ask you, but we'll have to have you back on. What I'd like to conclude is your thoughts on what would you like to see implemented in the next two years?
[00:43:56] Scott Portnoy: I think what we've got to get to is a place where it's easier for patients to access care. I think obviously there's always outcomes opportunities, and hopefully we find the next.
step function change in outcomes. I think the bigger barrier right now is whether it's financial access or journey access, meaning patient experience. I think those are going to become as much the differentiator as outcomes have been historically. And how you best do that Because you can't lose the patient relationship side of it.
It's too important. This journey is too hard, but how you can enable the use of technology and automation and all that good stuff to enable those relationships at the right time from your staff. And if we can get all that right, patients can get the care more easily. Everybody's happier. That'll frankly grow the market more than anything else, because you'll keep people around for the next cycle.
Patients will talk to their friends about how it wasn't that bad. And. Off we go. I think today is just a little bit too hard.
[00:45:03] Griffin Jones: Those specific solutions will be the topic of our next podcast interview. Scott Portnoy, COO of Genea Fertility. Thank you very much for coming on the Inside Reproductive Health podcast.
[00:45:15] Scott Portnoy: Thanks for having me Griffin. This
[00:45:16] Sponsor: episode was brought to you by AIVF. Maximize your clinic's potential with EMA by AIVF slash end to end embryo evaluation time by a staggering 97. 8 percent. Freeing your staff to focus on what truly matters. Curious how this reduction in evaluation time could affect your bottom line?
Visit aivf.co/precalc and use our free calculator to uncover the cost saving benefits of EMA by AIVF.
Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser. Thank you for listening to Inside Reproductive Health.