Today’s Advertiser helped make the production and delivery of this episode possible. 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, nor does the Advertiser's sponsorship constitute an endorsement of the guest or their organization. The guest's appearance is not an endorsement of the Advertiser.
Beth Zoneraich, CEO of Pinnacle Fertility, is back on Inside Reproductive Health to share the hard numbers and the deeper philosophy behind what she calls the Pinnacle Operational Model.
We deep dive into:
Why they automate the back end of patient care (but never the front)
How 3,000 unanswered phone calls became 500 new patients
The “J curve” of operational change (where things get worse before they get better)
Whether business leaders can help achieve work-life balance for clinical staff
The build vs buy debate
How they saved $1M saved by building (not buying) a witnessing system
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Beth Zoneraich (00:00.334)
The model was meant to be a few patients at a time and this one to one to one cure. And now you have an exponentially higher number of patients that one to one to one is going to break. And the problem is the systems and the operational changes that need to happen. These are not things doctors can just self invent. The solve is actually in some back end operations and some large scale tech, which is why I think it's so critical networks get involved and help solve this problem with the clinic in partnership.
Griffin Jones (00:44.366)
3,000 unanswered phone calls at one fertility clinic in one month. 500 new patients scheduled as a result of fixing that problem. Clinic overtime expenditures reduced by 85%. A million dollars saved by building instead of buying a witnessing system. 18 months of transformation on average to make these sorts of things happen. This is the Pinnacle Operational Model, or at least some of the highlights from my guest and their CEO, Beth Zoneraich.
I frequently tried away what I see as the pros and cons of corporate medicine. limited concentration of buyers, financial pressures that extract value from practices. Pros, not tolerating the waste and awful inefficiency that plagues patient care. That's Beth's wheelhouse. She talks about Pinnacle's decision to unify under one national brand their philosophy on build versus buy the J-curve where patient satisfaction and staff turnover get
worse before they get better? Why they automate the backend of the patient experience, but not the front end? The necessity of technology to achieve a nice work-life balance for doctors and staff. And if we business people can realistically achieve that kind of work hours that others can. I share an anecdote about UCSF's transformation that saves seven embryology hours per day in no small part because they're using embryo scope. Why don't you see if you can save seven?
hours of embryology time per day. They'll show you, isn't that a fun little challenge? No, fun? Here, I'll take the risk away for you. Three free months of embryoscope, if your lab qualifies. Three free months on me, GRIP, inside reproductive health. There, there you go. Who wouldn't want to take advantage of that with a pilot? Now I'm not a patient, I'm not a clinician, I'm not a pinnacle employee. If you're those things, you'll judge pinnacle through those experiences. Where I stand,
That's back on the show because she's an operational polymath and you're loco. If you don't think we need that kind of thinking to serve way more patients without doctors having to work a hundred hours a week.
Announcer (02:53.742)
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.
Beth Zoneraich
don't think that fertility clinics today already provide patients the best patient experience. I think they all very much want to, and I think anyone who works in a healthcare setting, specifically in fertility, our staff and our physicians, hear deeply about the patient and the patient experience. But the industry has changed, and while that caring for the patient and desire to help the patient has not changed, the methodology to which we need to mature models. And so when I go out and assess either new physicians, new clinics, or we...
I have partnered with in a management services arrangement and or I visit clinic. I actually find that many of the clinics, while they desire to have good patient care, don't actually have great patient care and sometimes don't even realize how bad the patient care is at their own clinic. Doctors on a routine basis don't call in trying to schedule a new patient appointment at their own clinics. They don't try and wait for an appointment. They don't know what it takes for staff to get back to them.
there being a way for them to know those things. So that while I feel like the doctors are trying very hard in their engagement, the system is actually right now set up for the physicians and the staff to fail with cases. And I think that's why we're seeing this fringe across, certainly across the Pinnacle Clinics and I would argue across the street.
Griffin Jones (05:06.7)
Is it because they view their piece of the system as the system? So I feel like when people are saying, we've got really good patient experience, they're thinking of their bedside manner. They're thinking of their clinical care, their clinical acumen. They're thinking of the good character of their team. That's only a piece of the puzzle. That has nothing to do with being able to get ahold of somebody or spending nine minutes on a phone tree or having to do your own case management, because you're calling the pharmacy and then you're calling the PBM. They're telling you to call the clinic and there's a triangle. Is it because they're seeing themselves as just a piece?
Beth Zoneraich
Yes, I think when our intentions are good and when we care deeply about the patient, we desire to have good patient care for our patients. But that doesn't mean we actually have a system in which we can provide that good care. So if you go, for instance, time, say even 10 years ago, right, very few patients had access to care through their insurance benefits. Therefore, because of the cost that fertility used to be, it was just unaffordable to most patients. And so as a result, we had very few patients and we had a terrible that was
one patient, one nurse, one doctor, and it was set up for that. And if you transform, right, and you come forward, say 10 and 20 years from where we used to be, now, and we applaud this by the way, patients have much greater access to care. They can work at any number of large employers and get full access to care. You have benefit managers like Progeny and Maven and WIN and Carrot that are increasing access to care. And critical we think about is, example,
And we want that to happen. And I would guess most of the networks, the clinics out there like this, because it gives more patients access to care. But what it does is it breaks the model, right? If the model was meant to be a few patients at a time and this one to one to one care, and now you have an exponentially higher number of patients that one to one to one is going to break. And so as people try and implement care in the same way that they used to with so many more patients,
You know, things get missed, calls get unanswered. And I see clinics with, you know, high amounts of overtime and weekend work and night work, trying to get back to patients and unable to do so without the systems in place to do it. And the problem is the systems and the operational changes that need to happen. These are not things doctors can just self invent, right? It's not something where they've been trained to write code and to create better systems and processes. They've been trained to be excellent clinicians and help patients on their pregnancy journey. But Solve is actually in some backend operations and some large scale tech. And while that's both difficult and expensive, and the clinics are unable to self-solve it, which is why I think it's so critical that networks get involved and help solve this problem with the clinic in partnership.
Griffin Jones
I've seen you talk about a case study with one of your clinics where the before and after, I don't remember if it was unanswered voicemails or missed calls, but it was tremendous. Can you talk about that?
Beth Zoneraich
I can, in fact, we've seen this in all of our clinics. The first clinic that we went into to try and partner together, they had a history of, there were so many phone calls coming in and they could never answer them, that they would just turn the volume down to zero and everything would go to voicemail. And when they got to it, they would return phone calls. And so when we got to the second clinic and saw that the phones weren't ringing, we assumed it was the same story, that the volume was gonna be at zero.
And for this clinic, the volumes were actually up. So we were confused and we realized they had bought and invested in a very complicated phone system with something called the ID lines. And with those lines, you actually needed every morning, just like you might sign into a time clock, you actually needed to sign into the phone system and dial a number so that you could be delivered at the phone you were sitting at that day, new patients on calls. Well, that clinic did not use that phone system. So nobody dialing it.
They had over 3000 unanswered calls every month and didn't know that they were there. And the phone system was just not working for them. The third clinic we went to had a 31 minute hold time in their phone system. And most recently in one of our most recent acquisitions, people have to call different offices and leave phone messages and go through multiple sections of filling out different forms before they can get scheduled. And we have over 500 patients waiting to be scheduled that hadn't been scheduled until we were able to help with better technology and call center answers in the first or second phone call. So every single clinic we've engaged with, I struggle with new patients getting phone calls answered and they feel badly about it. It's not what they want to do. They just didn't know how to solve the problem.
Solving that problem is one of the first steps in transformation. And it's not the only step. Unfortunately, I wish that was only step, because that's probably going to be easier once it's solved. But it is definitely something we see across most of the clinics we need to.
One of the implications of that is going to be reduced patient volume. If you're just not answering the phone, you're not going to be scheduling those patients who are trying to schedule, but it's not just new patients who are trying to get in for the first consult that affects. If you look it up any fertility centers reviews, huge swaths of negative reviews talk about billing and then just talk about communication in general. Didn't get back to me, wouldn't answer my call.
Griffin Jones
Did you see any difference in reviews when you implemented that intervention versus from before? Talk about sort of the transformation that Pinnacle takes with their clinics and I think we should take a step back.
Beth Zoneraich (11:04.59)
We recognize the need to change and we recognize where the operational model has been and where the cure model needs to evolve to. And we have a very thoughtful opinion and a model that we've been refining now for four or five years to help clinicians that should overcome this and have more concierge level care. it isn't something that happens overnight, it takes us 12 to 18 months. In every case, our clinics start with what is bad. Sometimes those reviews get worse during the transition period, but then they get significantly better. And so what we find is, is we need to pre-think patients' speech, we type the same upon analysis of patients coming through, we should know and understand where the patient is going to get caught. And we need to preempt that with wine chair or deeter that can talk to that patient from the minute they have.
They're new cases, so they graduate from one of our clinics pregnant. They need to be able to two-way text that, that's how the gator three hours a week during any normal hours. Now, I think it is neat to pre-think the journey so that if you're supposed to come on cycle day one of your period, and we think you're going to get your period in a couple of days, we should be proactively reaching out to you in advance, saying, you know, are we good to go or should we push your appointment off? And so that requires a lot of pre-thinking.
and a lot of automation to go on the high of his needs to make patient care and eat something truly concierge level and make the patient feel heard or stood and thought about it cared for. So we have to take the clinic where they started into this system and it requires the change of fundamentally higher operating model in the medical office. It does not require necessarily a change to the medicine. Prior it's changed to the technology and the way in which the cancer for us
schedule and coordinate care, allowing the doctors just in more time with their shift, the more the doctory, because all of the administrative stuff is either taken away or found in a morgue sheet.
Griffin Jones (11:04.59)
When you first got into the field, were people using navigators, that a concept that was in play at practices?
Beth Zoneraich (12:54.254)
So can speak to all of the clinics and what people have done in the past. think I signed, everybody uses the same terminology in the fertility space and they talk about technology and they talk about things. But what we mean by that and the level of integration is often very different across clinics. So while we may use the same terms, I truly believe what we're doing at Pinnacle has significantly more depth and more integration than what I've seen across other networks. So the first...
that it occurred to us that we needed this care coordination was actually in the four spaces and the right to those stay in a really high end hotel. You've got a two way app so that you don't go to the front desk and answer any more. You pay cash the front desk and say, hey, can you bring me some assistance? And so the first time I ever experienced that I said, our patients deserve this level of care. How could we put this level of care into the everyday person's children should be? It's so complicated.
So trying to convince me, if there was a place to do checks every day, I think it makes it better. The second thing I want to do that led to the development in the pinnacle now, frankly, I am two children and one of them has health issues. And I was going through, mean, being the mom of a kid with some health issues, I was struggling to engage Frank's working mom with some large health system. it...
As I did that, thought, gosh, what would be really helpful to me to help me navigate my child's health? And it was somebody to do, someone who would, you know, yes, I could leave a message and get something back two days later. But if I had a question that day that I needed the answer in an hour, it was very difficult to get that answer. And it was the definition of it and like whole child experience with being in child rights issues that came together for us to better like really dive in. What would a patient be?
this many, many years ago and start developing layer upon layer upon layer on an operational model technology that would more patient-centric.
Griffin Jones (14:58.326)
Some companies in the past have tried to provide this sort of concierge navigator model, but as a third party, sounds like you built it in house. Why did you feel that was necessary?
Beth Zoneraich
I think that's a really excellent question. And we talked about this a little bit at a lot of the IGF summit. So when we look at all the technology options out there, they're all excellent. And different people who have had a fertility journey, want to create and innovate in the technology space. They create really good products that help in one section of a fertility journey. Maybe it's onboarding, it's doing texting, it's lab witnessing, maybe it's billing services.
The problem is, is we only have one patient in one clinic and the patient doesn't want 16 different app. And they don't understand in their journey, when do I go to app number one? And then how do I switch to app number two? And how do I switch to app number three? And what is app number one and three don't talk to each other, but they give out different information. Very confusing. And so it's really important to us at Kinnacle and everything integrate into one medical record system, that everything go directly into the patient's medical chart.
and that our staff and the pharmacy and all of our vendors get the same view of everything happening to this patient and the patient only has to have one and that's ours. And that's just a critical role that we go by. So if we integrate and create partnerships, which we do, we have very valued vendors and partners within the fertility world, but we make those apps integrated into ours as opposed to us sending our patients into someone else's environment. And we think that's really important.
In order for tools to actually improve efficiency and deliver real value, they have to improve your profit margins and simplify your workflow. Clinics like Twig Fertility are expanding from Toronto to Vancouver and Care Fertility, the largest fertility network in the UK, expanding into the US, used Embryoscope to do that. They say the Embryoscope solves the biggest challenges facing multi-site fertility labs standardization. Right now,
Griffin Jones (17:06.444)
Your labs might be running completely different incubator protocols using different dish prep, following different observation schedules. That makes it nearly impossible to maintain consistent quality, train staff efficiently, or even compare outcomes across locations. You don't have to take the word for it though. You can participate in their Seeing is Believing program. That's a trial for embryoscope, three free months free of charge for those labs that qualify.
So check out VitroLife's team. You can contact them through us. You can contact them in the places where you put them. Tell them that you heard on Inside Reproductive Health. And try seeing if it's believing a trial for embryoscope for three free months. See if your lab is eligible. How far do you think we are from AI navigators? I was telling Ravi and Manish I called the HVAC company for my service. And it was 30 seconds into the conversation before I'm thinking.
talking to a robot? was like, I can't, it would be rude to ask her if she's not a robot. And then about a minute in she says, I'm a smart digital assistant. And I was like, oh, now I can ask. said, so you're a robot? And she says, no, I'm not a robot. I'm a smart digital assistant. I said, but you're not human. And I didn't know for the first several seconds of the conversation, it's a huge leap forward from
what used to be the credit card phone trees of, I'm sorry, I didn't get that, where it generated more frustration than convenience. This was the first time where I thought, is more convenient or almost as convenient as talking to a human being. And it seemed to be real, real close. How far do you think we are from AI patient navigators?
I think that's an excellent question. And while I'm a huge fan of automation, and in fact, my team calls me a serial automation addict, and I'm constantly pushing to automate routine tasks. I actually find we use a pinnacle automation to help take the no joy work and the administrative work off of our care team so that our care team can spend more direct time in front of patients. So our goal.
Beth Zoneraich (19:22.57)
is to use AI and automation on the backend so that our frontend team can directly engage with patients. But we don't have a desire at this time to put AI in front of patients and nothing we're doing right now connects a computer to a patient. That isn't our goal and not what we're simply trying to pursue.
You mentioned that phone calls are easier or they were among the easier changes. I'm not saying they were easy, but they were among the easier changes that you helped to implement suggesting that some were harder. What were some of the harder changes?
Well, to really drive improved patient outcomes in our clinics and need more standardization and standardization amongst REI physicians who have all operated independently and are independent physicians and HDLDs and labs that have all invented similar but different lab technologies, you know, is really challenging. But if you look out at what creates a success rate for an individual patient, more than 10 different people might touch
that patients, aches, sperm, embryo, different embryologists might do the freezing of the thawing of the embryo, different doctors might do a retrieval or a transfer or a stint protocol. And so the more you can use data driven by what creates better patient outcomes and standardized, the fewer number, the reduced variation that you can get by standardization, the more you can actually improve outcomes. And so...
I find that's the hardest part is to have the physicians get together and collectively decide on standard ways of moving forward using data. That's hard to do. Pinnacle is doing it every day through the medical leadership board. And our lab leadership board is taking those steps in the lab. So by the end of the year, Pinnacle will have all routinized standard media and dishes and processes and procedures in the lab that our own lab leadership board, our own lab folks,
Beth Zoneraich (21:26.456)
creating from scratch, using data of who has the best outcomes and visiting each other's labs and picking and choosing so that we reduce the variability that's happening. And our physicians are doing this with STIM protocols and other types of things. They self-discover the best of the best. We give them a statistician and access to really incredible rich data to make these decisions. And it is shown a huge ability to improve patient outcomes and improve standardization across.
and what used to be disparate clinics. And so that to us is the secret sauce, but those are the harder things to do with an.
You said there's a J curve with patient satisfaction, or at least there can be where it can get worse before it gets better. Is the same thing true with your team in terms of staff and doctors and embryologists of the changes being implemented that there's a resistance for an adoption and before they really understand and buy into the benefits of it?
Yeah, I think you bring up a really excellent point. is no question that change is hard. It is not just expensive. It is emotionally hard to create change and people resist change because it's fearful. Maybe they're scared of new technology or they don't know how to type. Maybe it takes a lot of inertia to go from an old way to a new way. Oftentimes people are embarrassed to ask for help. Like, how do I get to this stage on a medical record system or how do I do it this way? And so
People often fight to keep things the same and they fight very hard. And so as you go into create change, you go through almost a grieving process, like you would if somebody close to you has passed or if you've gone through a heart avenging your life and you will go through denial and you go through resistance and sort of maybe an awareness and then a resistance and an anger.
Beth Zoneraich (23:24.194)
Then you go through, I just want to out doubt, right? You heard on a recent podcast about Dr. Burnout and maybe doctors don't want to continue being doctors because their day to day life has gotten challenging. You add change on top of that challenge and you've made it harder for a period of time. The nice part about this change is it is only a period of time. It gets better because the J-curve really plays out, right? But there's that tail that goes so much higher than where you started because when you transform the clinic,
The work-life balance gets better for the doctors and the staff, a lot better. Overtime comes down, weekend work reduces, hours normalize. But people can go home and feel comforted because if you have a checklist and there's no patient left behind and you're more routinized and you have more helpers, you provide a better patient experience. Patients also get much happier. And as patients get happier, they're nicer to the staff. Nobody wants to be yelled at all day or feel like they're providing bad care. So as patients get happier,
staff gets even happier. And outcomes improve because as you get in front of patient questions, they are more compliant with their student protocols. They're able to ask their questions. There's less missed appointments. There's less missed any patient journey. So outcomes improve and then people begin to work collaboratively. When you see clinic after clinic transform and there is no question, they start thinking they're fairly happy. They go through a very negative physical time, but then they come out of it and they go.
So Mike's turn there in terms of, says, uh, it's a happiness. All of the Google or produce turn over. She says, you know, I have better outcomes and the staff really turn around and just well. So in the middle, it is difficult. We acknowledge that we wish we could do it faster and easier. It, it, it was really, everybody would have done it. It's just not that easy, but it is doable and it is best. We are getting better and better. I right. And we do see the same results in clinic after clinic.
I've fixed their stellate transformation already. And when you believe you see these changes play out again and again, it's very motivating. But the nicest part for us is that the folks who have resisted the hardest also need to become your best change agents. They go out to the next clinic and it's changed. know, one doctor will teach the next doctor out about 18 nights. And it's not overnight. I wish I could tell you it was overnight. It isn't, but it...
Griffin Jones (25:42.378)
How long does that take? That's not overnight.
Beth Zoneraich (25:51.246)
but it does happen. And we have an annual conference as host of the networks do. One of the clinics that has gone through the biggest struggle will get up and very vulnerably present to the group about what their path looked like and where they're at now and how happy they're at now. And we have seen clinics with 25 % of the staff walking out, turn around, they have almost no turnover, a year and a half a year. It really worked and it really did that.
but it very hard. And anybody in the same sense, this is going to be easy on it. It just to end in a similar fashion. Either is it really doing or they're not really being honest with you about how difficult this changes.
Does it get easier now that you have more ACE studies under your belt or is it still, you can show someone, look for clinic A, B, C, D, here's where they were before, here's where they are now, but people are just still resistant or is it easier once you have more proof under your belt?
It is always a question that I get as we talk about these transformations. And the answer is both. It both, yes, gets easier every time. And two, it's still really hard every time. So doctors get bought in faster when they can speak to doctors respond to it. We do a lot of travel within the clinical network. We mainly encourage people at all levels, travel to other clinics and learn from each other. We would much rather someone travel to another clinic, work in another clinic and bring it back to them team.
You get buy in a lot. Sure. Based on that when your clinic cuts changing and you're feeling threatened or vulnerable or nervous, you're still going to resist that change. Even if you were bought in at the beginning, then if you know it's going to end well, it's still nerve. So there is no way to take that J curve. We're just trying to reduce the time of a difficult nest lower to a shorter period of
Griffin Jones (27:50.24)
You had, I recall you talking about overtime and you could see that it had decreased. so it sounds like that work-life balance vision is coming to fruition. where it's probably not though, is I know you ain't working 40 hours a week. And so I see this possibility of doctors, even embryologists, nurses, staff.
them being able to work 40 hours a week. But I don't see that happening for us business people. And I don't just mean you as a CEO and me as a business owner, but anybody that's like a VP level above, director level above, I just, think that so much of what we do is like, you have to put in the extra time because we are in such a competitive world that that's often the difference maker. Do you think that the work life balance that you're seeing
for your clinicians and staff as ever possible for us business people.
That is another great question. So I agree, some of the hardest working people that I know are the people I'm surrounded with every day working at the Pinnacle Support Team. They work tirelessly for the clinics. Our clinics are our clients. We use it that way very distinctly. And as we manage change management, that is really what we do. We change matters when a trust member at these large clinic organizations.
that takes a lot of hours because it takes connecting one-on-one with doctors and doing a lot of coaching and counseling. It takes a lot of travel because very difficult to manage and be changed from afar. you're on site. And the most important critical people in the clinic may be the head of your front onset and the financial capsules and it may be your phlebotomist. So you need to know everybody at the clinic. You can't just focus on one group.
Beth Zoneraich (29:43.278)
All of the big groups fought in. The clinic is an entire organization, free member of it, is pretty great. so, clinical support, we feel like travel so that we know each individual in clinic and that we're doing this change management, not just with the doctors, but with the entire organization, because it's critically important. I myself was on a call with a number of our medical assistants at one of our clinics this week, because they're really important to us. And they were going through a tough time. And we wanted to talk, I wanted to talk directly to them.
And so there is no unimportant person in the clinic. And so I think it's really important that we keep that communication. And we try clinical support to mitigate and manage hours. And so the same level of tech innovation that we're trying to do in the clinics, we're also doing back at clinical support. And it really does save a lot of time, automating the new cycle into bots and...
using SQL and Python to close our book as opposed to Excel saves our financial funding and analysis and our budgeting group a lot of time. So we are definitely trying to pay the same tech innovation that we use in the clinics to help the patient journey to help our Pinnacle Support team on the back end.
A couple years ago, Mark Siegel asked me my point of view on a branding question and he sounded torn. It was, you let the individual clinics, do you keep them with their own old names and this clinic is called this over here, this clinic is over here, or do you unify the brand? I have a strong point of view on that. It sounds like you might too because you all have made a change recently. Tell me about that.
So we made the decision as a unified group to rebrand into a national identity. And Griffin, this isn't just changing one person's logos, it's really building a full national identity. Patients trust a unified, recognized brand. And on the back end, we need streamlined systems and consent forms and websites for better operations and flights. And so we wanna make sure that we have the very best in front of our patients.
Beth Zoneraich (31:53.344)
It is almost impossible to update 13 websites every time you make change. And if you have a consent form with a logo and you have 13 or 15 or 20 brands, imagine the ability to keep all of those at best to class. But from a culture standpoint, clinics want to feel part of something bigger. And we spend a lot of time and energy working with our clinics to create something bigger. are creating.
something bigger and better. And we work as a unified group and people get really proud of what we're creating. It's sort of a national strength with localized care. I really thought we were going to get a lot of pushback when we went to the clinics and asked if you missed rebrand and asked if we had clinics by date for Cuckoo Goldsfors. And we were really proud of that. We did not have anybody pushback. There is a huge pride and buy-in within the Pinnacle Network.
as to what we're doing and people are excited about it. And so it's been really important. It's been an important cultural moment for us that we were able to come from, you know, a difficult start with a difficult relationship with clinics that thought they were going to all operate independently to be here a couple of years later with unified systems and unified medical record systems and unified branding and one brand out and sign up a patient. It feels really good to come from
where we were to where we are now in the past future is very great.
Well, if they didn't give you a pushback, let me give you some pushback as devil's advocate. because even though I agree with you, I take that position fully. think that the whole point of brand is unity. That is what it's for. It is supposed to be that mark that galvanizes everyone around a particular cause and knows what we stand for and knows how we do things and sets the tone for the culture. It's how we got here as human beings. don't need a
Griffin Jones (33:47.242)
a brand to get 150 people to go to war in a tribe, but you do need a flag that means something for nation states to form and develop and go forth to all get thousands and millions of people around a particular cause. that branding is the same principle for companies. So let's pretend I didn't say that. Let's pretend I don't actually agree with you. And let me just take the devil's advocate view, which is I did have one CEO of a
different network who has done it differently decided to keep the names. I also think it has a lot to do with what their name is being geographically specific. But this point was, you know, these clinics, they've got their reputations in their own markets, they've got their name, and we just want to keep that. If you didn't have pushback, it sounds like you were able to show people the benefits
of going beyond that. But how do you respond to that?
You know, I think with any difficult decision, there's valid arguments on both sides. And there's no question that most of the clinics in the clinical network have a 20 or 30 or longer year history of providing really excellent patient care to their patients in market. And we would never want to lose that. I don't think necessarily rebranding makes you lose that. I actually think you take that and build on it to build your national brand. So
are clinics that are so well respected to be rooted. If you're proud of your new national brand, those doctors go out in the community and say, we were Clinic X, but we are now Pinnacle Fertility. And we are so proud because we brought all of the expertise and knowledge we had locally. And now look what I can provide you. I can provide you better technology for the patients and I can provide you expertise in labs all over the country. So if patients are traveling, they can get...
Beth Zoneraich (35:45.654)
monitoring at sister clinics with the same name and the same medical record system and the same methodology when they enter. And we can share records really easily. So while I fully understand and respect that there's two sides to this argument, for Kinnacle, it just was resoundingly the right place for us to head. we tried very hard not to lose local expertise and relationships as we move to a national. We tried to keep both.
I feel like we've successfully done that. But if you've been created this unified culture and unified central national, not just brands, but identity, then there might be more resistance to change.
Picture this, you're running one of the busiest IVF labs in the country or really busy fertility clinic network. Demand is high, staff are stretched, every minute counts. That's what UCF was facing until they restructured their entire workflow with the help of embryoscopes, time-lapse imaging. The result, they didn't just shave a couple minutes off. They're now saving seven embryology hours every single day. More transfers, faster XE, sharper embryo selection, less risk, and staff.
They're happier, they're less stressed, they're more focused. You know, what else I saw recently on a group starting a new clinic group, they were three new doctors starting a new group and they talked about using embryo scope as a marketing advantage because they're showing the patients, look, now you're able to see what's happening with your embryo. I think that that is likely the future. The more that you can connect with patients, the better.
They proved what's possible. UCSF proved what's possible. Now it's your turn. Reach out to Vitralife. Ask if your lab qualifies for a three month free trial of embryoscope called Seeing is Believing. Tell them that you heard it through us, but why not give it a try? It just might change everything. You've talked about leapfrogging technology before. What does that mean?
Beth Zoneraich (37:54.542)
So lethargy technology means when a healthcare industry or a fertility industry in general is behind and other industries have created something that is far ahead, maybe not one step or two steps, but completely a huge step forward, that you don't try and go through every step that older industries went through to get to where they are now. You simply jump over, you go get outside talent, and it's really good at sort of that.
the thing that you're trying to leapfrog and you take yourself from behind the times to cutting edge overnight. We did this for instance in marketing. So as we went through our initial two or three transformations within our clinics and we did top of license model and all of the technology, we found that we could grow our retrievals and new patient growth by 30, 40, 50%. And our doctors still had open times now on their calendar, even if they had wait times before.
So the need to lead drug our marketing technology became imperative to us. And we didn't want to go from what was really out of date within the Pinnacle system to, you know, one step forward each time. So I went out and we got an entirely new marketing group and we got a group that used to be in the travel industry. And the travel industry is known for selling time shares and cruises and other types of things, but they...
understood Salesforce and customer relationship management and integration of technology and follow-up and email and we took sections of people from various groups and we put them in place and they completely with it. About nine months, we dropped our marketing capabilities from what I would tell you was out of date. So what I think is really exciting, I'm proud of what they found as a team and really find for my goal to them.
but that would be an example of going from behind to right head and not having to each step along.
Griffin Jones (39:51.724)
When do you make the decision of this is when incremental improvement is needed or this is when we need to leapfrog or do you always want to leapfrog?
It really depends on what we're talking about. If you're making changes in your lab, I believe in much smaller incremental changes too, so that you're not trying to do something disruptive and embryology to show engine hits. Something like marketing, I felt like we could be more disruptive without risk causing any... And so it really, when you're dealing with high signage of medicine, things that affect patients do explore.
and really carefully in the studies and things that are maybe on the break going so you're using Excel to use in Python that go faster and you could lead far more. So we're very careful in what we do because it's really critical. You do not disrupt the patients.
How do you pilot things? So innovation efficiency are often at odds and you're implementing efficiency in many places, but it's been proven through the trial and error of innovation. How do you put that trial and error in a vacuum? And then how does it then get ready for prime time when it is?
So innovation might be my passion project or my favorite thing to read about. If you were to come to Pinnacle Together conferences, innovation is something that we bring in outside speakers to kind of talk about. And we have full clouds within Pinnacle and we read about why organizations often fail to innovate, then the answers are right in front of them. What stalls innovation? I believe in serial testing and very small
Beth Zoneraich (41:42.638)
incremental rollouts of lots of small innovations to get to exponential goals. So for example, if we're going to roll out on, as we did a centralized call center, we are not going to turn the switch one day from no clinics to all of our clinics. would never happen. We will start with two lines at our smallest clinic where we leave the old lines, open to build system, and we will start to take off 20%, 30 % of one small group of clinics into a system, test out the technology.
phone calls where we'll make sure we'll work out the case. Then we'll paper one whole clinic and we'll study it. And when we have success, start with 20 % off maybe a larger clinic and we test out just a small portion and then we keep going. We write VNC testing, whole and science, not just in marketing, but in every area of what we do, but innovations that are going to exponential and start in very small, incremental test space so that we can be
sort of incubating these technology test sites. It's also how you don't let technology get ahead of you. Big, scale rollouts are very difficult to manage. So we believe in as few of them as we believe in a lot of small little innovative things. And in fact, it is over the years, those build up and really big changes, but we don't roll them out in a big way.
I noticed that when I try to make changes, even just to pilot something, I drive my team nuts. Even if it's, just say, Hey, I just want to test this out this one time. Like, but that's not part of the process. That's not how it works. And it, and it's like, it really throws them off track. When you do this ABC testing at different test sites, is it always the same test site or team test sites? Like here's my one or two that are, are the people that are willing to just.
be crazy and try everything and then when it works with them we'll roll it out? Or how do you spread that?
Beth Zoneraich (43:39.342)
out. So in fact, I would tell you most small innovation and tests fail before they succeed, right? Someone who succeeds is just someone who tries harder and tries the fifth time after failing the same number of times. So innovation as a series of failures and so on, it could make it successful. We always test a different clinic. If you test all at one place, that tells everybody that only one group can innovate. It will lead that every person that works at Kennedy School is an innovator.
And I believe they have something of value to us as a company. So we want everybody at every level coming up with ideas and innovations. So we try and roll out a different clinic. Now some clinics are further along in their pinnacle operating model that there's. So it does make sense to test more at clinics that have putted through the model than those who have it. But we are willing to allow anyone to test a courage culture throughout our work at clinics and throughout.
I can see that a lot of Pinnacle's thesis is about bringing things in-house when possible. Am I reading correct on that and why is that?
The technical we believe really strongly in one technology stack, which often makes it difficult to use a lot of disparate one off the shelf technologies because they all have their own apps and they don't necessarily integrate. But second, if you were to go out and look at the entire patient journey and every technology player along that journey and you were to add up the recurring fees they want to charge you per cycle or per patient that uses it, total amount of cost
throughout that journey adds up to more than we get re-percycled. And we haven't paid our staff or our range or our supplies yet, we just paid our vendors. And so when you look at that, you realize the need for integrated solutions are critical and unfortunately, wanting to streamline this and keep costs down for patients and continue to increase the secure, we also have to be really thoughtful about waste and money on technology.
Beth Zoneraich (45:45.598)
and not sighing out with a lot of vendors who are just going to first either hold us hostage and once you get them integrated, they're going to charge you more and more every time you add another patient and or use them more. But I can't have the totality of our tech expense and our outsource vendors add up to more than we get reworsed for us. It's not a healthy way to run our business. So we're very careful to integrate. It's why we have a lot of internal resources who are very good and frankly not from healthcare that
understand data informatics, data programming, and how to develop tech in-house. And often in partnership with our vendors, we don't do it all alone, but we do do a lot of it in-house. And I think that's a strategy of continuous we move forward.
Doesn't that get really expensive though? I remember when I was in the marketing agency world, you would see companies trying to take like the building in-house marketing agency and it often wasn't more cost effective or you'd see companies building a software that cost them a lot of money to develop. And turns out of $50,000 off the shelf software was sufficient. It doesn't the resources that it takes to develop those really
eat into your overhead.
So in every case, when we're trying to decide how to move forward with the technology, we will do a pretty simple buy versus build economic assessment. And we'll move forward with sort of what makes sense from a financial standpoint and ease and how quickly we can move forward. So we're pretty good at just doing basic data and financial analysis on does it make sense to build versus buy.
Beth Zoneraich (47:26.602)
I will also share that we've been very good at rolling out technologies either on or under budget and on time. So I think our knowledge and skillset in our clinical support team is actually leading itself to being pretty good at developing and integrating these technologies. And as we've integrated more and more, our team has gotten better at the tech side.
What are some of those things that have fallen into the, it's better to buy than build category? Like you're not making your own pipettes and dishes, I don't think. So what are those things that you've found, at least for now, make more sense for to be in clinics or networks buy category?
So obviously we don't make any of our own supplies or our pharma medications. Those are all outsourced from, you know, leading hoax. So we try and standardize them, but we certainly don't try and make them in-house. And for like, for instance, long-term storage, we couldn't build our own long-term storage facility and we chose instead to partner with Smuro. Smuro has been a really excellent partner of ours and they integrated their technology into ours. And we chose not to build that in-house, we chose to...
On lab witnessing, however, we found the costs associated with the lab witness systems that were out in the market to be excessively high. And we were able to build that system for significantly less cost than even one year would have cost us to outsource. And we were able to build a lab witness system and integrate it into network. It is fully rolled out in every clinic. And to quite quickly and very cost effectively. And that made a world of sense to do it on our own.
So we go back and forth between outsourced versus not. We tried to outsource two-way texting, HIPAA compliant two-way texting platforms for a while. We've learned from that. And then we wrote our own program and integrated into our system. So some of the things we'll test out for a while and then try and figure out best way to integrate. Other things may stay consistently outsourced and work in partnership. And then others, we take a hybrid approach, but I do think each
Beth Zoneraich (49:35.68)
Each thing that we do needs to be a thoughtful consideration and a simple, most of these are pretty simple financial analysis that we've.
You've told me how much money you saved on the witnessing. It was astronomical. Are you comfortable sharing that?
that it would have been upwards of a million dollars a year for us to use a witness system and it cost us let's say under $50,000 to develop our own.
What are you most proud of when you look back at the last couple of years?
What I'm most proud of is that Pinnacle is building a unified platform that people are proud to be a part of that is improving the patient experience and patient outcomes. And that we're really creating something different and special. And that's taken so many countless thousands of hours by the doctors in the clinics and by the Pinnacle Support Team. And so many people have come together and many people thought it wouldn't happen, right?
Beth Zoneraich (50:34.774)
Many people thought that we would fail at this and to tell you we're not failing at it, it's really working. And I'm so proud of the unity that we're developing and creating as a network.
Griffin Jones
I love catching up with you to get these progress reports and if we're doing it once a year, should probably be even more frequent than that, because I really enjoy it. Thanks for coming back on, bud.
Griffin, thanks for so much for show today. I really enjoyed talking and always love to be a part of your podcasts.
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Beth Zoneraich
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