The 6 Pillars of the Fertility Referring Provider System

By Griffin Jones and Stephanie Linder

Give referring providers some credit.

Not all of it..but some.

Contemporary thinking about the impact of physician referrals on the REI practice tends to be polar. On one end, MD/DO referrals are responsible for the lion’s share of new patients. On the other, MD Referrals are dead and everyone finds their practice on the internet. Bent to their extremes, each pole is factually incorrect.

These are the facts as produced by a 2020 Fertility Bridge survey of over 250 REI patients from across the United States

• 60% of REI patients are referred by a physician 

  • That’s a lot, but it’s far from 100%

• 21% of REI patients say their MD referral was the most influential factor in choosing their REI

  • That’s the #1 slot, but 21% is far from a majority, and it’s almost neck and neck with location (20%) and recommendation from a friend or relative (19%)

While it is remiss to favor a referring provider strategy to the exclusion of all others, it’s equally irresponsible to forgo a system for reliably growing and nurturing referrals and relationships. In order to sustain and grow referrals, your Referring Provider Strategy is built from six pillars. 

1. Reporting 

2. Ancillary Services

3. Content 

4. Events 

5. Outreach

6. Referral Follow-Through 

By systemizing these six pillars, IVF centers are able to grow and sustain referrals without always adding the overhead of an additional physician liaison. 

1. Reporting

Reporting is the first pillar of the referring provider system because time and money are wasted whenever it isn’t correctly established. Three key performance indicators measure your referring provider efforts.

1. New Patient Volume

2. Number of Referrals

   1. Total referrals-EMR

   2. % of attribution-patient reporting

If your practice or your goals for growth aren’t large enough to do much outreach, then you only need to measure these two KPIs. Before you put substantial effort and resources into outreach, however, you must report on activity and results across these six categories.

It’s important to consider both practice groups and individual providers for two reasons. 

1. Your top referring physicians may not be accounted for in your top referring practices

2. If you have served a provider’s patients very well, the earned trust can readily leverage a relationship with their partner

If 60% of patients are referred to your practice by a physician, that means 40% are not.  But 100% of pregnant patients are sent back to a physician for OB care.  Therefore, a powerful way to focus your target list is to look at the OBGYNs to whom you’ve returned pregnant patients but have not referred to you.   

Roughly 25% of physicians that provide OB care for fertility patients are never recorded as a “referral” in most IVF centers’ systems.  However, if they’ve heard good things from your graduated patients, and seen the results of your care, they have reason to engage you.  

Activity is recorded in a CRM. Results are recorded in the EMR. 

2. Ancillary Services

30% of patients that see your practice for a referral Semen Analysis  or Hysterosalpingography, will return within one year for a fertility consult.  SAs and HSGs are not just useful tests; they’re powerful lead generation tools.  Offering them creates a very low barrier for outside providers to refer. 

1. Accept outside SA or HSG referrals

2. Promote services separately (content) 

3. Return results for SA and HSG to providers within 72 hours of the service performed 

4. Educate referring providers on how to interpret results (events, content)

3. Content 

Once you’ve identified your targets and solidified your ancillary services, you need captivating content to reach and promote them.  As before creating any content, it’s important to establish brand guidelines. Beyond the look and sound of your brand, referring provider content must include three differentiators

1. Performance (Success Rates, Technology, Lab, Embryology)

2. Patient Care (Staff, Physicians, Communication) 

3. Access To Care (Finance, Ease of Appointments, Insurance)

These differentiators appear across five key pieces of content: 

1. Referral pads

2. Referring provider page 

3. Differentiator checklist 

4. PreConception panel

5. How to Interpret Semen Analysis guide 

Checking these items off of a to-do list does nothing to ensure their effectiveness. Messaging and design is paramount for helping the message to be received and this is where good creative comes into play.

4. Events

Thorough and poignant content makes for cogent event agendas. The return on traditional outreach had diminished for years prior to COVID-19. The pandemic only accelerated the need to rethink the same fruitless methods of calling on doctors and clinics. 

Four events increase provider referrals and positively impact relationships. Each of them can and should be done both virtually, and in person. Feel free to turn them into lunches and dinners when appropriate, but the content must be good enough that you don’t have to.

1. Provider to Provider Meetings

2. Provider to Group Visits

3. Open Houses

4. Single-Topic Educational Events

5. Outreach

Even among groups with excellent physician liaisons, no one can supplant the REI’s ability to build physician relationships. Your reputation as a trusted educator is crucial to building a referral network.  REIs must be accessible, present, and communicative.  

Four forms of outreach in which the fertility specialist has an irreplaceable advantage are

1. Residency rotation

2. Medical school and residency relationships

3. Membership in local medical and specialty societies

4. Grand Rounds / Journal Clubs 

 Once a trusting relationship is cultivated,  leveraging other staff becomes far more effective. When REIs are unable to participate, outreach to referring providers should be delegated in this order:

1. Advanced providers

2. Nurses

3. Physician Liaisons and Marketing personnel

4. Front staff 

The Physician Liaison supports these efforts strategically: 

1. Total office calls

2. Updating target accounts, including wellness providers

3. Semi-monthly touchpoints

4. Content and event coordination

5. Referral follow-through coordination

6. Referral Follow Through 

Good News: You’ve gotten people to refer to you

Bad News: Now you have to keep them happy

Once a referral has been made, maintaining and growing the relationship requires follow-through in these forms: 

1. Thank you note for initial referral 

2. Semi-monthly touchpoint 

3. Post-consult referral note immediately following the patient’s consult 

4. Graduation update. If the patient is successful in achieving pregnancy, provide medical records, note and inform OBGYN that the patient will be returning to their practice 

WORK THE SYSTEM, GROW THE RELATIONSHIP

Though MD/DO referrals are not the overwhelming source of REI patients that they once were, they still do account for the most common influential factor in choosing a fertility specialist. Growing physician referrals isn’t about hiring a “door knocker” to distribute pamphlets and drop off bagels. A Physician Liaison may be an incredible investment or a complete waste of money for you.  First, invest in your system, considering the six pillars of reporting, ancillary services, content, events, outreach, and follow-through.

108 Managing the Pressures of Launching a New Fertility Center

This week on Inside Reproductive Health, Dr. Brian Levine and I discuss what it's like to launch a brand new center under the umbrella of a very large company in an extremely large market (New York City). We also chat about the pressures of launching a denovo clinic in a big market versus the pressures of starting a clinic as a satellite office.

Dr. Brian Levine is the founding partner and practice director of CCRM New York. He is board-certified in both reproductive endocrinology and infertility and obstetrics and gynecology. Brian Levine, M.D., leads the industry in normalizing open dialogue about infertility and educates prospective parents on a national level. He has been cited as one of the nation’s leading fertility experts in The New Yorker, New York Post, NBC, CNN, Avenue Magazine among others, and was honored with the Doctors of Distinction award in Westchester County. 

From this episode you’ll learn: 

• New York market dynamics insights

• The value of good mentors

• Where technological advancements are happening

• Why REI’s don’t get the training they need from school

Transcript

Griffin Jones: [00:00:52] Today I speak to Dr. Brian Levine from CCRM New York.

Before we get into the topic of what it's like to build a Denovo center within a very large group in an extremely large market. I want to give today's shout-out to Dr. Kenan Omurtag thought of Dr. Omurtag because I met him around the same time that I met Dr. Levine also did a piece of content with him early on when, in my tenure, in the field.

And so shout out to Kenan and hopefully, I get a text or an email that he got wind of this shout-out. Today's show with Dr. Levine is about what it's like to launch a brand new center under the umbrella of a very large company in an extremely large market. We talk about what that's like the pressures of that are like, versus the pressures of starting a clinic as a satellite office for someone else as an associate, for example, and we talk about the dynamics of the New York market. What CCRM is like. A little bit of background about Dr. Levine. He's the founding partner and practice director of CCRM New York. You may have seen him on New York Post, NBC, CNN, Avenue Magazine.

He gets around, I believe ASRM tech committee is where I may have originally met him. And so please enjoy today's episode with Dr. Brian Levine, one of the Castle Connolly, top docs from New York's super doctor ranking about what it's like to start a Denovo clinic within a large group, big market 

Dr. Levine, Brian, welcome to Inside Reproductive Health. 

Dr. Brian Levine: [00:02:32] Thank you Griffin for having me, I'm super excited to be here today. 

Griffin Jones: [00:02:35] I almost said welcome back. But when I realized it, when my podcast producer brought to me a list of suggestions for topics, and we put you on there and I thought, oh yeah, we'll have Brian back.

You haven't been on the show. You were a guest author in the ultimate guide to fertility marketing, which we wrote five years ago, but this is your first time on this show. And I always; I guess I just always thought you were on Brian. So it's, we're overdue, but I'm glad that you're on the show right now.

And I want to talk about the situation that you've been in, in your career, which is starting a new practice in a very established group in a new market. So do you want to set us up with a little bit of background for that? 

Dr. Brian Levine: [00:03:18] Sure. To help set the foundation for our conversation today, the theme that I think we should bring forward is a partnership.

Cause that's what this whole topic is really going to be about. And, starting a clinic and working with an established brand and helping, be part of a new of that brand. Now growing into something new and exciting the theme is partnership today and, I've been very fortunate.

For me, I think it was timing being in the right place at the right time. So I'm a New York guy, right? Like I literally have not left New York City since the summer of 2002, when I graduated college. I went to graduate school in New York City, I went to medical school in New York City.

I did my residency here. I did my fellowship here and truth be told. I always viewed myself as someone who was going to be part of that academic rigor. Like I always thought I was going to be at some hospital with some affiliated medical school teaching seeing patients mentoring, residents, and whatnot.

And there really was a turning point for me in fellowship. Where I had to make a decision. I had to make a decision of, do I want to go down this academic pathway and help train the next generation? Or do I want to start treating the current crop of patients that are having trouble achieving their goals and what really pushed the envelope for me was ASRM.

You and I were just talking a few minutes ago about conferences. And I remember going to these these meetings and seeing just the publications that were coming out of places like the Colorado Center for Reproductive Medicine or CCRM and saying to myself, oh my gosh, like you'd have a private practice that does research.

And that is actually moving the needle, improving patients. That's outside the confines of the academic models that I've grown up in. That I've been a part of. For really 11 years of my life. 

Griffin Jones: [00:05:05] Why was that your conception at the time that research was for academic? You wouldn't expect to see an abstract or research from a private institution.

Why had that been established in your mind? 

Dr. Brian Levine: [00:05:19] I think unfortunately that many of us are very jaded in medical school. We never learned about the business of medicine. I never learned about leadership and how to run a group or how to form a practice. And we also learn, unfortunately, either by osmosis, right?

No one ever says it, but they just infer it, that the private docs are out there for the wrong reason. And that it's the academic people that are going to move the needle forward. And I think it's a culture thing. Unfortunately, I think it's a culture of academic medicine and the training of young physicians.

And so to me, I was always jaded. I always just thought, like the only way you can make a difference in the world is to be part of this academic rigor and, become an assistant professor and strive to be associated and strive to be a full professor. And it just didn't jive with who I was as a person.

Right. I'm a geek. Deep down inside. I'm a big technology geek. I like data. I like technology. That's why I'm in this field to be quite frank. And what I saw was that the most innovation that was occurring, that real bench to bedside transition of taking a concept to an experiment, to a trial to a patient treatment paradigm was actually occurring in these private practices. And that's what intrigued me. 

Griffin Jones: [00:06:32] Do any examples come to your mind when you think of those experiments and what was happening in the private realm that you weren't seeing in the academic realm? 

Dr. Brian Levine: [00:06:44] Absolutely. I'll give you a great example of the great debate of our field, the genetic testing of embryos.

I will never forget one of the first American society for reproductive medicine, annual clinical meetings that I went to was, someone's standing up on stage with a soccer ball saying, if you take a biopsy of an embryo, you don't know if you're getting the black or the white, and you're going to judge an embryo by the specimen or the biopsy you get.

And then you had these other doctors standing up saying, look, I have a private practice in Las Vegas. And I can tell you just straight-up frozen embryo transfers versus fresh embryo transfers. There's a benefit to frozen. And if I can pick the right embryo that I'm putting back in that frozen setting, I can not only have an advantage based on the frozen.

I have an advantage on that embryo selection. And it was literally that debate about genetic testing, which by the way, What's in its infancy stages compared to where we are today, nine years later that really drove me towards the private side was the ability to have freedom of vendors, the ability to incorporate new technology the ability to incorporate new protocols and treatment plans without having to deal with the confines of the academic institutions that are very well established.

But, there are restrictions that are there 

Griffin Jones: [00:07:58] That experiment and others, like it are what drove you to the private side. And I do want to talk about partnership. I want to unpack that some more, but first I want to be between partnership and being interested in the private side was an interest in where you are today, which is CCRM at the time. Maybe they were still in Denver, mostly.

Maybe this might've been the time that they were expanding into other markets. But talk to me about how you came to get CCRM on your radar.

Dr. Brian Levine: [00:08:30] Yeah. So I've been really fortunate throughout my entire training career. I'd say now professional career is to have good mentors, right? So everyone needs a good mentor.

When I was in medical school, it was Dr. Jamie Grifo at NYU. I finally remember skipping classes even to just go shadow him. I hate to go to the operating room as a first-year medical student to see him remove someone's diseased fallopian tubes, or remove fibroids or come in on a weekend to see him do an egg retrieval.

When I was in residency, people like Dr. Mark Sauer and Roger Lobo. Amazing mentors again, who were really pushing the envelope of reproductive endocrinology, and from Dr. Salaria, I learned about the whole world of donor oocytes and donor egg. And then of course in fellowship, I had Zev Rosenwaks who is an unbelievable mentor.

And, I'd say really one of the pioneers of the field, but when I was in fellowship there are certain names that just come up and be like these pioneers of our field that really are pushing the envelope over. And we kept talking a lot about Dr. Schoolcraft, Dr. Bill Schoolcraft at CCRM, who is the founder and the lead of that group, and how they were doing things differently.

We would talk quite often about the research they were doing about genetic testing, how they had an entire integrated genetic testing core. And it just piqued my interest. So it was at the Boston ASRM that October I'll never forget 2013 where I met him, I just went up to him and introduced myself briefly.

And I said, I just want to learn what you do because I keep hearing your name in a positive light and in a true mentor, mentee fashion. I think that's where he took an interest in my interest in CCRM and that's where I started learning more about what they were doing. I had no idea that they were ever-expanding.

When I went to go talk to him, even though I'm a Newark guy, I think part of me thought I could end up in Denver if I'm lucky enough to be there.

Griffin Jones: [00:10:28] I want to talk more about that expansion and I certainly want to get to the partnership, but your thoughts on mentorship really have me in a bit of the soliloquy here, which is, I think this is one of the challenges that many centers that are having difficulties recruiting fellows are facing what I get emails from fellows.

Brian, I'm a D biology student. I run a business development and client-services firm, but fellows will just ask me about where do they think I should go or who I should connect them with? And maybe it's because I'm completely fiduciary. I can just introduce them to anyone. But I also think that there is somewhat of a dearth of, it's not that there's a dearth of clinical mentors in the field or people willing to help.

I think that there's a certain scarcity of. Doctors that have a profile that's facing the fellows that they see, that they can reach out to in the same way that you just described Dr. Schoolcraft, that in and how you reached out to him at ASRM Boston. And that does have that. There's a handful of groups that are getting more than their fair share of younger doctors in terms of recruitment.

Yeah. Maybe just talk a little bit more about that because especially for, these midsize groups that now they're starting, maybe they had an associate and that associate left and didn't end up moving on to partner and they're having a little bit of a struggling with recruiting the next person to replace them.

I think that it comes with this profile of mentorship. So maybe you could unpack that a little bit more. 

Dr. Brian Levine: [00:12:03] Yeah. No one can do it all. You can't work 365, you just can't. And if you are, you're probably not good at your job if you're working 365 because either you're not giving yourself enough time to Recoil and, build yourself back up and build up those reserves again.

Or if you're burning yourself too thin, it might be that you don't work well with others. And that you actually don't have a group where you can really have collaborative care. But what I think is happening right now is that there's this push for volume. And I don't know if you're hearing this from the other guests of your other podcasts and people you've spoken to, but definitely on the clinical side.

 I see this push to cycle, right? Meet Susie today, cycle her next week. And as part of that push to volume. It might be because of managed care. It might be because reimbursements are going down. It might be because there's increased access to fertility services. It might be because there's increased public interest in fertility services.

What we see is that quite often, people get into this rut and just keep doing things over and over again. And then they don't have time to actually mentor and sit down with someone. And so what I think you're hitting at is a really important point, which is. These fellows need mentorship. We don't learn in fellowship. How to bill, how to approach a patient, how to recruit a patient, how to get rid of a patient how to refer a patient out, right? Like none of that stuff you get to do, because as a fellow, you're pretty much the grunt worker in the middle and the patients come to the clinic and then you have the opportunity and privilege of taking care of them.

What I think is happening right now is there's this. This push for growth. And is it private equity firms? Is it the commoditization of women's healthcare? I don't know, but as we see this, continued growth pattern where everyone needs to grow and grow, fellows are just getting hired and going into these practices without taking a step back and saying, sure, I want to work for the Yankees, but I wouldn't work for the Yankees if there's no batting coach I wouldn't work for the Yankees.

If there's no one who's going to help me learn how to learn the plays and I think that part is not happening for me. I came out of fellowship and I had a year before this practice opened. I had a year to work with Dr. Schoolcraft and his team in Colorado to not only learn his playbook, but to learn the team of how to talk the talk, how to walk the walk and I'll tell you, I will never, if I could do it all over again, I would not change a thing because I spent a year helping with monitoring of patients who were from Colorado in New York city.

And during that time, I got to learn their protocols, learn the treatment plans, to think about how that group was thinking about the patients. Which I think every day has benefited me now in my clinical practice. 

Griffin Jones: [00:14:53] The difference here might be in the difference between a partner position and associate position because when most doctors are leaving fellowships, they're becoming an associate of a practice.

They're not a partner of the group yet. They sign an employment contract very often. The terms for partnership are not elucidated in that employment contract, but either way they're expensive. They're a quarter mill, maybe 300,000 a year. That's a big investment for a good plus whatever benefits and training and other considerations on top of that.

So that's part of the reason why they're going into work-horse mode is because someone is paying them a big salary off the bat and they need to recoup that. So that's what I want to understand about a Denovo center, especially one with CCRM, because that's different from being an associate doc isn't you're buying in, you're putting capital in and you're starting a group within the larger group.

Can you talk a little bit about how that works? 

Dr. Brian Levine: [00:15:53] Sure. So I've always enjoyed the entrepreneurial side of medicine and I'm a very patient person, so I was willing to have the conversations with. Colorado about what's long ball look like what's a five-year plan. What's a 10 year plan. And that's what you have to think about when you're building a Denovo clinic.

 I recently spoke to a fellow who talked to me about starting a clinic and hoping to flip it or get it acquired. I was like, you didn't spend 11 years of your life to learn how to flip a clinic. Hopefully spent 11 years of your life to learn how to help patients.

And if you're thinking about flipping clinics and you might be on the wrong side of healthcare right now. And I think the fellow was a little taken aback when I said it, but I was very honest because if they're thinking about pumping up a clinic to then flip it that's the wrong approach because I think if you're going to build something, you have to have, at least my view was that this will be my first and last job.

I'm going to cut my teeth at the same desk that I hope to retire from. And that's the way I walked into this and, along the mentorship lines there's Dr. Schoolcraft, who is the founder and physician, but then there's also a CEO of the entire organization, Jon Pardew, who to his benefit is a very approachable individual.

I don't actually think I know anyone who calls him Mr. Pardew. Like everyone knows him as Jon. And that is a benefit for us in that as we had all these business questions and expense questions and how do we model things and how we put it all together, you had Dr. Schoolcraft helping with the business and, he trusted Jon.

And then you had Jon who is helping us understand the finances behind it. So it was this dual mentorship as we were building literally from scratch. 

Griffin Jones: [00:17:39] So why is it important to you that you want to be a part of something that stays for a while, or you want to be in the same venture for a while?

Because I'm not sure I don't disagree with your view that maybe it isn't the best idea to flip, but I also. It's not immediately obvious to me that it's necessarily a bad decision entrepreneurs do different things all the time. And just by launching a venture in that way, you can learn so much and it might be what's necessary to be the base for the next venture.

So why is it important to you to have that long-term continuity? 

Dr. Brian Levine: [00:18:12] So with only 40 of us coming out of training on average around the country per year, and knowing that infertility affects one in eight couples nationwide. 12 and a half percent of the people in America will deal with the diagnosis of infertility.

I do think there's an altruistic side where I view that like we should be taking care of patients now, should we be fairly compensated? Absolutely. Should we, should our pay be commensurate with the work that we're doing? Absolutely. Should we be trimming the fat and really trying to make sure that no one's riding on the coattails of the hardest worker?

Absolutely. Like I'm all for clinical efficiency and financial efficacy, right? Like the doctors should be paid fairly and efficiently while the clinic is very efficient. In the same regard though, with the model of pump and flip there comes a point where you have to show unparalleled growth and I would worry a little bit about that individual who walks into that clinic with that goal.

If you walk into that clinic, would that goal that I'm going to flip this thing? What you need to flip it on is exponential growth. And if you're getting exponential growth and the earliest stages, you may be rushing to treat, patients that don't get treated. Other places you might be using a key performance indicator or KPI.

That's not appropriate. Medical indicator of the success of your clinic, but you're saying I can increase revenue, unnecessary tested. I can increase volume, unnecessary cycling. And there is, I would say a push and, thank God again, we have great clinical oversight and I think what sets us apart and we'll get to this is the partnership mentorship model by definitely seen at the smaller other clinics.

Where all of a sudden, they open in year one, it's 50 cycles, year two it's 400 cycles. And you're like, how did you do eight X? Then you find out, 46, 47 year-olds are told that this is the place to go, for your first IVF cycle ever. And the donor egg conversation is not happening.

Griffin Jones: [00:20:15] That's a very interesting view on the difference of the business KPIs versus the medical KPIs. And if your goal is to flip, then you're probably doing a lot of those things, possibly prematurely, and. I think there's an interesting constraint that I'm, I've been given by one of my favorite business minds.

His name is Blair Enns, but he gives his readers, listeners, clients, the constraint that you can never sell your business. Not that you won't or shouldn't, but just operate with that constraint and notice the difference in the type of. Venture that you build. And I think that's been very true for me too, is in doing that is whether I sell Fertility Bridge someday or not.

I have no idea, but I really like what I'm building right now and the way I'm building it is different because it's as though I'm going to be the one that ends up with it. 

Dr. Brian Levine: [00:21:14] It's an interesting view. And again, when you speak to young fellows who are coming out. They all stress over their contracts.

And I'm sure you've heard this as well. So there's this, SREI annual retreat that used to happen in August. And you do this between your second and third year, and he'll be talking about the contracts that they're, they've received, or the contracts that they're reviewing and people get so focused on how they're going to break up.

Like, what's the exit, what's this, mean what does this non-compete and I tell everyone the same thing. I'm like, if you're looking for what the exit is, if you're looking for, where's the pin to pull the grenade to set the grenade off, you're not looking at the right big picture.

You should be looking at your contract of where's my opportunity to demonstrate my value to this practice. Where's my opportunity for partnership, where is my opportunity to accelerate if possible, my responsibility, so that I can increase my productivity and also increase my share of, my take home.

That's a very different approach that very few fellows, I think right now we're looking at.

Griffin Jones: [00:22:25] I think one thing that's really missing from employment agreements is the terms for the buy-in trend. That's the source of a lot of frustration that I see in associates leaving a practice after two or three years, they thought that they were ready to be a partner.

The existing partners felt differently now, whatever was the source of that disagreement. There's multiple sides to any argument. I wasn't a fly on the room in those situations. But what I can say in summary is that there was a difference in expectation that could have been enumerated or at least made much more explicit in the buy-in agreement. I think what you're talking about is it maybe is a little bit more about that. Okay. What do I have to do? And spelling that out more to be a partner, rather than just okay. When it doesn't work out in two years, how do I get out of that?

Dr. Brian Levine: [00:23:15] Yeah. And I think, and I give everyone the same advice.

If you're looking for a job at CCRM or you're looking at, some other place cause for academics is very clear, right? There's not going to be a partner. When you're in these academic constraints at these academic practices, You're going to end up becoming an employee of either the department of OB-GYN or the independent practice that's employed or owned by the hospital.

So the view is very different. And maybe you will be dealing with RVU. So you'll be dealing with a different system of how you figure out your compensation plan, but on the private practice side, people get wrapped around the axle about the non-competes and what's going to happen.

And what do you mean I can practice in New Jersey if I lose my, I quit my job in New York and. And it drives me bonkers. I'm like take a step back. Think about growing yourself and growing that practice. So the point that you say, how do we open up a practice in New Jersey? How do we open up a practice in Connecticut?

Does this contract limit me from the ability to grow this practice to where maybe the partners don't have the time or the energy or the resources to do this today. And that's a very different deal. 

Narrator: [00:24:18] okay. So here's the skinny, just as your fertility group has advantages over other groups, your competitors also possess advantages over your IVF center that you don't have access to yet. Now you can say their consolidation model won't work or their lab sucks, or their doctor's crazy, or that low-cost model cuts quality, or who would ever get their fertility testing done from a food truck, but many of them are onto something.

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It's only five 97, and we equip your partners and leadership with the foundation to leverage your competitive strengths, not mimicking someone else and not let your competitors have an unfair advantage. There's no long-term commitment whatsoever, and there's a 100% money-back guarantee. Send your manager to fertility bridge.com.

Have them sign up for the goal and competitive diagnostic. And I will see you and your partners on zoom.

Griffin Jones: [00:25:58] Brian isn't there more contract angst if you're signing up to start a Denovo clinic, because instead of okay, you the entity, are just giving me a salary to become your associate, and then there's the opportunity for my me to buy in and two or three years, it's, I'm putting down capital now to start something with you.

And that seems like there'd be a lot more X'd. 

Dr. Brian Levine: [00:26:19] So that's the unknown, right? So that was the scariest part of it because I recognized very early on that this was the least popular decision that I could make which was to start a new practice in New York when there's some really great, well-established practices and that it would ruffle popular among who I think of amongst the other practices, mentors other individuals, there's always.

There's always concern about the new kid on the block. And part of inherent in training of any fellow or resident is learning the playbook of that practice. And so I do think that there's an element there of secret sauce that people don't want shared in the local market. 

Griffin Jones: [00:26:58] I want to talk about New York as well because we had Dr. Bob Stillman on the show a few weeks ago. And when he was talking about shady groves history, he was talking about New York and He talked about the other east coast markets that they went to first because there was not a dominant single group there. Contrast with New York where he described it as sumo wrestlers, that the reason why there wasn't one dominant group is because you had a few sumos that were the equilibrium of that in the ring. And so how did you decide this was the ring you wanted to get into these sumo's knowing that you are a New York guy as you described, but how did we get from meeting Dr. Schoolcraft in Boston to doing this opportunity might take you to Denver to saying, I want to stay here and do this in Manhattan. 

Dr. Brian Levine: [00:27:49] So I told him the truth. I'm a highly competitive individual, but in Denver, the bagels are terrible. The pizza is terrible and I can't get behind the Broncos being a lifelong Giants fan.

So I was like, if you don't have football, you don't have good carbs. I just can't live there. So how do we bring your clinic to New York? Because I'll be a much happier individual. That was literally the elevator pitch now in full transparency. Since that time, my father-in-law has switched me to come a Jet's fan and I probably wish I was a Broncos fan because at least the Broncos have been in the super bowl in recent history.

Griffin Jones: [00:28:22] Brian, if you're switching football teams right here on the podcast, I'm not believing your conviction in any NFL club whatsoever. 

Dr. Brian Levine: [00:28:29] Yeah, unfortunately, my father-in-law pulled the meanest ever, which was the night that I asked for permission to marry my wife.

He asked me if I'd become a Jet's fan 

Griffin Jones: [00:28:37] You failed the test, right? I'm sorry. But my father-in-law said that you've got to root for any other team, but the Buffalo bills, it would be over. So this was part of your pitch. And then, but what was the value prop to them 

Dr. Brian Levine: [00:28:52] New York, it sounds very cliche and very Frank Sinatra, but if you can make it here, you can make it anywhere.

Now, of course, I didn't know what their growth plans were for the future. I didn't know that in 2021, there would be 11 Denovo clinics around North America. Oh, sorry. 11 fertility and fertility clinics around North America, including Denovos. I had no idea what their plans were for the future, but I felt that New York was lacking CCRM science and as a geek and as a tech person, that science resonated with me.

Unfortunately, what I realized early on would be that even though CCRM has the fastest path to parenthood, right?  We focus on this, right? Like we focus on how do we get someone pregnant and how do we get them to achieve their goals and whatnot? That's what we talk about every day is how do we be faster at this?

How do we get someone more efficiently, pregnant efficiency, being fewer cycles, fewer transfers, better outcomes, whatnot. I felt that in the current practices that existed in New York, I was going to end up meeting resistance. If I tried to incorporate this CCRM approach at these other places. So literally, why compete at those places when you can compete with those places?

And I think competition is a good thing. Everyone thinks it's a bad thing, but competition is good. It makes us all better, right? Like when you become complacent, you're probably not a good doctor. One size does not fit all. Unexplained infertility is a frustrating diagnosis and that should not just be something you check off on your cert data and call everyone unexplained.

You should dig deeper and figure out why it's unexplained or why they're not getting pregnant. So for me, it was all about how do we integrate a high tech high touch clinic. Into the most competitive IVF market in America, right? More fertility clinics are within five square miles of where I'm sitting today than anywhere else in the United.

Griffin Jones: [00:30:46] So what was the hardest part about starting in that landscape? 

Dr. Brian Levine: [00:30:53] I think the hardest part was the honest conversation with Dr. Schoolcraft and CEO, Jon Pardew, which is. So we're all excited. We want to get married. We're dating, how do we do this? And the hardest part of it was recognizing that the real estate costs in Manhattan for five to 10 times what they were in any other market that either CCRM was already affiliated with, or that they were looking to expand to.

That was the hardest part to be quite frank was just, it was a numbers problem. It was literally an issue with zeros of understanding the market. Now you can do deep analysis of what is the payer mix? What is the population of New York look like? Is the, are the needs met or unmet? We actually made a heat map at one point, looking at the map of Manhattan, figuring out where the actual clinics were.

I don't know if you recognize it or not, but CCRM is on 53rd and seventh, which is in the heart of Manhattan. Suppose the many of the other clinics, which were where people lived, right? Upper east side, or, in the thirties on first avenue or on the upper west side, we took a different approach, which was, let's go to a place that has high touch, high transit near the subways, near the path train from New Jersey, near port authority for buses to come in near long island railroad from Penn station.

Let's pick a place that's near where people work so they can get treated and get to work. 

Griffin Jones: [00:32:14] So we have to revisit your value prop because I imagine your value prop was revisited during that difficult conversation, that if you can make it here, you can make it anywhere. That's reason to go to New York five to 10 times the cost of real estate, probably not going to make five to 10 times the amount of profit.

So what is really behind this sentiment of, if we can make it here, we can make it anywhere that's truly advantageous to the entire company. 

Dr. Brian Levine: [00:32:41] So right at the time that we right at the time that we were really having these conversations we looked at the data, how many patients were flying from New York and the east coast out to Denver.

How many patients could be flying out to Denver? How many patients are probably just frustrated and either staying at their current clinic or just unmet needs and are just giving up. And when we had that conversation about the inherent volume that was currently in New York at that state of time in 2015 of what was sitting in New York City, either the unmet need or the defined number of patients that were already doing there, there was enough volume to support the finances of the clinic.

So it was a very calculated financial decision. But the other thing we recognized was that I couldn't do it alone back to our cold concept of partnership. We recognized early on that I was going to need to bring partners on people who are well experienced, people who had volume behind them, people who had demonstrated their own volume at other clinics, because you have to remember coming out of fellowship.

You're an unknown, not just me, anybody, anyone out of fellowship, you don't know how. What they're going to be like when they're actually practicing medicine. And so it was that unknown, which was me, but I think I had to the grit and the stomach for the growth phase, and then taking some people who had demonstrated interest in transitioning to new jobs who had growth who had growth behind them.

Griffin Jones: [00:34:13] What has that growth been like since the inception in you? You had this conversation, I think in 2013, I think you started working on opening the practice in 2015. Is that right?

Dr. Brian Levine: [00:34:24] Yep. I finished fellowship in June of 2015 and that's when we started, 

Griffin Jones: [00:34:28] What is growth been like since then? 

Dr. Brian Levine: [00:34:30] A 50, 50 mix of absolute excitement and absolute exhaustion.

It is not felt like we've taken our foot off the gas since we started doing over a thousand cycles pre-pandemic a year from starting at, 200 our first year. So each doctor, if you average it out; call it two 50 per doctor, which is I think a very comfortable number as I'm to now really having banner months for the last.

By actually the last six months now, as we've recovered from this pandemic at a 20% growth rate compared to what we've done in the past growth has been continuous and patient volume. We've, haven't grown in the other two places, which I hope we do. One is in the number of doctors, right? We're still four.

We've been four really, since we opened the doors June 1st, 20, 21 will be our five-year anniversary. We are still four doctors since that time. We're still one location. We do have, a small site that we use two days a week for monitoring, but we haven't done the big growth you've seen with other clinics were in a five-year span, they'd gone from four to eight doctors or on a five-year span they've gone from one location to three or four satellite locations.

I do think that there's an issue that occurs. In many of these other practices where they put the junior person out of the satellite that doesn't allow for that mentorship as we were talking about before, I also don't think that feels very much like a partner because you're saying let's farm you out.

Griffin Jones: [00:35:59] 

But weren't you firmed up right? Weren't you the ultimate satellite you're New York to Denver, as opposed to new Rochelle to New York. 

Dr. Brian Levine: [00:36:07] I never felt like that. I felt like from the beginning that Colorado was our biggest cheerleader. They wanted us to succeed. They wanted to see, their New York volume, go down as our New York volume went up.

I never once felt like we are, taking from the mothership. I always felt like it was let's grow together, which is really important because there's a lot of really tough stressful days. And. You know there when we first started. And you should definitely have Jon Pardew on here and he'll tell you his whole story of his team and, the initial management team that was there, that he worked with, but there was this attitude that I still maintain to this day, which is just to do one more, one more of anything, go see one more patient, come in, an hour earlier to see one more patient, stay an hour later, see one more patient figure how you can just do one more.

And what happened was during this initial growth phase, especially 2016, 2017, where we really, I think hit our stride and just continued to grow from there. Was this attitude of let's build what we have and let's kick the tires, right? Let's look introspectively, let's figure out what's working, what's not working.

And let's optimize before we get too big for ourselves. Which has been really important. 

Griffin Jones: [00:37:19] So now you're at a point where it sounds like you're ready to add on a few more doctors. Perhaps this will be a little bit of recruitment advertising for some of the fellows that are listening. If they want to go to New York, maybe reach out to Dr. Levine. I want to talk about another dynamic that I hadn't thought to talk about until you just made me think of it, which was yours. Growth and then the hindrance of not having other physicians. And so I'm introducing a hypothetical here, but when you're. In a group within a group, sometimes they might not have the same needs.

And so part of the reason why you bought into this whole thing was because you wanted their process, their methodology, their system, but what happens when a certain. Location region office runs into different challenges. And I'm thinking, what if there's a place that has four docs and they're doing a thousand, but now they could be doing 1250 that the new patient volume just keeps stacking up.

We'd love to be using advanced providers here. This is a hypothetical, I'm just saying, not saying that's what one group wants to do or that the system doesn't want to do, but there can be. Different needs of the systems, so we don't do that. And then, so how are those differing interests reconciled?

Dr. Brian Levine: [00:38:38] Wow. So that's, I think that's a tough that's a tough one because you need to drink the Kool-Aid or not. I think when you're doing what I did and I very early on. We recognized that outcomes speak for themselves and you can define outcomes, however you want. Those could be pregnancy rates.

Those could be in my opinion, the more important than just pregnancy rates is patient satisfaction scores patient satisfaction rates, online reviews feedback from colleagues. Asking people in the community, like if you need a treatment yourself, where would you go? If you need your sister to receive treatment, where would you go?

And so I think what you're hinting at is you do need to drink the Kool-Aid of the practice that you join. You do need to understand that there is a well-oiled process, that's there. But to be for all the fellows who are listening out there, when we're looking to hire someone for CCRM. As important of an interview is meeting the doctors in the practice of the location that they're going to go to.

And speaking with Dr. Schoolcraft and the leadership team is a visit to Colorado is a visit to the lab to see how, the science is integrated into patient care. To understand the science is not tangential to the care, but it's actually part and parts of what we do and to understand how the protocols are being optimized, how the laboratory environments being changed.

When people started to see that a laboratory environment has vertically integrated with a genetic testing core and together, these two things are talking. It might sound like a minor point, but for example, many practices in America use a third-party vendor for genetic testing. Very little conversation occurs between that third party vendor and the laboratory leads of the clinic that's using that service.

In our environment, because they're all under one roof, we've got a ton of crosstalk that's going on. When we're talking about the mosaic embryos or the no results, or the embryos that come back without enough genetic material to make the call, the inconclusives, it's a very different conversation.

For those patients, because we can tell them that the genetic testing people are talking to the laboratory people and together we're talking about the environment and the medias that we're using and the techniques that we're using now in the same regard as you were hinting at I'm not going to go change the lab.

Even though I'm a doctor and I utilize that lab freely, that's not my place, like I kind stay in my lane, which is, I take care of people. And I sleep at night really well, knowing that there is a killer lab, like there's an engine to this place. That's churning out great results. And there's a bunch of people who are much smarter than me behind the scenes.

And I have the opportunity in New York to reach into that resource, to work with those people. 

Griffin Jones: [00:41:29] That is an extremely interesting thought to conclude on. But before we conclude, I would like you to leave with. Thinking back to all the mentorship that you received from Jon, from Dr. Schoolcraft, from what you've learned yourself in the last six plus years, what should fellows be studying, learning?

What should they be seeking out either in terms of learning on their own or learning from someone else with regard to the next step of their career or business? Before they leave fellowship.

Dr. Brian Levine: [00:42:05] So I think, in the second year of fellowship, which is, what I call the messy middle of fellowship, right?

There's the first year, you've been OB-GYN for four years now. All of a sudden you're like, it's like drinking from a fire hose, right? New language, new talk, new procedures, whatnot in the second year where you're really starting to cruise along and you're starting to, get into your groove, take a step back and take a look at either.

Where are the patients are going when they're dissatisfied, where the patients are coming from. And the doctors in the group that you think are most satisfied with the current setup and talk to them. Like I remember in fellowship, I used to ask people all the time, are you happy? Fellows are very scared to ask these questions, but ask them in attending.

Are you happy? Is this what you imagined? It would be like, is this what you were hoping for? And people will tell you the truth and right. You had someone start talking just, you have to, of course, if you're going to ask a question, be a good listener but ask them and people are very honest about their experiences.

This is the purpose of ASRM. This is the purpose for PCRS. As a fellow, you should also take a deep dive into yourself. What do you want to do in a private practice? You probably have more control over your schedule. In a group practice, private or academic, less control over your schedule in an academic practice, you probably have less risk and more stability.

So you have to understand that. What is your personal threshold? Where does your rheostat get set or your risk reward ratio? Because you can actually make much more money potentially. If that's your goal in academics and private. But you could potentially have equity on the private side and not so you could play long ball with it and you just got to figure out, like, where do you wanna turn that dial?

Like where do you want to be? The last thing I would say is that for any fellow who's out there is talk to anyone, everyone we're not all competitors. Like we were all fellows too. It's actually really humbling when a fellow reaches out and is Hey, can I ask you a question?

You don't know me, but I'm a second year. I'm a first year. I'm a third year. Or can I find some time to chat with you? Most likely we'll even pick up the bill and pay for the dinner or the coffee or whatever else, or pick up the phone reach out there's our community of fertility doctors is so small.

And when I hope happens in the next 15 years is that as that generation that started this field really. Ages out and retires that you start to see this other crop of collegial people. I actually like the people that I work with of other clinics. I mean many of us trained together, residency or fellowship.

We like each other, we refer to each other. And I think if you can demonstrated for the fellows out there an interest in being collaborative and an understanding of the collaborative nature and that taking care of a patient as a partnership. No one ever got pregnant from just one doctor.

It's a team of individuals behind that doctor that worked with that doctor that worked with that team together. You'll kill it, but just got, figure out again. I think the big picture is where's your rheostat set. Are you on the risk side? Are you on the reward side? And what is your reward? It's not money for everyone for some people's stability and control their timing of their schedule.

But reach out. Reach out to everyone, reach out to Griffin. You talk to more people than, probably anyone else out there. So just talk to people. 

Griffin Jones: [00:45:23] I'm happy to make those introductions as well to anyone that I know, not the least of whom is Dr. Brian Levine. Dr. Levine, thank you for coming on Inside Reproductive Health.

Dr. Brian Levine: [00:45:36] This has been a lot of fun. Thank you so much. Stay safe. 

Narrator: [00:45:41] You've been listening to the Inside Reproductive Health podcast with Griffin Jones. If you're ready to take action, to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society, visit FertilityBridge.com to begin the first piece of the fertility marketing system, the goal and competitive diagnostic.

Thank you for listening to Inside Reproductive Health.

107 Converting Patients into IVF Patients

In this week’s episode of Inside Reproductive Health, we don't talk about new patients. We talk about patients ready to move on to treatment that are a good fit for IVF, how you convert them into IVF treatment, and some of the national averages when it comes to conversion. If your concern is mostly about having more IVF patients and you want to reach your IVF goal, but you’re good on your new patient goal, this episode was recorded for you. 

I brought Stephanie Linder, our Director of Client Success, on the show with me. She sits in the operational marketing seat very often and gets to get close to this part of the patient marketing journey. We talk about the reasons why patients don't move through treatment and how to overcome those reasons to increase the conversion to IVF patients when they are in fact a good fit for IVF. 

Some topics we cover include: 

• KPI’s to focus on moving patients to treatment

• National averages for conversion of patients to IVF patients

• Reasons patients don’t go through with IVF

• How online reviews impact your business

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Transcript

Narrator: [00:00:00] Welcome to Inside Reproductive Health. The shop talks about the fertility field here. You'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field. Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit FertilityBridge.com to learn about the first piece of building a fertility marketing system, and the goal and competitive diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.

Griffin Jones: [00:00:39] IVF patients- on today's episode of Inside Reproductive Health, we don't talk about new patients, we talk about patients that are ready to move on to treatment and are a good fit for IVF. And so if your concern is mostly about having more IVF patients and you want to reach your IVF goal and you’re good on your new patient goal, this episode is the beginning of the rabbit hole that you need to go down. I have Stephanie Linder with me. She works here at Fertility Bridge. She's our director of client success, and she also sits in the operational marketing seat very often. So sometimes she gets really close to parts of this.

And we talk about the reasons why patients don't move through treatment. We talk about the four, but really three KPIs to focus on. To move patients to treatment. Before we do that today, this shout-out goes to Jackie Sharp, who worked for a group on the west coast, in marketing, and got me thinking about IVF conversion even before I was even when I was still focusing mostly on new patient acquisition.

And so I want to give a shout-out to Jackie. I hope I get an email from her and hope that she still listens to the show on occasion. So please enjoy  this episode about the third phase of the fertility patient marketing journey, moving new patients beyond their initial consultation and through treatment with my colleague and employee and friend Stephanie Linder

 Stephanie, welcome back to Inside Reproductive Health 

Stephanie Linder: [00:02:15] Thanks, Griffin Jones. I'm so excited to be here. 

Griffin Jones: [00:02:19] Going forward. I'm not going to even do that intro for you because you're neither a guest nor the host. It's both with me. The last time you were on was actually, you were interviewing me.

You were the host, you were interviewing me. And that was probably two years ago. And now that you've been with fertility bridge for a while, I trust you to have you on the show and share some of these points of view with our listening public. And because you're so instrumental in crafting them with me and with the rest of the team.

And so I just view this as having you on more. I don't view you as like It's just being, it's a Fertility Bridge hosted show without a guest. I'm not even considering you a guest in this sense. One day, I'll have you on just to talk about Miami, to talk about salsa dancing, and it will be a complete interview, but as far as you're on today, I want to go through the third phase of the patient journey with you.

And as we. Go through more of these going forward, or as we zoom into certain parts of certain phases, have you on to do those things. But today I want to talk about moving people from initial consultation to treatment. Typically IVF, is that okay? That'd be wonderful. I can't wait. Okay. So part of the reason why Stephanie and I and Fertility Bridge have invested so much in this phase is because we always hear people saying they want treatment-ready patients.

They want IVF patients now qualified patients. You can go back and read the four phases of the fertility patient marketing journey. You'll see that it isn't just a cohort of people. It isn't one demographic of people that are treatment-ready. Indeed. There are people that are more treatment-ready, but it's how you work the system.

It's how you move people along the three, the four phases. Part of the reason why people want to do that is yes. Sometimes they want to do it because that's what's profitable. Other times, I think a lot of what is going on Stephanie's that people are so busy that they're so slammed with new patients.

It's almost like triage. It's like, well, if we're going to be treating people, we, if we're going to be seeing people, we should be seeing the people that we think we can treat. I would agree with that. So that's why we're zooming into the third phase today, but you should know that there are aspects of the third phase, just like all of the other phases that are seen later in the patient journey that are seen in the fourth phase, and that are seen earlier, things that you have to do to pre suede people.

And we're going to be talking about some of those things, but there's really not just one reason why people don't move forward with treatment. There's. Probably eight or 10 and you could come back to us and say, well, I think that those two should be combined, or I think that one should be split up.

Yeah, I get it. You can always break it down to a semantic level, but when we firm our points of view on these different phases of the patient journey and these different segments of each phase, we're really zooming in and really defending on why we think it's this. We're going to talk a lot more about the things that you use to measure it, but there are probably eight to 10 reasons we've come up with eight or nine Steph, what are those? 

Stephanie Linder: [00:05:42] So first I would start with a poor prognosis. I mean, patients come in and they get some really bad news quite often. And sometimes it's so bad that they don't see that the chance of a live birth can actually happen for them. But there's also some other ones like that. Physicians don't think of it as often.

So naturally, they may go to something like, oh, they can't afford it, or they don't want to pay for treatment. And while that's true, the idea of taking on something that could be 20,000 can often be overwhelming.  

Griffin Jones: [00:06:10] Some of them are a little bit self-explanatory, so go through, list them off for me. And then there might be a couple that I want you to dive more, deeply into. 

Stephanie Linder: [00:06:22] So just kind of start from the top. Okay. So there's a lot of reasons that patients don't proceed after consults. The nine that we really zoom in on are core prognosis, the fact that this journey is extremely overwhelming. The third one is just the uncertainty of what happens next.

The clear steps aren't laid out for them. The fourth is really paralysis by analysis. Do they do IUI? Do they do IVF? How many IUI's? There's a lot of options for them. Number five is they didn't finish their testing and they may not even know it. Whether it's the female partner. Or the male partner. 

Griffin Jones: [00:07:00] So why did you feel strongly about signaling that one out, Steph?

Because we talked about incomplete testing. Like maybe it's just part of the indecision part, or maybe it's part of the, maybe it's part of the uncertainty part, but you. Really zoomed in on testing. And what's your case for that? 

Stephanie Linder: [00:07:19] I mean, it comes from firsthand experience, hearing it from our clients and just my experience in the fertility industry.

And to me, it's always the one that surprises me the most. And I have a specific example of this. You know, we had a client that did a follow-up post-consultation to figure out why this couple didn't come back in for treatment. And what they found was that the husband or the male partner was just too embarrassed to give a sample to an office.

And they shared with them that there's a way to do this outside of the office. And that got the couple back into treatment. So to me, sometimes we imagine that the barriers are so great, but we can really solve them by just asking them, Hey, do you have any questions? And then providing a solution to what their concern is.

And so I really focused on this one because I've just heard and seen it firsthand from so many of our clients. And to me, it's such a simple, easy.

Griffin Jones: [00:08:15] What comes next? 

Stephanie Linder: [00:08:15] So the one that I hear that people assume the most often is the financial barrier. And while that's the case, we can deep dive into the different facets of that. Just not a sense of urgency. This could be a lot related to age or with that egg freezing patient population. The eighth one would be just the disappointment and the experience.

And this is really where the clinic has to look in the mirror, but this could be with the initial consultation, something, a blood draw that the man does, for example, so many different things, but essentially they just had a poor experience. And last but not least, I would say is a more positive one, which would be that they got pregnant naturally, which is always amazing news.

But there's still ways to leverage this patient or prospective patient. To really get more referrals. So it's still someone that good news, but not something that concentrate on for today.

Griffin Jones: [00:09:04] I want to zoom in on the financial barrier for a little bit because finance and payment are a big piece of the third phase of the patient marketing journey. It's one of the things that people leave reviews about sometimes, but it's one that might not be immediate. It might not just be having the money to pay for treatment or not. Talk more about that.

Stephanie Linder: [00:09:31] Well, That's of course a possibility, but it's also deciding, do I want to spend my hard-earned $20,000 going this route? Or do I want to spend it doing $2,000 IUI buckets or whatever they may be? It's also because they don't understand the options that they have in order to pay for this. And really who to talk to at the clinic that could help them navigate these options.

I would say the last part of that is really just the mess that is insurance. I don't foresee, I don't see a lot of our clients, our clinics I don't see a lot of clinics necessarily explaining the in-network versus out of network in an optimal way. And I think patients just really don't understand what their options are.

And if they had a better explanation of how to pay for treatment or the resources available. They could reduce the barrier to treatment. 

Griffin Jones: [00:10:26] We'll devote an entire piece of content to finance and payment in the future because it deserves one. But to your point, it's telling people how they're able to pay for it, not being able to pay for it is part of finance.

So of all of these reasons why people don't move through treatment money is only one of them and even have money. It's not always a question of. They don't have the money. Sometimes it's a question of, they just haven't looked into the options enough on their own, or had it explained clearly to them because it's much different to think, oh gosh, I'm going to have to take out a $20,000 loan or whatever it might be versus looking at something with payments versus looking at.

A couple different options. So we will dig more deeply into that. I want to spend time talking about the four areas that we'd measure. So we've got eight to 10 reasons. We think there's nine reasons why people don't move on to treatment. And there's four different key performance indicators that are going to help someone realize, are they getting to that IVF goal or not?

What are they? 

Stephanie Linder: [00:11:38] So we want to measure your new patient volume appointments IVF conversion rates. So your conversion from appointment to IVF, egg retrieval, your online ratings. So what the public sees and then the patient's satisfaction. So the surveys that you conduct internally, what are those ratings and aggregate numbers?

Griffin Jones: [00:11:59] So new patient volume, we've done a lot of content about, we will do a lot more content about. I don't want to spend much time talking about that today because new patients just tend to be a different goal entirely. And some high growth groups do still have new patient volume needs or some that may be were.

doing really well previously and then found themselves in a very competitive market and they didn't invest much in business. So there are people that still have new patient needs still, but we've created a lot of content. I want to zoom in on the other three KPIs. So we've got IVF conversion rate, online rating, which is also online reputation.

And then patient satisfaction. Let's talk a little bit about IVF conversion rate because. A lot of people don't measure it at all. This is IVF conversion rate. This is the percentage of people that move on from consultation to IVF. And part of the reason why they don't measure it is because it can be cumbersome.

If you want a really accurate way against the actual patients that moved on, it can be cumbersome to get. All of that from the EMR, but there is some napkin math that can be accurate. We'll talk about the stipulations when it's not accurate, but what's the very basic formula stuff. 

Stephanie Linder: [00:13:25] Well, it's taking your IVF retrievals times 12 months divided by the new patient appointments that are for fertility.

It's crucial that you remove any egg freezing appointments or fertility preservation out of that new patient number. Times 12 months and equals your conversion 

Griffin Jones: [00:13:41] rate. So retrievals year's worth of retrievals divided by a year's worth of new patients is IVF conversion rate. So this formula doesn't work with one month of data or even a quarter because your IVF cycles are typically lagging two to six months.

So that's why we're saying to do it. Over 12 months because it's not going to be accurate if you're doing it over a quarter, there's also something else that makes this whole formula go kaput. What's that? 

Stephanie Linder: [00:14:13] It's egg banking. So in a lot of areas where there's well, two things, a lot of coverage, like progeny or carrot, where they give you a certain number of retrievals upfront, especially in patients that are older, they'll tend to do multiple retrievals before they ever get to a transfer.

And that can really throw off the numbers. So we do just take that into account, but it will likely make your conversion rate look higher if you do a lot of egg banking upfront. 

Griffin Jones: [00:14:40] So for most people this isn't an issue, but I have seen it where it is an issue and it looks like the IVF conversion rate is overall a hundred percent and that's definitely not.

Yeah, right. So if you don't have these exceptions working against you, you can figure out relatively quickly how many people you've been converting to IVF. And we have the privilege of working with every kind of fertility center, ones with dozens of docs, ones with single docs, ones that are part of corporate networks, and ones that are completely independent ones that are in Canada and the United States.

And those that are academic versus. Being private. And we have seen a range. And from the 40 plus practices that we've worked with, what is the, what would you say are the points? And when Stephanie and I were talking about, I put them as points, Stephanie put them as ranges. The reason why I didn't put them as ranges is because it's not like, “oh, I'm at 49% and that's in the good range. And then I'm at 50% and that's a great range.” So that's why I put very specific points. What are those points for what's good? What's average? What's bad for IVF conversion, Stephanie? 

 Stephanie Linder: [00:15:55] So we'd want to put a little stipulation to this before we speak about them, that we want to really divide this into two categories.

So if you're in a mandated state where people have more access to care, the conversion rates will likely naturally be higher versus being in a non-mandated state. So anything in that 20 to 30% range regardless is what we would consider. Poor or not a good conversion rate.  

Griffin Jones: [00:16:18] I don't care who you are.

I don't care if you are in a very poor small market because we hear that sometimes. Oh, well, you know, this isn't Chicago, this isn't Atlanta. It's not San Francisco. If you're below 30%, that doesn't matter. If you're below 30%, you're not. Moving enough patients to treatment. If you're below 20%, I'm worried that you're going to close the doors.

That's something that we can tell by looking at clinics across the country and across Canada, I can't say exactly how many patients should be moving on to IVF. And so that's normal. You made your caveat stuff. That's the caveat that I really want to make is we're not telling you clinically how many people should be moving on.

We're just looking at what's happening across the country. This is what is happening against the total patient population that could be being served and. Under 30% is definitely cause for concern. 

Stephanie Linder: [00:17:22] Right. Especially when you're looking at this over a year average, and as you said, you're not just taking this at a month at a time.

If this is under a year average, it's something that I would look at more closely. But what I'd consider more in the good to very good range is your 40 to 50% especially in a non-mandated state. So I would say in a mandated state, what I would consider average is more in that 50% range and very good or exceeding expectations would be 70% and above.

Griffin Jones: [00:17:50] So 40%, if you're non-mandated if you're in one of those markets that was giving us the excuses that we were talking about 40% is good for you, 50% would be very good for you. If you're in that type of market. I mean, you are really good at moving on. People to treatment. And you're really good at triaging.

50% is a lot more common to see for those that are in mandated states or that have a lot of progeny Cared employer kind, body, employer coverage, and then 70%. You'll never see that. At least now you'll never see that in a non-mandated state, in a place where there's not a lot of employer coverage. The only places where we're seeing that is where there's a state mandate or there is a ton of employer tech company type of coverage, and often both in order to get something that's that good. 

Stephanie Linder: [00:18:46] Right. And if someone has it, I'd welcome him to be a guest on this podcast with you. 

Griffin Jones: [00:18:50] So that's IVF conversion rate. That's one of the four key performance indicators to measure when you are going for an IVF.

Goal and new patients is the first, but IVF conversion rate is what you would look at right after new patients. We'll talk more. In separate pieces of content about the specifics of influencing that KPI, but we've got new patients. We've got IVF conversion rate. The other two are online reputation, online rating.

If we're looking at what the actual numerical is and patient satisfaction. So talk to us about online ratings. 

Stephanie Linder: [00:19:31] Online ratings, every physician in clinics, favorite metric it's really what's public-facing and what your patient sees when they're not only doing initial research about your clinic. But they're still leveraging these online ratings, even after they've done the consult, just to almost confirm that their decision is the right way, perhaps even deciding between your clinic and the clinic down the street.

So it's really just providing them evidence that they're making the right decision and it's you know, their peers are also giving them or supporting them that, okay, this is the right decision to make and making them feel more comfortable and all their emotions on all the decisions that are going on in their head.

Griffin Jones: [00:20:08] So we chose to separate it from patient satisfaction. And there's a couple different reasons for separating online ratings from patient satisfaction. Maybe we'll get to that when we talk about patient satisfaction. Right. But we do believe that they are separate things. And if you're reading anything about internet marketing or anything about marketing, you'll often hear.

Reputation management is one thing. And even sometimes we say that if we're talking about online reputation management software, but total reputation management is really your online reputation, your online ratings, plus your patient satisfaction, the internal and the external. So if we're being really judicious, it's not that its online reputation is patient satisfaction. They really are two sides to the same coin. If we're staying with just the online part of it, what are the important sites to focus on platforms to focus on as of May, 2021? 

Stephanie Linder: [00:21:18] Yeah. And that's a really good question because you do have to take a look at what platforms are influencing your referral patterns probably on an annual basis because they are always slightly changing.

So right now, Google still reigns Supreme as probably the most influential people are still going to Google to do their searches and seeing your reviews on the right-hand side of the screen. It's still Facebook as number two and fertility IQ has become a lot more influential in recent years, probably due to the robust amount of content they've now put on their site. So we're seeing that As number three and then number four would be Yelp. 

Griffin Jones: [00:21:52] So I was ready to kill Yelp off of this and write it off as irrelevant. You made a case for it. You went back to the rest of the team. You spoke to our digital strategists.

You got the evidence from them and came back and mentioned why Yelp is still relevant because there are lots of centers that are still getting. Reviews on Yelp. And I thought a little bit more about why that is and my hypothesis of why that is because Yelp is the default review for apple listings.

So in the same, for the same reason that Google is so important because it's Google reviews is the review for a Google location. Listing Apple doesn't have their own review platform, they just integrate with Yelp. And so I'm glad that you. Made that case. And I think that's why it still belongs there in the 2021 world.

So now we've got the places that we want to focus our attention on what is good. What's bad because this is a question that people have. Very often they say, well, people only leave bad reviews online and that's not really true. There's definitely a range. And we can tell you what's good and what's average and what's bad.

So walk us through that. Yeah. 

Stephanie Linder: [00:23:20] So, three of the four of the platforms we just listed are on a five-star rating. So likely what we see is if you have a perfect five-star rating, we want to see more reviews, more social proof. But if you have at least a 4.5 or above, it helps you, it makes the patient.

Decide that you are the right choice in the right clinic and support their decision, but anything between a four and a 4.4 is neutral. It doesn't really push one way or the other. Anything under a 3.9 hurts you and really hurts you, is anything under a three even more so. 

Griffin Jones: [00:23:58] Yeah. And I think it's important why we included this in the third phase of the patient journey.

Why is it an IVF consult to, excuse me, initial consult to. IVF. Why isn't it only in the first phase of the marketing journey, which is just vetting new patients to increase? The reason why it's in this phase is to begin with “why,” it's so important for actually converting people to treatment is because you can get people in the door with a 3.2 rating.

Maybe they'll say, “well, you know, we just need to see a doc and our other doctor recommended this person.” You can still get people in the door with a poor reputation, but it always has the potential to be the devil on the shoulder. And once people start facing. The hardship of treatment, the reality of treatment, injections, cost uncertainty of success.

Once they're actually faced with all of these things, then they go back and they're like, well, was Susan Wright when she said that they're not going to get back to me. Was Tiffany correct when she said that it was a complete waste of money and a complete waste of time? And so the reasons that Stephanie brought up of the range that Stephanie gave for this is what helps you.

This is what's hurting you. It's not just for getting new patients in the door, it's getting them to treatment because people are. Still going back for this social proof, even after they've come to visit you, they still have to make more decisions. And they reference these for doing that. So we separated online reputation, online ratings from patient satisfaction, which is measured, that rating is measured differently. So why don't you talk to us about patient satisfaction Steph? 

Stephanie Linder: [00:26:01] Yeah. While online reviews are public-facing and really anyone in the world can meet them. Patient satisfaction is meant to be an internal measure of patient satisfaction.

So these are set by sending or understanding by sending patients surveys really at two key points in the process sending right after their consultation, and we want to do that because we know that approximately 50% of people, well, maybe even more don't proceed to treatment. So we really want to understand their experience and why they did or did not proceed.

And then doing it after the egg retrieval, really once a bulk of their process has been wrapped up. 

Griffin Jones: [00:26:41] So there's a couple things that you're looking for and maybe I'll have you get into some detail. I don't know that I'll have you get into all of the details today, but the reason why we're measuring patient satisfaction separately from online is there's basically three reasons.

Online reputation ratings can be incomplete sometimes. People don't have hardly any and or sometimes they can be misleading because they really worked the heck out of rate MDs in the early days. And know how to use reputation management software and really have a good process. Yeah. And they're working too hard almost on, on that.

It's not a question of working too hard on the online site. It's more of a question of working it really hard on the online side, but not working hard enough on the satisfaction side. So it can be misleading. Second is that It doesn't allow you to quantify your issues. It doesn't allow you to prioritize those real concerns.

And then third is that when you get internal feedback, it allows you to address those issues before they become public. And that's something that you have a very strong point of view on. So. Of all of the things that you could go into more detail about patient satisfaction. Why don't you talk more about that, Steph;  about getting feedback from patients so that they're not going and leaving negative reviews necessarily?

Stephanie Linder: [00:28:08] Yeah. I have a firm belief that if any clinic out there wants to become a world-class clinic and wants to improve their workflow, they have to ask their patients. What's happening during the journey. And as a physician or a leader of a practice, you are so inundated with just your day-to-day stuff, that it may not be clear to you.

Some of the things that are happening, maybe the way someone speaks to someone at the front desk answers a phone call. Hurt someone with a blood draw. You need to understand what's happening, not only with your patients, but if you're the leader of a large practice, what's happening with your colleagues, patients as well.

And look at these as a group, so you can assess it properly and perhaps fix any workflow operations or staffing issues that are not easy to address, but are absolutely needed. And it's one of the key ways you'll be able to improve the practice and know where to focus your next initiatives on. 

Griffin Jones: [00:29:04] I notice it when my Southwest flight is like 10 minutes late, I get on Twitter, like, oh, I'm giving it to Southwest.

I'm totally giving it to Delta or Chevy or, you know, whatever company I feel like I don't have control over. That's clearly at play with negative reviews. It's not all of it, but a big part of it is that. Leaving a negative review gives the person some sort of control back. They take back some sort of control.

Like I might not be able to control any bit of this process, but if I feel slighted by you, I can at least slam you in front of other people. 

Stephanie Linder: [00:29:43] That's what we don't want though. Right. So by doing the survey, we're circumventing and preventing that from happening. 

Griffin Jones: [00:29:49] That's what I mean. Yeah. Because otherwise they're going to take that control.

And so if you give them some control in a regulated space. That's what you're saying is the means to avoid some of that negative venting, which is a third of negative reviews anyway. 

Stephanie Linder: [00:30:10] Oh, yeah. I mean, I'd rather know about these grievances internally so I can fix them and that. A patient, another prospective patient doesn't read it and go to the clinic down the street.

So really it's a means to review internally, improve workflows, improve operations, and then hopefully. Fix those. So you're reducing any future patient drop-off. So they don't go into what I like to call the post console black hole, where you just don't hear from them. And you don't understand why.

This is just giving you a huge opportunity to be better. 

Griffin Jones: [00:30:41] So I know that patient satisfaction data is part of the arsenal that you like to use for referring provider strategies. We're not going to get into it today. I want to keep the people chomping for more. So they'll have to tune back in when we do an episode about referring provider strategies.

But I do want to get your thoughts on why patient satisfaction, even though it's often like the 4th. You might think it appears in the fourth phase, it's part of delight, but why is it so important to measure when you're working in the third phase when you're trying to convert people to treatment?

Stephanie Linder: [00:31:23] Yeah, I mean, I mentioned this a bit earlier, but half of your patients, at least likely won't proceed to treatment at least immediately. So you want to know what's happening post consult so that you can fix it for the next patient or even fix it and address it for this patient. 

So essentially though your more positive reviews are going to, if you could take the patient journey, that's now flat, probably on your screen and make it 3d and turn it into a funnel. The people that leave positive reviews are going to be essentially your biggest fans, your biggest word of mouth referrals that will talk to your friends at the dinner party.

Go back to their OB and brag about how wonderful and patient-centric their physician is. And that's essentially funneling more patients back into. The first phase, which is just getting more new patients in your door. And that's also the goal of this patient satisfaction survey is to know who is speaking positively about UC.

You can even ask them proactively to leave a positive online review in a public-facing forum like Yelp or Google or Fertility IQ.

Griffin Jones: [00:32:31] Yeah. I just blanked on my conclusion, but I'm just gonna. Wrap up here. So we're going to go into some of those tactics that you can do specifically for IVF conversion rate. I think we'll have you back on Stephanie.  That's what we'll talk about next is IVF conversion rates specifically, and things people can do to impact their IVF conversion rate positively.

 There's nine reasons why patients aren't continuing all the way through treatment.

One of them has to do with money. Two of them have to do with the clinic side. All of them have to do with communication. And there's four things, four key performance indicators that you need to measure to complete that IVF goal. And if you're at new patients already, if you're at your new patient goal, then there's really three.

And we talked about those today. IVF conversion rate, online reputation and patient satisfaction. We can talk more about those in detail, but if you'd like to talk more about them in detail with us and have us look at your situation, have us assess where your efforts are impacting the third phase of the fertility patient marketing journey.

You can talk with both Stephanie and I, because that happens in the goal diagnostic. You can sign up for it www.Fertilitybridge.com. You've heard the commercials and we can zoom in and talk just about that particular part of the journey. If that's the goal that you are striving towards. So Steph,, thanks for coming on, and I look forward to going into some of these more deeply in future articles and future podcast episodes. 

Stephanie Linder: [00:34:11] I do as well. Thanks. 

Narrator: [00:34:14] You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action, to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society, visit Fertility Bridge.com to begin the first piece of the fertility marketing system, the goal and competitive diagnostic.

Thank you for listening to Inside Reproductive Health.

106 The Future Outlook of AI in the Fertility Field

In this episode, Griffin Jones interviews Eduardo Hariton about the current and future state of AI in the fertility field. Eduardo Hariton received his undergraduate degree at the University of Florida, followed by a combined MD / MBA at Harvard Medical School and Harvard Business School. He is currently a clinical fellow in Reproductive Endocrinology and Infertility at the University of California, San Francisco. He has published extensively on both clinical and nonclinical high impact journals on topics that range from fertility and reproductive surgery to technology and medical education

Artificial intelligence is changing the landscape in our industry and will continue to affect fertility clinics in the near future. How much and in what ways, are the real questions that should be on your mind. That’s why I brought in Eduardo who is on his way to becoming the leading expert in Artificial Intelligence in the Fertility Industry. 

Some topics we cover include: 

• What is keeping AI from progressing faster

• What should we keep under human control vs AI? 

• Future of IVF Cycle prices

• Data rights and privacy issues. 

Eduardo Hariton Info: 

Facebook: https://www.facebook.com/pg/haritonmd/about/

LinkedIn: https://www.linkedin.com/in/eduardo-hariton-6687ab63/

Twitter: https://twitter.com/eduhariton

Instagram: https://www.instagram.com/haritonmd/

Website: https://obgyn.ucsf.edu/eduardo-hariton-md

To learn more about our Goal and Competitive Diagnostic Click Here.

Transcript

Eduardo Hariton: [00:00:00] People should look at their agreements and see who owns what data and your ability to use it too. I think anytime you enter into some agreement where there will be data sharing, You know, people define very clearly, like who owns that   relationship, who owns the IP that comes out of, you know, any insights from this data. 

Narrator: [00:00:20] Welcome to Inside Reproductive Health. The shop talk of the fertility field here. You'll hear we are authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field wall street and Silicon Valley both want your patients, but there is a plan.

If you are willing to take action, visit fertilitybridge.com to learn about the first piece of building a fertility marketing system, the goal and competitive diagnostic. Now here's the founder of fertility bridge and the host of inside reproductive health, Griffin Jones,

Griffin Jones: [00:00:59] On today's episode, I've got Dr. Eduardo Hariton back with me. We talk about artificial intelligence to a lot of the degree that I've just had Dr. Bob Stillman on and others that I've talked about artificial intelligence with, but we get into the specifics of what needs to come down in terms of the walls that bar certain technologies and platforms from talking to each other, which is actually, what's going to accelerate the progress from artificial intelligence as it applies to outcomes, as it applies to clinical operations, definitely the human impact.

Dr. Hariton has a strong opinion on, and we try to break down the nuance of what that is. And then we really disagree on something. Before I talk about what we disagree with, today's shout out is going to go to Dr. Pietro Bortoletto haven't spoken to him in while I don't know if he still listens to the show, but hopefully he does because he's another one of the rising stars in the field and would love to just get an email from him with this conversation with Dr.

Hariton we talk about the cost of IVF and what's going to happen. In the next five years, I say, it's not coming down. Eduardo says it is. It depends on, I guess, how we're phrasing that. And he and I are making a wager, we're still disagreeing on the terms of our wager because of course, both of us want to be right.

We're both trying to phrase it in a way that I'm hedging to where I am going to be. Right. And he thinks he is, I think I'm right on this. So I gotta get with my legal ease because I want him donating to my charity, not the other way around. And I'll let you decide. I would love to hear what you think about this.

Argument debate discussion that I have with my good friend, Eduardo.  I think Dr. Hariton is one of the brightest minds coming up in the field, as much as it pains me to say that, because I'm jealous that he's got both that crazy business mind, as well as your ultra clinical mind. And so you get to hear that discussion being unpacked today, and I hope you enjoy it.

Eduardo, welcome back to Inside Reproductive Health. 

Eduardo Hariton: [00:02:55] Thank you so much for having me again, Griffin. 

Griffin Jones: [00:02:58] You're back not just because you're my friend, but because I think you're in kind of a unique position. You are a second year REI about to be a third. Your REI fellow at UCSF. And you are also you're in the mix where you're looking at your career thing of practicing medicine.

Also looking at what the future of the field is going to be like. All of these companies and ventures in technologies that are going to impacted. And so I want to center our conversation around artificial intelligence, mainly because if you're not the guy qualified to talk about it right now, Eduardo, I think you're going to be the guy qualified to talk about it in 20 years.

So why not just have you on early and explore some of these thoughts? I want to start with what are you paying attention to right now with regard to AI technology? 

Eduardo Hariton: [00:03:56] Thank you so much. I think that's like an overstatement of an introduction, but I'll take it. 

Griffin Jones: [00:04:00] But listen, you might be miserably underqualified right now. Maybe you should just turn it off because here's some fellow talking about the future of the field right now.

So I'm not blowing sunshine too hard. I just think that you are going to be the guy. So I will put my. I will bet my ponies on that. 

Eduardo Hariton: [00:04:18] I appreciate that. I can tell you what I'm paying attention to is the massive amounts of investment coming into the field in order to bring technologies that we use in other areas of medicine.

Into reproductive medicine. I think when you look at what's happening in not only other areas of healthcare, but around different industries, automation is big. There are a computing power is becoming less and less expensive.  () And the ability to draw insights from really complex sets of data is growing and becoming more powerful.

And we see that applied throughout healthcare in diagnostics, where people are using AI to find different targets for therapies to bring the cost of drug development down. You see it across healthcare systems that are applying AI in order to move patients through that system in a more efficient and effective way.

To monitor patients in the ICU to recognize that they are not going to do well before. That actually happens inclinations to in order to early intervene. And I think people are realizing that in IVF being a very costly unexpensive treatment with a growing market and increasing the man that outstrips the supply.

There's a lot of opportunity for investment. So everywhere from predictive analytics to the way we stimulate patients, to the way we, follow gametes in the embryology lab on selects, which wants to transfer. I think there's people looking at all of these parts of our fertility journey. I'm trying to apply artificially intelligence solutions in order to improve our process.

Griffin Jones: [00:06:07] So when keeping with other specialties of healthcare, how prevalent is this technology is it's still very nascent. Give us a couple of examples where it is proven and adopted at scale to improve either clinical outcomes or just efficiencies and process. Where is AI being used? Were a couple of specific examples that are pretty established.

Eduardo Hariton: [00:06:36] Well, I think we're not very established anywhere. There's not one company that's taken over one solution that is used everywhere. I think we're going to get there, but I think we're still in the nascent stage. I think when you. AS for examples the are in markets. There are companies that are looking at vision.

So convolutional neural networks, looking at embryos to try to not only grade them and replicate what embryologists can do, but to select embryos with a higher implantation potential. And there's companies that are trying to bring those products to market or have those products to market. They have not been widely adopted.

And I think that one of the challenges of artificial intelligence technologies is that the models can show benefit. But I do still think that needs to be replicated perspectively and you need to actually show, you know, not that it predicts that it will improve outcomes, but that actually does. And I think those studies are ongoing in several parts of the world, but that is kind of the technology that is furthest ahead at this moment.

It's the use of computer vision to select embryos with the highest implementation potential also to select eggs that are more likely to create pregnancies. 

Griffin Jones: [00:07:55] So that's with regard to clinical outcomes. Where else are we going to see AI being applied within a practice setting? 

Eduardo Hariton: [00:08:07] Well, I think, you know, to the first part of the process, which is understanding a patient's prognosis right now, we have some tools.

We know their age, they're vary in reserve. We have start data, we have studies, so we are able to look at some of these tools, which are relatively crude compared to personalized AI. And we're able to say for someone like you with your diagnosis, your part in their semen analysis, based on your age, I predict that your per cycle light birth rate is 22%.

Right. Whereas when we take AI and we say, you incorporate all of that data, that that patient has where they are in their journey, and you can get a much more personalized prediction. I think that's helpful for patients because it allows them to decide, do I want to go through IUI? Do I want to go straight to IVF?

What are the pros and cons? What is my own individual expected success rates and what does it cost? And they can make that calculation themselves. I think it's helpful for the clinic because they can use their own data to try to drive some of these predictions. I lot of clinics are offering resharing models where they are allowing the patient to sharing the risk of their journey.

They subsidized part of the treatment. Some of them have guarantees and it's much easier to feel comfortable and have your final finance folks feel comfortable with a risk sharing model. If we have a very personalized prediction, As to what that success rate is rather than a rather crude measure. So on the predictive side, we're seeing some folks working on that, that in my mind is something that we could do before with more linear prediction models, but they use of machine learning and more complex  algorithm makes them better.

Griffin Jones: [00:10:01] In order to really personalize prognosis technologies would have to talk to each other wouldn't they, in order to have in order to have better data, meaning EMR and fitness apps and all the way down to the smart technologies that will appear in the home. So what technologies are starting to talk to each other now, or if you.

Don't necessarily know the answer to that. What needs to be able to talk to each other? 

Eduardo Hariton: [00:10:32] Well, the answer is not enough because no one talks to each other. And I think you hear of one of the big challenges for the artificial intelligence community. And for people trying to work on this, there is no one heterogeneous data set that these models can be trained on.

These models are. Need to be trained on very large amounts of data in order for predictions to be good, you know, training them on, our data UCSA for data of a single institution, even very large institutions. It's not enough because one in the magnitude of AI, it's not enough data for it to be really good.

And then in, if I take an algorithm that's built in the East coast and they bring it to the West coast, or I take it to Europe or China, It's not going to work in the same way. So what we really need to do is we need to build data sets that have patients from all over the world and, you know, different ethnicities, races, weights ages, and see how they do so that the algorithm can know how to react to different situations and weight those to your point.

Those do not exist, and there are some initiatives to create them, but. You bring up another good point, which is not everything that matters to your fertility. You talk about in your initial visits, you know how much you walk everyday, what you drink, what you eat, how you sleep, certainly can have some effects.

I think that probably we are further from incorporating those into our datasets that we use. I think m ost likely the initial models will be more clinically based, based on what a clinic can aggregate. And hopefully, what clinic collects in one area will be. Easy to homogenize with what a clinic collects somewhere else.

Another challenge, most databases don't look the same, even for people who use the same EMR. So there's going to be a lot of work upfront and creating this large data sets. But I do really feel like it will pay off in the long run. 

Griffin Jones: [00:12:34] So even before we create the large dataset, let's go down this rabbit hole.

That have technologies that don't talk to each other, let explore the reasons why I can think of a couple that I hypothesize. One of which being eventually you a massive privacy concerns we're already dealing with second is that everyone wants their data. The EMR companies want us to be able to sell their data and people should be.

Paying them for their data and the genetics companies think that people should be paying them for their data. So everyone wants to keep theirs so that they're the ones able to sell it. So I see those as two reasons, privacy concerns being one at a global level, two, being everyone wants to monetize what they have and not give what they have for free and they want to get more of it.

What reasons do you see for technologies not talking to each other yet. 

Eduardo Hariton: [00:13:33] I mean, privacy concerns are real, but the reality is that when you use these apps or use this products, you are agreeing to, for them to sell your, the anonymized data. So it's kind of happening anyways, for the most part. And you usually can request your data.

So that's something that you could pull. I think the reality is that when you participate in, you know, wearing a ring or a smart watch or have some of these products, Part of their value proposition to their investors is that they're collecting a lot of data that they're going to use to drive insights and create the higher value for their investors, for their consumers and grow their own individual products.

So I think that's right. There are very few incentives for those companies to share their data outside of their companies, unless it's in a symbiotic type partnership. And. And that creates a challenge for the data sharing and for incorporating some of these really large data sets that, you know, may help.

But we don't know because we have not explored that or incorporated it into the data that we do have. 

Griffin Jones: [00:14:43] And so who has the most leverage then? Who gets to say no, our data is worth the most. What do they have to do in order to aggregate the most. Data or have it as to make their database uniform. Who's got the leverage? 

Eduardo Hariton: [00:15:04] I would say that the leverage is whoever can derive the most value for their consumers. So if you are able to create a large dataset, you have some leverage there. If you're able to drive insight from that data set and share it with. Your consumers, then more people are going to come because they're going to want your insights.

They're going to want to learn from what their peers are learning from the device that they think it's really cool from an AI perspective. You know, if you start with a large dataset or you have some sort of relationship or value that you can give someone else for them to share data with you. Then you can get other people to perhaps share anonymized data with you.

Another thing that is extremely interesting is the use of blockchain based technologies to share data. You know, one of the challenges is that for HIPAA reasons or because you don't want to give away your data for free to someone else, you don't share it. And there are ways on the blockchain to be able to aggregate databases.

Without a centralizing institution so that every participating party can contribute data, but can also use other people's vietnamized data without actually owning it and taking it over so that you can train some of these models in broader data sets. But at the same time still be able to own your own data without, you know, openly sharing it or sending it outside your servers.

So those are some approaches that might be able to give us the heterogeneous data sets that we need. But again, to your original point, you know, not all columns are going to align. All rows are going to be the same, not all clean it's code in the same way, or feel the fields in the same way. So it still takes a lot of data clinic and that is incredibly time intensive and manual process that we will have to overcome before we can drive. What I think are the most valuable insights. 

Griffin Jones: [00:17:07] Well, there's a rabbit hole question, but it's too tangential that maybe we can get to it. It's about actually aggregating and making that data uniform, but that lack of uniformity might be the reason why.

EMR's aren't the direct answer to that last question who has the most leverage? Because I know as you're talking, I'm thinking, well, isn't the answer. The EMR's because they have the most information, but there are so many ways to query so much different information store, different information EMR. Is that the reason why they might not have the most leverage right now?

Because. Yeah, they've got a lot of data, but it lives in a lot of different places and looks like a number of different fields.

Eduardo Hariton: [00:17:55] I guess the question is that depends the EMR and what their user agreements are and who owns that data. Because just because I use EMR, X doesn't mean that EMR X can just pull up my patient data and then aggregate it and use it for profit.

You know, some agreements might be like that, but some agreements, the data's owned by the individual user. And yes, it's nice that everybody uses the same one. And perhaps there is something there where the EMR says, I'm going to build a product based on all of you guys as data clinic, a, B, C, and D. And then I'm going to give it to you for free because your data helped me build it.

And I'm going to sell it to other places or I'm going to. Use it as a reason for new clinics would be then participate in the original content creation to come into our network of EMR clinics. That being said, it really depends on how that data is shared and organized. And I don't think, at least to my understanding that EMR companies can just pull them profit from their clinics data.

Griffin Jones: [00:19:01] Would we advise Inside Reproductive Health listeners to check those service agreements upon signing to see who owns the data? 

Eduardo Hariton: [00:19:12] I think that, you know, in the 21st century, what we do with data and the insights that we drive for them are going to be hugely valuable, not only for clinics, but for our ability to make better decisions.

So. Yes. You know, my guess is most people do. But if you haven't looked at who owns the data that you're creating in your clinic, certainly something worth looking into and making sure that, you know, who's using your data on who's allowed to use your data. 

Griffin Jones: [00:19:44] So is that's true for almost any service agreement tha t not just CMRs, but should people be looking at that for the genetics companies with carrier screening companies with. The pharmaceutical companies they buy from, or I guess anyone that would have their data. 

Eduardo Hariton: [00:20:03] Yeah. And we didn't say we know with Fertility Bridge also. I bet you people should look at their agreements and see who owns what data and your ability to use it too. I think anytime you enter into some agreement where there will be data sharing, You know, people define very clearly, like who owns that relationship, who owns the IP that comes out of, you know, any insights from this data.

And that should be very clear upfront and something that people should be paying attention because in many of these cases, I expect that some of these companies and some of these algorithms will be quite valuable. And you want to make sure that if you are contributing to an algorithm or you're contributing data, you get to be part of their rewards and fruits of that data know most importantly, I think we're all in it to help patients, but your ability to help patients will also be.

Better and increased if you have the financial means to do well. 

Griffin Jones: [00:21:08] What if the service agreement doesn't say anything right now, fertility bridge agreements. Don't say anything about data with regard to centers and we get some, one of the things that we do whenever possible is. We do have people agree to not give us protected health information.

And so from a marketing lens, we only get any kind of patient information after the patient signs, a HIPAA authorization in which case is no longer Phi. So we don't have any of that kind of information. We do get numbers on we, we do track volumes and because we want to know if we're driving IVF volumes or egg freezes or recruiting the donors that we're supposed to be recruiting a new patient volumes. So we do have that sort of stuff. It all lives pretty archaically right now in spreadsheets. So it's not like we have a machine to go out and monetize, but how would that look? Like? What would that, what does it look like when there's no agreement?

Eduardo Hariton: [00:22:12] That one that I'm going to defer to my lawyer friends. Cause I actually don't know the answer and one pretend to know, but you know, my only advice is, you know, get a good lawyer and make sure you understand what you're signing, which is probably good in life. 

Griffin Jones: [00:22:27] Yeah. Well, in the meantime, we, I don't, we don't have so much data to, to really worry about, but I think ultimately even client services firms like mine will have to get into.

The data game to some degree. And I think it's a lot like how software has been the last 20 years, where in the beginning, there were a lot of people creating proprietary softwares and some of them really needed it. And very often a lot of people found that they were much better off just using an off the shelf software or some SAS company that already existed and applying it to.

Either clients or themselves. And so I don't see us as builders, but I do see us. I see even client services firm like mine, having to just review the insights that come from data. When we put together averages right now, they're pretty rudimentary. It's not the same accuracy that one would have if they were all aggregated so 

other than you making people scared to do business with fertility bridge when we're like number 190 seventh on the 197,000 down the list of people that are actually trying to get data who is trying to get the data. You don't have to say particular companies, but in the direction of, who's really trying to both aggregate and ultimately monetize, data from patients in clinics? 

Eduardo Hariton: [00:24:07] I think who's trying to get data from you is literally everybody who you touch online, Google, Facebook, Apple, literally every single interaction that you have is recorded and a, and studied and used to monetize and sell your stuff or understand you better or serve you better products so that you spend more time.

So, you know, You know, broader level, every interaction that you have in the digital world is. Studied and likely monetize to some degree. I think on the clinic level, you know, without mentioning companies, there are companies that are trying to aggregate data. There are academic institutions that are trying to create consortiums to aggregate data in order to drive these solutions.

Like I mentioned, I think they're still in the early stages. I think the data sets that are being built are on the smaller side. They're usually single center or a few small centers and the projects that are coming out are more on the proof of concept side. So there are people trying to show. Yes, we can predict pretty well how people are going to do, or yes, we can, you know, help make better decisions in the stimulation process in order to.

You know, make outcomes better or, you know, remove physicians from part of the process or at system at the list to make better decisions or in the lab, we can help embryologist create embryos or pick embryos so that we get patients pregnant faster. So we're seeing some of these projects happening, fertility and sterility is seeing more and more publications regarding AI and just had a whole, you know, aim monthly.

Journal dedicated to AI in reproductive medicine. So I think we're at the early stage. I do think that over the next five to 10 years, we're going to see a lot larger databases and perhaps more heterogeneous databases come out and. Prospective projects where you not only build an algorithm, but actually test it and compare it to physicians or make a prediction and then see what happens after.

And that will help validate this concept. And perhaps some of those will come to market and become widely adopted. But I don't know if it's going to be six months or six years. You know, we are terribly bad at predicting timelines, but I do think that in my life then as an REI, the decisions that I'm going to be actively involved with in a day to day basis are going to be incredibly different than some of the decisions that the people who trained me were involved that their beginning of their careers.

Griffin Jones: [00:26:51] I would be a bad fertility doctor because I only want to take on the cases that I know are going to be successful. I only want people to say these sorts of things about me and my company, like Greg in Chicago, 

"Our resources are not endless. And I think that with fertility bridge there's a much deeper dive."

or Dr. Young in Iowa, 

Narrator: [00:27:14] "I've gotten more positive feedback from patients from anything in the last 30 years of practice" 

or Brad in Seattle, 

"You have multiple experts on your team and for, you know, a very small price to get that level of  consulting for just a couple hours" 

Griffin Jones: [00:27:33] Would be really valuable.

Okay, you get the idea. So this is how we set you up. So you are 100% guaranteed to be successful in your goal over time. It's not a magic wand until you do this, do not pass. Go do not collect $200 indefinitely. Do not get in any long-term commitments or launch initiatives, you sign up for the goal and competitive diagnostic at fertilitybridge.com.

You fill out your business needs profile. We establish your benchmarks and desired outcomes. Then we meet for our 90 minute consult. We provide you with business Intel revenue estimates, and a competitive overview of the field to facilitate the prioritization of your goals between your partners and leadership team.

Then we have a 30 minute up. We tell you exactly what you need to audit and strategize to build your plan. I'll also give you one big marketing idea that will make you say, damn, that's good. If we failed to do any of these things, we give you your money back because it's only five 97. And because I need you to be successful because I need you to say all those really sweet things about me and my company.

Maybe even a gem like this one from Holly and Dr. Hutchison from Arizona. 

Narrator: [00:28:41] "I have, we didn't have fertility bridge, honestly. I think we would be getting close to retiring."

Griffin Jones: [00:28:47] There's no long-term commitment whatsoever and there's a hundred percent money back guarantee. Send your manager to fertility bridge.com, have them sign up for the golden competitive diagnostic.

And I will see you and your partners on zoom. 

Well question in terms of what the timeline will be like in our inability to predict it. I see the same trajectory happening with broadband and voiceover internet protocol voip, where it sucked for years for fricking year in 1999, we're like this, everybody's going to have broadband.

We're going to be able to download movies in a second. And we're going to be able to have conversations like we're having on zoom right tomorrow. And then 2005 came, it still sucked. And then 2010 came and it still sucked. And all of a sudden, I don't know if it was. 2017, but all of a sudden it was like, Oh, we've all we all have.

Perfect voice over internet protocol right now. And good timing too, with a global pandemic happening in March of 2020. But it was like, where is it? Why isn't it here yet? We've been talking about it forever. And then all of a sudden it was just here and that's not a very scientific way to, to anticipate the advent or growth of.

Of artificial intelligence we're past the admin, but I do think that that's, what's going to happen. 

Eduardo Hariton: [00:30:15] Yeah. I mean, I don't disagree. I think bill Gates is the one who said that we always overestimate what's going to happen in the next two years, but then underestimate what's going to happen in the next 10 because technology does not

kind of advancing a monotonic linear way. It advances in an exponential way, the cost of technology goes down in an exponential way. So, you know, I agree. I don't know if it's going to be two or 10, but I do really think it's coming on and I'm excited to see the impact that we can have on patient outcomes by using some of these very powerful tools.

Griffin Jones: [00:30:51] We also don't know what. The catalystic events will be to speed it up. And so the example, I knew that we were moving to a virtual. Dominant workforce. It's why in 2014, I started my company. We've been virtual from the beginning. All of my employees live elsewhere in the United States and Canada, as well as do our clients have never had a physical home office other than the office in my home.

And I knew because I knew that's what, the direction that we're going to. And in 2014, it felt like. Starting a digital agency in 1999. Like it was too late to do the brick and mortar type of route, but it was still like early and it was kind of awkward. And I remember our clients in the earliest years, some of them would be like, Oh, she's in Denver and you're in Buffalo.

And your project managers in Tennessee. And. They're your account managers in Florida and people didn't totally get their heads around it. I knew that it was moving to that. I just didn't think that there was going to be a global pandemic that made it the status quo. And so what do you think are potential catalystic events?

And I understand that I'm making you speculate and putting you on the spot to do it, but that would. Accelerate the adoption of artificial intelligence in healthcare fertility, specifically. 

Eduardo Hariton: [00:32:26] Yeah, well, unlike you, I also didn't predict COVID and did not invest in soon a year ago. Wish I had, but you know, I can tell you about some trends that I think are definitely going to keep pushing us towards adoption of some of these tools, you know, partly because they improve outcomes, but also because they will improve.

Efficiency and lower costs. I think when you look at the IVF market in the United States, we don't have enough capacity to handle the volume that we need to handle. David Sable gave a very good talk at ASM a couple of years ago. And he said, we're doing somewhere between two 80 300,000 cycles. And when he sizes up the potential market for IVF, based on the infertility cases, we have the, you know, genetic disease prevention, opportunity, egg freezing trends on how fast that growing.

We can easily do up to a million cycles a year. You compare us to places like Israel, where they're doing like, you know,  a cycle for every 200 to 150 people, Japan, which is somewhere around 300 Europe, which is under a thousand. We do a cycle per 1600 people. So we're very under-penetrated and we have an opportunity to grow our market.

There was a study by started in 2016 that showed that on average physicians, REI is lead about 130 cycles a year. Some people do none some people do a thousand and you know, I want to meet those people because I'm interested to see what they do. But with about 1300  we need to do around 800 to 900 cycles per person, per REI, to meet that demand of like one to 1.1 million cycles.

Anybody who you ask right now that works, their tail off is doing. 300, 400, you know, 200 is a lot. So we are not designed to accommodate this kind of demand. Yes, we could work nights and weekends and nonstop for 24 hours

Griffin Jones: [00:34:31] And have 15 IVF coordinators and never do an ultrasound. 

Eduardo Hariton: [00:34:35] And. You know, but that's a challenge, right?

We need to get more efficient than, yes, we can. We can stop monitoring. We can stop doing, you know, procedures. We can stop doing everything. You still don't have enough hours in the day, you're still going to hit a wall. So the reality is how do we number one become more efficient. So what are some aspects of this process that can be automated?

From our prediction to our stimulation, to our embryology lab in order to make this process more efficient. And that will give the REI opportunities to spend more time with patients. Because I think one thing that does not get talked about enough is that. People are still human. Even if you're taking care of 600 cycles a year, those people want to see your face.

They want to hear from you. They want to call from you. If they're pregnant, if they're not pregnant. And we really have to think very carefully as we redesign the way we take care of patients to not lose that human touch? I think it's important for the patients, but it's also important for the area.

You know, we came to medicine because we like thinking we like being challenged and we like learning. And if you take all the fun out of it, because it gets automated, you're gonna lose REI's as well, because it's not going to be what they signed up for. So it's really important to keep that in mind as we do this.

I think the go ahead. Well, let me finish this. I think the other aspect where this is important is. Part of the reason we're under-penetrated is because IVF is really expensive. Access to care is a real issue. And, you know, art still something where high socioeconomic. Status patients have a much differential aspect and it's not something that's accessible to the lower classes.

And I think that's a real problem by applying some of these technologies by removing some of the human component, which is exceedingly expensive and contributes a big amount to the cost. We will be able to lower the cost of. Not only an IVF cycle, but of the ultimate goal, which is reaching a pregnancy.

Cause our cycles will be a little cheaper and they will be a little better. And hopefully we will get to offer the amazing, you know, the amazing opportunity to start families that we offer some of our patients to everybody who wants to have a cycle or get fertility treatments. 

Griffin Jones: [00:37:04] You think that the price of cycles is going to go down?

Eduardo Hariton: [00:37:08] I think that as we incorporate technology, I can remove some of the costly elements that we have now. Yes. I think it will go down. I think there's also increased amount of payers coming in and that's going to put downward pressure on the price that gets paid for cycles. So that's another aspect, unrelated to the AI that will.

you know, will push prices down, but you know, if you want to compete and your payers are pushing what they want to pay you for a cycle down, I way to maintain your margins is to become more efficient than AI is a way that you can do that.  

Griffin Jones: [00:37:44] So it does push the price down because of what they reimbursed. But they're also bringing so many more people.

If we look at markets where that are really. Progeny heavy and maybe it's character kind by now, but it's employer benefits. When we look at those markets that have a lot of those companies, they're so fricking busy, right? I mean, you live in the Bay, so you know how busy they are and it's not just, Oh, we're busy on the clinic side, but maybe we're not converting enough people to treatment.

There's met mashed in the lab too. And so I don't see prices going down. And what, where are, where's the precedent for that in healthcare of prices going down 

Eduardo Hariton: [00:38:29] It's market power. I mean, you see it in places where there is a. You know, someone that controls a large share of the population, they can say, you know, I don't want to pay you, you know, $15,000 a cycle.

I want to pay you $13,000 as cycle. And if I represent 40% of your cycles, you can't lose me. So you will take 13,000

Griffin Jones: [00:38:52]  that's the thing they might be. They might be able to lose it because people are getting so busy and as more employers start to offer coverage and more States mandate. Then now it's not just a progeny game.

Now it's United and Aetna getting back in because insurance and who has well, we're losing all of these employers. And so we're not getting a cut of any of this. So they start to get back in whether it's Cared or Kind Body, eventually that. Particular profile becomes a two horse race. And then if you're in a big enough market of busy enough market, you could say, okay, well, these, this group has Facebook, Amazon, Google.

This group has McDonald's LinkedIn and general motors. And this group reimburses 10% higher than the other group. Yeah, we can lose the other group. I don't think that's out of the realm of possibilities. 

Eduardo Hariton: [00:39:47] Yeah. I mean, there might be some centers that feel comfortable losing a payer because they don't want to do it.

And you know, that's the art of negotiation. You have to know when to walk away, you have to know when your what's your BATNA or your best next alternative and walk away. But my guess is that as these negotiations play out and as these players start covering more and more cycles, they are going to start reimbursing less, or they're going to start reimbursing for value.

Or it generally is going to drive what they are willing to reimburse down. You know, some clinics might walk away. Some might take the lower reimbursement, hopefully no one's losing money on a cycle, but ultimately the way to create value here is to lower your cost of the cycle, because it's good for you.

It's good for your payer. It's good for your patients. And. And that technology is incredibly scalable. So that's something that will be helpful. I think another part that I didn't touch on where I, you know, AI or machine learning can be helpful is, you know, you might be familiar with this Griffin.

There is an incredible amount of heterogeneity in the way that we practice. There are some standards of care that we follow, but if you go. To my clinic and the clinic next door, and then the cleaning next door to that, we do things three different ways. No one way is better than the other. And we don't know for sure because otherwise we would all do it the same way.

And then within the clinic, Dr. A likes to look at things one way and Dr. B likes to do things another way. So then the lab has to be always on their toes, figuring out which doctor is said, do they want to transfer this day or that day? What kind of, you know, Extra concoction they want on their media. And at the end of the day, that heterogeneity and lack of standardization is incredibly expensive for the labs.

If we apply big data approaches, and if we use AI to standardize, what is the best approach for a given patient or a given clinic, or maybe we realize that it doesn't really matter. We should just pick one so that the lab knows that when those eggs are coming, they're going to be processed in the same way all the time, you know, on, you know, nothing's going to be a hundred percent.

There's always going to be patients that don't fit the mold. So I don't mean to say that AI is going to be a hundred percent better for everybody. We still need our brains. And we still are going to have patients that have receptor mutations or don't respond like we expect. And we're going to have to think them through that's the art of medicine and where.

Our education and all the years we've put in will really matter, but we're going to find that a lot of things we can standardize and that can also lower variability and reduce costs and take that out of the system. 

Griffin Jones: [00:42:34] So is AI going to be the hammer of Thor that finally breaks down? At least some of that heterogeneity in that isn't every other REI in EDS, except for the one.

That the given context at any moment, except for maybe their partners or someone else. But it seems to me like everyone I talked to, Eduard, it's pretty amazing, everyone has the best success rates in the country. It's pretty incredible how they're all number one. And they their competitors are idiots that don't know what they're doing.

And I'm. Hyperbolizing a little, but this isn't something that I hear rarely. And so it's also been one of the main challenges in the consolidation that's happened on the private equity side. You have. Standardization and people don't necessarily want to follow them. And there are some groups that could be selling to private equity and haven't and it's because they want to have that say so that, I guess there's a marketplace of ideas happening within that heterogeneity.

How does AI break the tie? 

Eduardo Hariton: [00:43:44] Because physicians are committed to giving their patients the best outcomes they know how to give, and they don't want someone else coming and telling them. I know you do it this way, but I want you to do it that way because that's how, you know, the clinic that we acquire in X city does it.

That's not what physicians are going to respond to. They're going to respond to data. They're going to respond to well

Griffin Jones: [00:44:10] . Why isn't the data from the clinic that we acquired in X city sufficient right now. And what's so much more compelling about the data that comes from AI. 

Eduardo Hariton: [00:44:20] Because it's going to be much bigger and larger scale.

Like if you come and you tell me Griffin, like, Hey. You know, this clinic in another city does this way and they have 3% better outcomes or 10% better outcomes. I'm going to say, well, look at that patient population. They're three years younger. Their BMI is a little bit lower. It doesn't really apply to me.

I, you know, I can just change my whole protocol based on what someone else does, but when you have, you know, a group that has data from 15 clinics and you aggregate all the data and you say, Hey protocol, you know, doesn't matter beyond these two or the starting, those should be this within this parameters or.

This is how we should, you know, do XYZ in the lab and it's working well across the system and it's clearly superior. You know, we're all competitive. We want the best for our patients. And we want respond to a suggestion or we won't respond to an example, but we do respond to data. We read the journals and we try to understand.

How do we change our practice in order to provide the best outcomes to patients? We do that every month and every week and every day we continue to incorporate data. And I think what AI is going to do is that it's going to give us data that is a lot more convincing and powerful because it's a heterogeneous.

So from a lot of places, very large and very robust. Another interesting thing that I think will happen is as a field, we have accepted a lot of Adam's therapies. So new medications that make it to market or new therapies or injections, because we want our patients to do better. Sometimes what happens is that these medications make it to market and become available to patients before they're truly studied.

So before you have a randomized controlled trial that can show benefit, what happens then is that it's very hard to do a randomized controlled trial to show benefit when people can go to the clinic next door and get that treatment anyways, because they don't want to get, you know, the sugar pill or the saline shot.

They want to get the medicine they're spending 15, $20,000 and their time to get pregnant is now. So. Doing those studies is quite hard right now when things already made it to market. I think by aggregating data from a lot of places from cycles that look the same, other than the fact that one of them use, you know, growth hormone or some other additive medicine and recognizing, Hey.

This medication really works, but it only works in this subset of patients or there is no patient where these medications showed a difference. We're going to be able to figure out what actually works and hopefully stop using the words that do not. 

Griffin Jones: [00:47:08] I want to go back to the human touch part because I've been, it's been cycling around my head because we are at this bottleneck challenge where there's what 11 or 1200 of you in the entire country.

And you talk where maybe we're doing 300,000 cycles. We can be doing a million to me. A million seems like on the conservative side of the estimate if other variables were addressed. And so. You mentioned, well, people still want to see their doctor. The doctors still want to have that human interaction.

They don't want to just be behind a screen and managing dozens of case loads at a time without getting to know people. 

But we have a ways to go before we can meet the demand. There ultimately seems to me like even when we address so many of these other elements that can be, 

That can be taken care of with technology that will still have a very limited bandwidth for the attention of the REI for any given individual.

So what are the things, as you talked about having to be intentional about how AI comes into play and what we're automating versus what remains human interaction, what. Human interaction. Do we need to safeguard? And I know it's a general question, but try to be as specific as you can. 

Eduardo Hariton: [00:48:40] That is a hard question.

And it's something that I, as a believer of AI and as a believer of how fast this market's going to grow and how limited the amount of REI is  struggle with on. And I think about it. Day to day think about it in the shower. It's something that I think it's really important to keep top of mind. You know, when I think of some really efficient decisions, you know, you had Doctor Amy on the show, You know, a couple of months ago and she sees hundreds of cycles and has a huge case caseload.

And she goes out of their way to make sure that every patient feels like she's thinking about them all the time. And she has a process that she set up in order to do that. So thinking about that type of process, I think is important. I think understanding which are the interactions where physicians can add the most value to patients face-to-face and which ones can be.

Perhaps delegated, not to a computer, but to another human, to a wonderful nurse. Our nurses are the backbone of our industry. They interact with our patients more than anyone else. So helping build that group of nurses and mid-levels, that can still. Make them give them that human touch without perhaps extending the REI beyond the hours that they have available will be important.

And I think that one thing that we're going to see, you know, related or unrelated to AI is that eventually I think patients are going to segment themselves and figure out how much do they care about seeing the REI and how much are they willing to pay for that? I don't think that.  I think that some places, for example, have NPS that are managing fertility preservation cycles and doing those initial visits and for some patients that's okay for some complexity of case, et cetera.

Okay. So rethinking the system and understanding what is the value that we bring is important. And you ask for a specific example. One example that I always think about is. The only time in most places where a physician spends a whole hour with a patient is in the initial visit. That visit is where you take a history and you get information from the patient, but you don't have labs and you don't have testing and you don't have anything concrete to guide them.

You say, well, if the semen analysis is normal, we'll do this. If it's abnormal, we'll do that. If you're a vary service high, we'll do this. If it's low, will you that if your tubes are blocked, we'll do this. If they're not blocked, we'll do that. And then you spend an hour counseling them on generalities, and then you still need to come back and counsel them after the testing.

So why don't we switch that around? We get some information, do some testing and do the counseling two weeks later when the testing is long done two months later, or whenever it is, that is a much better use of physician time. Patients would appreciate it a lot more. And I think. Rethinking this kind of framework where you go from visit to testing, to treatment, to hopefully pregnancy and really white boarding it and rearranging how we spend our time with our patients so that they feel connected to us.

But we also are giving them. The most valuable time that we can give is something that I hope happens again. I don't know if it's going to be two or six or 20 years, but I think we're going to be pushed into doing that sometime in the near future. 

Griffin Jones: [00:52:09] Well, that's a good point that those operational changes though, are things that people can do now.

They don't need to wait for AI to come and they only help you as things start to become. Automated. So there's no reason to say, Oh, I'm just going to wait until something established comes down the pipeline, the way that people use software, the way that people manage their operational systems allows people to incorporate these technologies as they change.

And the example that you gave, I don't know that I have enough evidence. To make it our official point of view yet, but we might soon enough because what I'm seeing anecdotally, Eduardo, is that what you described where the initial consult is shorter, those groups, actually, those physician convert more people to treatment because in that initial comment, you make it a half hour.

For example, you just spent it telling them this is what we're going to do next and not go into the contingencies and the variables. The patient is able to digest that information better. I don't know that I have enough evidence to say that that's certain yet, but I'm starting to see more of that. And that's just one example of an operational change that can be made now and among other things that help AI to come in.

I want to, I was reflecting on your answer of why it's so hard to be specific about the human touch answer, what human touch still needs to be. Available my philosophy is that the patient needs to be cared for, but needs to feel cared for bottom line. It doesn't necessarily need to be the physician for something.

Ultimately, the patient decides what feeling cared for means and how much the physician needs to be a part of that. It isn't the physician that necessarily gets to this side. And I think it's important for. People debate well what can our team do to make the patient feel very cared for? But I think the things that we use either you and I could really quantify, have to do with the things that go above the expectation.

And when I first got into the field, I asked my clients if I could talk to some happy patients that just really understand what they liked about the process, what they didn't like. I remember one of our earliest clients. Someone talked to, they just adored his position because he walked her to her car and then there's, that has nothing to do with clinical outcomes.

It doesn't even have to do with how you make them feel cared for in the office. It just makes them feel cared for. And so I, as you mentioned that the struggle to think of something specific, that's why, because it's above the expectation as opposed to being within it. That I think. Feeling cared for.

Eduardo Hariton: [00:55:05] I think it's, that's a very good example. And you hit the nail on the head because it's not the same to every person, you know, so to someone feeling cared for is getting a call after each pregnancy tests for someone feeling cared for is getting their labs. As soon as they resolved for someone feeling cared for is seeing you.

For their monitoring ultrasounds, even though you have a sonographer, so you stopping by, or you're doing it yourself and every patient's different, you know, I always think about how can I capture in my initial visit? What are the things that matter to a patient so that I can go. Above and beyond for that given patient in the way that they want me to go above and beyond.

And so that I'm not calling the person that rather get a text and texting the person that rather get a call. And, you know, I go back to fertility IQ, ask patients in their questionnaires if they like to a blunt doctor or they like. A doctor with a soft touch and they ask questions like that, about what kind of physician or what kind of care do they want to get?

You know, I imagine that there are some questions you can ask a patient in your initial intake to build you some kind of profile so that you can make sure that. When you're going to call that patient, you talk to them in the way that they want to be talked to. You, share information in the way that they want information to be shared.

And that might not mean a lot to you because you're just trying to take care of them and your care won't change. But how your care is received will meaningfully change and your patients will I'm sure. Feel a lot more connected and a lot more satisfied, no matter what the outcome of their treatment is .

Griffin Jones: [00:56:48] That personalization is something we're getting.

A lot more in doing the patient acquisition journey with regard to physician profile, you don't even need to get that preference from the patient. You can share with them. We've got five doctors. Dr. C is not necessarily is is not the warm and fuzzy type of doctor. It's okay to say that Dr. C is very direct.

If you would like someone that has a, more of a social bedside manner. Choose from one of our other four doctors, people will choose Dr. C, they do it. And that's a bit tangential. I want to kind of conclude Eduardo, with when you see IVF prices going down, because he came on the show for the first time. I think two years ago.

It won't be the last time that you're on the show. And I want to know when I can tell you that I was right. And you were wrong. So, and 

And when prices don't go down, when do you think that the price, how long is it going to take for the price of an IVF cycle to decrease? Because I say it's not happening in the next five years.

Eduardo Hariton: [00:57:58] Well, I will say this. I don't know when it's going to decrease in absolute dollars or what that's going to look like. I think there's like inflationary pressures that will distort that equation. But I think that in 10 years from now, if you have me on the show again, I think the average American's ability to access an IVF cycle will go down.

You know, if, even if there's no universal healthcare, the ability of an average American to cash pay and IVF cycle will go down and it might not be an IVF cycle with the top doctor, the top clinic, because that might still be concierge lag, but their ability to go through an ovarian stimulation and egg retrieval, and basically go through IVF will be more accessible.

To the average American who does not have coverage. And yeah, you know, you can remind me of this. We can see what happens, but I think that generally the increase access and all of this technology will drive the cost of a cycle down, you know, for the people listening to this and worried that's gonna obliterate our margins.

I think we're going to have a lot more volume. So yes. Prices might go down and reimbursement might, you know, put some downward pressure, but like you mentioned, some of these players, I'm bringing an incredible amount of scale. So as long as we keep up and we're able to handle it by incorporating some of these technologies and becoming more efficient, we will be just fine.

And more importantly, more patients who desperately need access to our services will have access to them. I certainly hope so. 

Griffin Jones: [00:59:43] I don't think it's happening in the next five years, but part of the reason is because I think that technology needs to happen before the, because the volume is rising too quickly right now.

And that technology needs to get ahead of that curve, you know, and like even being equal to it would take some time. And so I don't see it happening in the next five years. You said you've given yourself a comfortable time period of 10. I want to be right about this because I think in most things between you and I, you will end up being right, because you're one of the smartest guys that I know in this field.

And I do think that you're one of the rising stars in the field. It's a privilege to have you back on Inside Reproductive Health. 

Eduardo Hariton: [01:00:28] Thanks for coming back Eduardo.  Thanks for having me, my friend. Good to talk to you, Griffin, and look forward to seeing what happens in five or 10. Sounds good. Bye-bye 

Narrator: [01:00:39] You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action, to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society, visit fertility bridge.com to begin the first piece of the fertility marketing system, the goal and competitive diagnostic.

Thank you for listening to Inside Reproductive Health.

105 Organizing your Marketing Team for Success

Marketing is a huge part of a successful business, but marketing teams look different for every organization. Whether you have a marketing team, one marketing person, or no one solely thinking about marketing on a daily basis, we cover your business needs with resources to be successful. In this episode, Griffin breaks down the role of each marketing title, what targets they should be hitting, and what additional resources they need if any. You’ll be able to refer to this episode as a resource to understand the purpose of each marketing role, and more importantly set outcomes that they are being evaluated against.

Listen in to today’s episode to get the rundown on how to make your marketing department run more efficiently and effectively. 

4 Phases of Fertility Patient Marketing Journey: https://www.fertilitybridge.com/inside-reproductive-health/2017/10/17/fertilitymarketingfundamentals2018?rq=marketing%20journey 

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Transcript

Griffin Jones: So now the next time that you say I've got a marketing team, I've got marketing people, you can use this resource to define what that actually means. And more importantly, you can use it to set outcomes that they're being evaluated against. To see where they're at and also to give them the scope and the skills of resources, the scope of skills and resources needed to achieve them. 

[00:00:24] Narrator: Welcome to Inside Reproductive Health. The shop talk of the fertility field here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field wall street and Silicon Valley both want your patients, but there is a plan.

[00:00:43] If you're willing to take action, visit www.FertilityBridge.com to learn about the first piece of building a fertility marketing system, the goal and competitive diagnostic. Now here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.

[00:01:04] Griffin Jones: Should you fire your fertility marketing director? Whoa, let's find out first. Let's find out what they all do. That's what we're going to talk about on today's episode. So you've got yours truly, because we're going to go in depth on all the marketing roles before we get into the meat of the show.

[00:01:20] Today's shout out, goes to Alex Lagunov a lab director from Toronto and giving a shout out to anyone who worked at Hannam Fertility. At that time, Alex and friends took me out at a CFAs meeting when I didn't know anyone in the field. I think it was maybe my only my second or third meeting ever in the field.

[00:01:39] And that kindness is something I really remember fondly. So hopefully Alex hears this and I get a text or an email about it. Today's show, should I fire my fertility centers, marketing director. We're going to be talking a lot more than just about marketing director. We're going to talk about all of the positions and not just clinics too, because some of these positions are a lot more common in other parts of the fertility field.

[00:02:04] If your team isn't getting the results you want, it might be all of their fault, but it might not be, it might be all your fault. It might be nobody's fault. REI partners, IVF, execs want to step out of marketing responsibilities for good reason. It falls below the top chief executive seat, and you have a lot of number of seeds to occupy, but you can only fully walk away.

[00:02:28] When someone else is completely in charge of the outcomes, if you walk away, but the person that you're delegating to, isn't responsible for those outcomes or doesn't have the authority or resources to do it, then there's a mismatch and you still have that responsibility in your lap, even though you're paying somebody to do it.

[00:02:46] The outcome is what matters. When outcomes go unreached. Even when they are clearly defined, it might be because the staff is incompetent, but it's more likely that. Expectations are set without any real understanding of the experience, authority, skillset, and breadth that goes in to ensure that success.

[00:03:09] So I want to detail it for you across these positions today, before you go firing or hiring anybody, understand these roles, and then I'm going to give you the outcomes for each of them. It's physician liaison, starting on one end marketing coordinator, marketing manager, director of marketing, vice president of sales and marketing.

[00:03:29] And then chief marketing officer, sometimes people go by chief revenue officer, but far more important than the person's title is what they are actually responsible for. Sometimes there's big mismatches in our field. So just because you say, Oh, I've got this title doesn't mean that's the person they might be under titled underpaid or vice versa.

[00:03:55] You may have heard me say this saying before that marketers are North Korean officials and practice owners and executives,

[00:04:08] you may have heard me say this before.

[00:04:14] You may have heard me say this before marketers are North Korean officials, practice owners and execs are Kim Jong-un that can be replaced for any marketer and any business owner and client. But what I mean by that is it's a vicious cycle where one person is saying, I'll tell you whatever you want, just please don't kill me.

[00:04:33] The markers values often because of this ambiguity or the mismatch is so intensely questioned that they'll often say anything to keep you from terminating them. And that's a negative feedback loop because you're so skeptical of the value of marketing. If that's you, that those in your employ again, if that's, you frequently feel compelled to exaggerate the results or make promises that they can't keep, it happens all the time.

[00:05:01] And that's fortified because marketers. Very often feel threatened by one another and for good reason, because in their attempt to justify their livelihoods, they're notorious for throwing each other under the bus. If you hire a marketer, whether it's an agency or an in-house person, and you have them critique here your current marketer they're very often going to throw them under the bus, even sometimes a very authentic experts do that. And you ain't going to get that from me because I don't want to live in Pyongyang. The people that are so eager to put somebody else under the bus and put somebody else's head on the chopping block, don't realize that it's their head that they're rushing to put on the chopping block in replacement.

[00:05:45] They don't take the time to end the vicious cycle, frankly, because it's often not in their interest for doing so. It's the big hefty promises that they make that get them the opportunity. So calibrating expectations doesn't really serve them. They are often punished for doing the right thing. That's why we do it upfront.

[00:06:05] So we're going to talk about defining outcome and equipping for success. Many of you say that you have a marketing person or marketing people, and very often don't know what that means. Say it, in those terms, marketing person, marketing people that could mean any number of different things. That's why we're going to go through this range today.

[00:06:23] This ambiguity is the source of a lot of frustration, because they're are essentially paying someone to increase your top line. I know that's usually what you have in mind. If that's what you're hiring someone for, but that doesn't mean that they're in a position to do if your marketing people don't have hard figures to put in the outcomes, I'm going to give you XYZ fields.

[00:06:46] If you don't have actual numbers to put in those, then you don't have outcomes for them. They need to be the first section of the job description and they need to be the exact metrics for which you're interviewing on and which you're evaluating their performance on. Sometimes marketers don't want practice owners or the execs of fertility companies to do our goal diagnostic.

[00:07:12] Why would they feel threatened by such a small engagement that has no duplication that has no commitment it's just a small evaluation from our firm. The only one that sub specializes in the field.  When that happens, it's often because they're afraid that we're going to come in and tell their bosses everything that they're doing wrong.

[00:07:35] And that's usually not actually the case. If your marketers are totally inept, we promise to tell you that, but more often than not, we're going to show you where they're under resourced and where they're being held accountable for things that they don't control. Frankly, because you are their only source of income.

[00:07:55] If they piss you off, they lose their job. We have many clients and we don't need any particular new ones. So we're in a much better position to challenge you than they are more likely at play is a lack of defined outcomes, a mismatch in position and/or a lack of resources and authority could be any one of the three or a combination of the three pay attention to the responsibilities and outcomes.

[00:08:23] Because again, misalignment is so rampant, we're going to start our overview today with the most junior end of the spectrum, which sometimes even the smallest practices don't even have. And then we're going to work our way up to the largest level. Which only the biggest companies in the field have. Let's start with physician liaison.

[00:08:48] This post often falls at the junior end of the spectrum because a lot of them are just walking billboards. They don't really impact referrals. They drop off donuts and bagels and pamphlets, and they don't really. Impact your business, the best ones, however, are worth their weight in platinum. They're not junior.

[00:09:09] They know the exact things that they need to do. They know the exact things that they need to differentiate your clinic and to actually be the liaison of the relationship. Let's take that word literally. It's your relationship as a provider, as a physician, that they are the custodian of and. The people that are really good at it, disrupt referral patterns from competing practices that maybe sometimes people have been referring to a long time because they give them a reason to change those referral patterns.

[00:09:44] They build new ones, they grow them and then they're handsomely appreciated and compensated because they are so darn good. Their mission statement. I'm gonna give you a mission statement for each of them, increase referrals from OBGYN, PCPs, and other specialists by building and growing and nurturing relationships.

[00:10:05] It is not reasonable to expect from them increases from other referral sources, responsibility for revenue or profit, a creative expertise that digital expertise. These people are just the physician liaisons. Now here's the outcomes grow MD referrals from Y to Z. You have to have a Y you have to have a Z grow referral.

[00:10:28] So from X target accounts, that's both a number and very specific 10 to 20 target accounts that you said, we want more referrals from these people. And so that X needs to be. Identified and the Y to Z need to be enumerated.  They also grow referrals from employers and insurance and benefits providers groups because that's such a big part of our field now. So you want to have Y to Z for that growing part for the companies that use progeny and carrot and others.

[00:11:07] Create X referring provider materials. That's a little bit more of an input than an output, but I, I put it on there established reporting system to account for all referrals by office, physician, and month. The way that your people report to you, that your PLS report to you is critical. The resources they need to be successful in their job.

[00:11:27] Is accurate reporting, accurate. Multi-source not single source, new patient referral sourcing, multimedia referring provider materials, not just pamphlets. They need to have a number of different resources that they can engage people with physician participation, your that's, your participation. They need training on your clinic.

[00:11:47] A CRM or reporting system. And then if they do have a CRM and they need CRM training, we're still on the junior end of the spectrum. And now PL can sometimes be like a thing of its own because it's physician liaison, you have more junior PL's, you have more senior PL's. Now we're really going into marketer, not just physician liaison, starting at the junior end of the spectrum is marketing coordinator.

[00:12:12] This is a very catch all term and probably for a good reason, because even when it goes by one of the other titles, this range of responsibilities is very common for fertility clinics to have in-house it, isn't realistic to expect someone at this level to be responsible for revenue sales. Procedure volumes or even leads.

[00:12:33] That's a problem because very often, if you're thinking I've got a marketing person and you have someone at this level, you are thinking I'm hiring a marketer because I want them to increase the top line. That's not really what this person does. Their marketing coordinator as with most junior positions.

[00:12:52] Outcomes are seldom assigned to junior positions because they're so task oriented, but even the most junior marketers ones that don't have any control over revenue or profit, they should at least have defined outcomes that way, if they're hitting them and if they are hitting them and they're hitting them well, they may be worthy of higher outcomes and a higher position, higher pay, et cetera.

[00:13:16] When you're making their outcomes, resist the temptation to put their inputs as those outcomes, the number of pamphlets designed social media posts, articles, events, those are all inputs. And I may have made one. Exception, but I'm going to give you those outcomes. The mission first is to execute some aspects of the marketing strategy and coordinate the rest with the other parties involved.

[00:13:43] That's what a marketing coordinator is. They coordinate, it's not reasonable to expect responsibility for new patient volumes ownership. The sales & MD referrals, not for them to do, to make the strategy or to have technical and creative expertise in all of the verticals, the outcomes that they should be responsible for.

[00:14:02] Our plan and build X informational events, increase attendance at informational events from Y to Z. That's a good outcome because it's not, micro-managing all the tasks that they need to do. It's Hey, we are doing these egg freezing events. These IVF events increase it, where it would be in 10 people per event increasing in the 20.

[00:14:21] We're doing 30. Increase them to 40 increase attendance at informational events from Y to Z. Increase patient testimonials from Y to Z increase social media engagement from Y to Z. If you have Y to Z for each of those individual outcomes, and even with a really junior position like that, you don't have to micromanage every task that they're doing.

[00:14:42] You delegate that outcome, and if they achieve the outcome then there's opportunity for advancement. And if they don't, you're probably looking somewhere else. The resources that they need to be successful in. This are. Participation from providers and leadership in events and content. If you have them coordinating content, you're the star of the show.

[00:15:06] And so if the provider, the partners aren't involved, the content that they create is not going to have a big. It's not going to have a big result. They need a marketing strategy. They need someone else to give them the plan and say, do this. They need a brand guide. They need technical assistance on some different things.

[00:15:27] Whether it's web development, paid media cinematography, because one person can't do all of those things. They need an events budget, and then they need training on social media. The marketing coordinator is mostly responsible for columns in the first phase of the fertility patient marketing journey.

[00:15:45] And if you want to go back and check what that is, that article, that page is on fertility bridge.com and we'll link to that as well as the episode where we talk about the four phases of the fertility patient marketing journey in the show notes. Marketing manager comes after marketing coordinator and before marketing director.

[00:16:06] So I'm not going to outline the mission or the outcomes here because it's very often just a hedge Sometimes at pharma companies that actually is legitimate position because they do have that marketing hierarchy very often, it's just someone that is under titled as a marketing director over titled as a marketing coordinator.

[00:16:26] So I'm going to talk about. Director of marketing in more detail, because that's enough different from marketing coordinator and marketing manager, the director of marketing or your marketing director. And I don't think there's any difference between those two director of or marketing director. Maybe one gets paid a little bit more.

[00:16:44] Maybe if they look on Glassdoor, one version of spelling gets paid more. So that's why they asked to be titled that way. But it's the same thing. The person oversees the execution of the marketing strategy. So they are the ones that make sure that it gets carried out at this level. They can be responsible for new patient numbers and they should be or if they're on the business side sales qualified leads, they.

[00:17:12] Can contribute to the strategy very often, very meaningfully, but they shouldn't be expected to have all of the experience or skillsets needed to craft the strategy. And the same is true with brand. These people are excellent brand guardians. When you have a good person. But to have the creative design experience to build a brand, shouldn't be expected of this role.

[00:17:36] They should be responsible for bringing people in the door, but if you want them to actually be responsible for revenue, that's not this role. So we're still at the point where you're hiring someone in your thinking I want them to increase the top line. This person can't be expected to do it by themselves.

[00:17:55] Or again, this role you might have someone that's. In this title and more qualified to do that. But again, I'm talking about the role, not the person. So if you're a marketing director and you said, Hey, I do those things. I'm not that junior. It's, this is a mid level position. And I'm talking about the role, not about you.

[00:18:16] You might be better off in a more senior position, but if you are going to have that more senior responsibility over revenue, you need a greater level of authority. And cross-functionality for that. The mission of the marketing director is to increase new patient volumes or sales opportunities by directing the established marketing strategy.

[00:18:39] It's not reasonable to expect them to be responsible for revenue,  complete strategy, technical and creative expertise in every vertical. Their outcomes are to increase new patient inquiries from Y to Z increase qualified sales leads from Y to  Z. Increase new patients from Y to Z, increase X consults from Y to Z? 

[00:19:02] I would be a bad fertility doctor because I only want to take on the cases that I know are going to be successful. I only want people to say these sorts of things about me and my company, like Greg in Chicago, our resources are not endless. And I think that with fertility bridge there's a much deeper dive.

[00:19:23] Well, Dr. Young in Iowa, I've gotten more positive feedback from patients from anything in the last 30 years of practice where Brad in Seattle, you have multiple experts on your team and for, a very small price to get that level of, uh, consulting for just a couple of hours would be really valuable.

[00:19:48] Okay, you get the idea. So this is how we set you up. So you are 100% guaranteed to be successful in your goal over time. It's not a magic wand. Until you do this, do not pass. Go do not collect $200 and definitely do not get in any long-term commitments or launch initiatives. You sign up for the goal and competitive diagnostic at fertilitybridge.com.

[00:20:09] You fill out your business needs profile. We establish your benchmarks and desired outcomes. Then we meet for our 90 minute consult. We provide you with business Intel revenue estimates, and a competitive overview of the field to facilitate the prioritization of your goals between your partners and leadership team.

[00:20:27] Then we have a 30 minute follow up. We tell you exactly what you need to audit and strategize to build your plan. I'll also give you one big marketing idea that will make you say, damn, that's good. If we fail to do any of these things, we give you your money back because it's only five 97. And because I need you to be successful because I need you to say all those really sweet things about me and my company.

[00:20:50] Maybe you've been to a gym like this one from Holly and Dr. Hutchison from Arizona. I have, we didn't have Fertility Bridge. Honestly. I think we would be getting close to retiring. There is no long-term commitment whatsoever and there's a hundred percent money back guarantee. Send your manager to Fertility Bridge.com.

[00:21:09] Have them sign up for the golden competitive diagnostic. And I will see you and your partners on zoom. 

[00:21:16] The resources that a marketing director needs to be successful is positioning from the partners and executive leadership. They can't make the positioning, the marketing and business development strategy.

[00:21:28] Again, they can really contribute to it, but they will need help building up a brand guide. Budget proportional to new patient or sales goal. I have to have a realistic budget, an external agency to do the technical and creative areas. A CRM. If you're a sales organization, most clinics don't really need one access to scheduling system.

[00:21:50] And oversight of call center. That's where you start to get into the cross-functionality. But if you really want them to impact new patients, they have to have a say in how the call center does their jobs. They have to have a say in scheduling.

[00:22:05]We are now on the senior end of the spectrum. This person is sometimes called the president of marketing. Sometimes the vice-president sometimes senior vice president, but often it's vice president or senior vice president of sales and marketing because this title is not very common on the clinic side.

[00:22:25] It's not too common to see a VP of marketing. It's a lot more common to see it on the industry side. And have it be a vice-president of sales and marketing, where they're responsible for both. And this is when someone can be responsible for revenue, cross authority. Is very important here. They need to have control over all four phases of the fertility patient marketing journey, not just the first phase, which you often equate with marketing.

[00:22:55] This type of person can be responsible for outcomes of revenue,  But they do need that authority to contribute to customer service, clinical followup, front desk, call center, delivery training. They need those to be set up for success, their mission to increase the total revenue of the company by increasing the number of clients or patients and to craft and lead the strategy for sales and marketing.

[00:23:24] Don't expect them to set prices. Don't expect them to be responsible for. Profit or at least net profit and don't expect them to have technical and creative expertise in every vertical. Their outcomes are increasing new patients from Y to Z increasing total revenue from Y to Z increasing X revenue streams from Y to Z increase X sales from Y to Z increase X procedures from Y to Z and create, marketing strategy. You have to fill out X.

[00:23:50] You have to fill out why you have to fill out Z. If you don't, you haven't given this person actual outcomes for which they're accountable. And that should be in the job description and it should be what they're evaluated on every quarter however often you evaluate their performance. The resources that a vice president of marketing needs to be successful is a target for revenue, a bonus structure for revenue advice.

[00:24:16] They need advice. They need consulting. They need professionals on components of the strategy because one person can't be responsible for all of it. They need that cross functional authority. They need an external agency for those technical and creative areas like digital dev. Video, et cetera. And then they need either an agency or subordinates in-house to execute the strategy.

[00:24:39] They need a marketing coordinator below them, a marketing director below them, or they need to have, or they need to have an agency to do it.

[00:24:56]Now we're at the senior, most end of the spectrum of marketers in the fertility field. This is chief marketing officer. Sometimes they go by chief revenue officer. I don't know if I've ever seen the CRO position at a fertility company. It's not the superior of a CMO If it's the superior of a CMO, then it doesn't make sense because by virtue having the word.

[00:25:19] C in the title, a chief position, doesn't have more than two bosses at most one, the CEO to maybe the COO. If they have more bosses in that they're not actually a chief and this is a annoying miss titling that happens. Broadly in the fertility field broadly in business broadly in society. It's annoying.

[00:25:43] You're not a Chief if you have more than two bosses. So it's often to maybe elevate somebody that's in a VP or a sales position. But if it really is a chief, it does make sense for some of these companies to have this person. And so it really is a executive position. So I'm defending the position when it's warranted.

[00:26:07] If fertility companies are going to have somebody at the C-suite of this level of chief marketing or chief revenue officer, they have to have executive cross-functional authority. I don't just mean like an impact in scheduling. They need to be able to make decisions about those other parts of the business, because.

[00:26:28] As you move further down the fertility patient marketing journey. And that's just one journey. For example, sales is on the right end and that overlaps with ops a lot more than the earlier phases of marketing do. So where do you really make your money is in the conversion and that overlaps with ops. So your chief marketing officer has to have executive cross-functional authority.

[00:26:56] Because they're responsible for financial planning and profitability. They are peers with the CFO, their mission drive revenue and drive profit, build out positioning, set by the CEO and principles they can contribute to positioning. But remember only the principal of a company can actually set the positioning.

[00:27:14] You can't even delegate for this. I can't delegate for it as the owner of my company, nor can you, if you are the chief executive or the founding partners. Of your group, they commission the sales, marketing, and business development strategies. They are the ones that set all three of those do not expect of them to have technical and creative expertise in every vertical.

[00:27:37] They should be able to call on resources to have strategic counsel, whether it's consultants or anything, any other. Type of advisory that allows them to get that expertise, but you can't expect them to have expertise in every vertical. They've got the breadth. They don't have the depth in all of it.

[00:27:55] exp them to manage the strategy themselves. Don't expect them to execute the strategy themselves.

[00:28:01]The outcomes, the CMO or the CRO are responsible for are increasing revenue from Y to Z, increasing gross profit from Y to Z. They should have a profit goal increase profit on X services from Y to Z. Add X revenue stream. So CMO can actually add revenue streams. They create the BizDev budget. They create the.

[00:28:21] Marketing strategy, the sales strategy, they set those and they can actually set prices as well. The resources required to make them successful. A revenue, target revenue bonus. They need the financial statements. They need to be able to look at the P and L they need to have a profit target. They need to share in profit sharing is key for this position.

[00:28:45] I have cross-functional authority. They have an external agency that helps them with those tactics, like paid media development, cinematography. They have advisory on components of the strategy. They have a marketing director, they've got training for their marketing team, for their sales team. They have a CRM, especially if they are on the industry side, but even if they're on the clinic side, if you're big enough to have a chief marketing officer, you are big enough to have a CRM and should, and they have the authority to set prices.

[00:29:23]As we start to wrap up, I want you to be able to adjust these expectations because even the highest people still need some help. Now you'll notice a paradox, maybe that the more capable someone is of returning the investment, the greater the investment. And you have to be careful because the flip side of that isn't necessarily true.

[00:29:43] A large investment does not guarantee a return. When these expectations, when these outcomes aren't clearly defined in numbers, that person shouldn't be expected to achieve them either because of that or because of a mismatch in position or a lack of authority. And resources to give you an idea of how rare the people at the top end are.

[00:30:05] I looked for our account manager for 10 months. I source the heck out of LinkedIn. I cold emailed you. Probably. I talked to so many people that I knew asking for recommendations. I talked at some level like peripherally or not to 60 people or so, and. I was blown away by how few people knew about the business outcomes that they were going for.

[00:30:29] Not just the marketing activities, but the business outcomes that they're supposed to be driving for very few knew anything about revenue, profitability, or conversion. And that's not necessarily their fault because some of them were definitely incompetent. We'd never be paying them to have them on my payroll, but some of them were very talented and hardworking and could definitely.

[00:30:50] Rise to the occasion, but they didn't have those outcomes and the authority to actually pursue them. So the three or four that I did find that were really exceptional one I hired, but the others were, I couldn't sway them away because they were so well taken care of. So well-regarded because they are so valuable and they are so rare.

[00:31:12] And even when you do find that person, we have to talk about what, understand what it takes for them to do this. And even when you do find the right person you have to understand the scope of what's needed to successfully do their job, especially as things get more competitive as especially as you want them to have higher outcomes or more specific outcomes that the scope of sales, marketing business development is simply too vast for any one person to be expected to be able to do it all. I'll just give you a little example of a digital campaign, cause that's just one sliver of sales and marketing. A digital campaign is one little sliver for that one little sliver you need at least four people.

[00:31:53] You need somebody that can write to convert. You need somebody that can design. You need someone that is a master at analytics, so that they're optimizing it. And you need somebody that can shoot and edit great video. And I'm pushing it by putting that editor and shooter in one person's I'm taking, I'm pushing it.

[00:32:09] I'm trying to get five into four very often. You're trying to get all of it into one person. There are plenty of Jackson Jill's of all trades out there, but very few people are excellent at all of them. And before you tell me, you have a unicorn might want to think of that. Unicorn actually works for 80 grand a year.

[00:32:27] For a non-marketing company. And remember that's only one piece it's not realistic to expect one person. To have the breadth and the depth of all four phases of the patient journey and all of the different patient and customer journeys to put it in perspective for you. We've got 15 specialists on our bench for photo cinematography, conversion, copywriting development, graphic design, editing, animation, social media, marketing automation, SEO paid media, client operations, customer service, and.

[00:33:01] That's our bench. So for some companies, it makes sense to have one or two of those positions in house because their utilization rate is so high and you're using them for so much. Maybe you're using them from other things, but it almost never makes sense to have all of them in house. The cost is simply prohibitive and people often judge their marketers.

[00:33:25] Against us, for example why don't you do what fertility bridge does or why can't you do what Griffin and those guys do? And it's because we have a whole firm for this, you can't expect one person or an in-house team to possess both the breadth and the depth simultaneously just to manage. Those people that I told you about.

[00:33:45] I've got a full-time creative manager, a full-time project manager, full-time director of client success. Full-time ops manager, full-time digital strategist. These are all full-time W2's, but do nothing but their role, their sub-specialized role of marketing in our sub-specialty. And expecting one person or even a team of people on your team to have all of the depth and breadth just isn't realistic.

[00:34:12] It's not fair or reasonable to, to have that expectation of them. And even those that do have in-house agencies, even they need some strategic advice and some help from time to time. So now the next time that you say I've got a marketing team, I've got marketing people, you can use this resource to define what that actually means. And more importantly, you can use it to set outcomes that they're being evaluated against. To see where they're at and also to give them the scope and the skills of resources, the scope of skills and resources needed to achieve them.

[00:34:50] It's okay that your marketing people need help. If they're good, they can still return their value handsomely, even with the additional investment of training or strategy or help that you might be providing for them. You can hire internally for any of these roles or you can outsource any of them. It works both ways.

[00:35:11]Most fertility companies mix and match depending on their size and their goals for growth. You just have to make sure that the resources aligned with the correct outcomes, the correct position. If you have a full marketing team, they need training leadership strategy. If you have a chief marketer.

[00:35:28] They need strategic advice on very specific points of the marketing system. And they need people to implement them. If you have one person at the director level or lower, they need strategy and execution over those parts that they don't have technical or creative expertise.

[00:35:45]Maybe your team isn't capable of achieving the outcomes. Maybe they do need to be dismissed, but don't go firing your marketing personnel until you properly define those outcomes. Give them those necessary resources because if outcomes aren't explicit. Each party has left to fill in the blanks for themselves.

[00:36:02] That leads you to expecting more revenue, more IVF cycles or sales. And someone else thinks that their required outcome is just the task list that they have to do. And that's the source of a lot of frustration and should be borne out. And if you want our help with figuring that out.  You can get Fertility Bridge's help in selecting your marketing personnel, like where, when you're hiring for them, when you're designing their responsibilities and their outcomes, or giving them the support that they need to achieve that. And that starts with the goal and competitive diagnostic.

[00:36:35] There is no long-term commitment for that whatsoever. Four dozen fertility centers and a dozen other companies in the fertility field have done it. And you get that at fertilitybridge.com.

[00:36:48] I hope you enjoyed this episode. And that it gives you a deeper understanding of what's involved in marketing, what you can expect from your people and the breadth of responsibilities that are increasingly needed because we no longer live in a day and age where people spend half a percent of gross revenue on marketing.

[00:37:05] Now you've got. Wall street and private equity and venture capital and alternatives to coming into the clinic and tech companies that are going for leads. And in order to compete with that and actually achieve the business outcomes you want, but there is a spectrum of responsibilities and hopefully you can now identify that, make those outcomes for your people.

[00:37:28] Get them the resources that they need and hold them accountable so that, when they're working well or not. And if you need our help, just let us know. So I hope you enjoyed the episode.

[00:37:39] You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action, to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society, visit Fertility Bridge.com to begin the first piece of the fertility marketing system, the goal and competitive.

[00:37:58] diagnostic Thank you for listening to Inside Reproductive Health.

104 Attracting Gay Male Fertility Patients

Connecting with your target demographic is vital to running a successful business. However, in your target audience there are many subsets that each have their unique needs. One of those subsets is the LGBTQ community. The best way to get to know your customer is to talk with them, and to help you better understand the best way to serve this audience I sat down with Ron Poole-Dayan.

Ron is a marketing and business strategy expert. He is the executive director and founder of Men Having Babies. Along with Greg, his husband of 25 years, they are among the first same-sex couples in the nation to father children through gestational surrogacy. Their twins, born in 2001, were conceived with the use of eggs donated by Greg's sister, and carried by a gestational carrier.

Tune into this episode to hear us talk about: 

• How to market to the LGBTQ community

• Men Having Babies Conferences 

• How to make the LGBTQ community feel welcome 

• Why gay couples may consider fertility clinics vs surrogacy agencies

Resources:
GPAP (Gay Parenting Assistance Program): https://menhavingbabies.org/assistance/criteria/

More from Ron Poole-Dayan: 

LinkedIn: https://www.linkedin.com/in/ron-poole-dayan-9bb76/

Twitter: @MenHavingBabies

Facebook: https://fb.com/MenHavingBabies

Website URL: https://MenHavingBabies.org

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com.

Transcript

Ron Poole-Dayan: [00:00:00] 

You're not just putting a rainbow flag on you or side, but also. For a lot of us it's it is a, as I said, the act itself, the experience itself is something that they want to be positive, you know, for, I don't think that a lot of infertility patients think of this to be something that they want to put in a picture album later and go over. But we do

Narrator: [00:00:23] Welcome to inside reproductive health. The shop talk of the fertility field here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field wall street and Silicon Valley both want your patients, but there is a plan.

If you're willing to take action, visit fertility bridge.com to learn about the first piece of building a fertility marketing system, the goal and competitive diagnostic. Now here's the founder of fertility bridge and the host of Inside Reproductive Health, Griffin Jones .

Griffin Jones: [00:01:02] In today's episode  I talked to Ron Poole-Dayan, he's the founder of Men Having Babies.

You may have heard of that organization. They have events all over the world for prospective same-sex fathers. Many clinics, many agencies, many or groups want to compete for same-sex males in particular, as well as LGBTQ plus patients at large. So we talk about some strategies for that. Ron is a marketing and business strategy professional.

He founded men having babies. Out of a need that after he and his husband, Greg were among the first same-sex couples in the nation to father kids through surrogacy they're twins are more than 20 years old today are almost they conceive them with donated eggs from a relative, and they were carried by gestational carrier.

And Ron saw a need in the marketplace. That's a need that many people are competing for. Nowadays. So we talk about that as well as not just marketing strategies, but the buy-in required at the level of the principle to actually court this patient demographic and not just post a rainbow flag on one's website.

So I hope you enjoy today's episode with Ron Poole-Dayan.  Mr. Poole, Diane, Ron welcomed Inside Reproductive Health. 

Ron Poole-Dayan: [00:02:26] Thank you. Thank you very much for having me. 

Griffin Jones: [00:02:28] So one of the reasons why I wanted to have you on is because the LGBTQ+ patient demographic is really more than just one patient demographic.

It's really an amalgam of different patient demographics. It's also a segment that many want to pursue, but some may not be equipped to. You run an organization called men having babies. And I want to, in, in hearing about what that organization does, what others looking to serve, the LGBTQ plus community can serve particularly gay men can do.

But in getting there, why don't we start with why the organization, even before the, what. Let's start with the why of what need was it that you saw that led you to forming? Men having babies in the first place. 

Ron Poole-Dayan: [00:03:20] And I thank you for this question because really Men Having Babies wasn't didn't evolve or wasn't created out of some sort of brainstorming, what can I do or what can we do?

But rather, to fill a void, it was literally. Me noticing as when my husband and I more than 20 years ago were thinking of creating a family through surrogacy. And our twins from surrogacy are now 20 years old. But when we started our journey, there were very few resources out there.

And that the LGBT center in New York in particular, they were. Support groups to people wanted to pursue adoption co-parenting and even biological parenthood. But the biological parenthood support group was for lesbians who wanted to have a family through IUI. And there was just very few people who were Interested or surrogacy was not really that of course, widely practiced.

So a few years later after I stayed home with the kids for several years, I decided to volunteer at the center and create a group for people who were interested in surrogacy. And here is really the issue. The issue is that. This is about surrogacy more than it's about gay men. So far that it's a self-selection within the LGBT community lesbians are even less likely than the general population to need surrogacy.

Because even if they're suffering from infertility at the same rate as the general population, they have. Tools to start with and gay men can never just do IUI without, at the very least traditional surrogacy. So, so it was a very clear distinction. If you're interested in surrogacy, you're, you know, you're gay.

If you're just an IUI or lesbians, we're interested IUI, so that was the void that we stepped into. In the first place. And then after running this group of which to which people thought there's not going to be any demand, but you know, it grew and grew or started 2005. There wasn't going to be any demand.

Yeah, I would. When I came to the Terry bogus at the time they had of center kids, now it's called center families at the LGBT center in New York. She says, sure, we can. Split the biological parenting group into two, one for a surrogacy, one for IUI, but I don't think you're gonna have enough people.

And of course it was very successful from day one and grew gradually. And then in 2000 leading to 2012, when we incorporated as a not-for-profit we were thinking that we wanted to tackle the issue of the, not just the high costs and of course they were not quite as high as they are even today.

But also the fact that there was no financial assistance. Available for people like us. And that's the second void we moved into. And at that point we needed to incorporate for that purpose as a separate organization. And that is that I literally found a dozen financial assistance our organizations or initiatives out there for people who might among other things need surrogacy, but they were all organized for the purpose of people that were defined as infertile and the medical definition.

Fertility always excluded us. So we didn't create an organization to exclude everybody else. We just created an organization that would fill the void since we were excluded from the other sources for information and for financial assistance. So that's the void we moved into. 

Griffin Jones: [00:06:39] So you moved into this void partly for partly because of the community that was very different from the other half, just going into IUI, for example.

And secondly, for the financial part of it, because other organizations exist to help with financial. Assistance for those that are medically infertile that didn't include gay men. And so you formed this organization and then how did it start to become the event-centric, community centric tribe, almost that it is today.

I don't know if you use that word, but just looking from afar. Kind of how I perceive it. 

Ron Poole-Dayan: [00:07:20] It's definitely a community. And but it, of course didn't start as such. And it's interesting because I always tell people that while our visible part, to many people, of course, he's the silo of the organization that is organizing events.

Although that's, you know, a funny thing happens, you know, the last year, as far as events are concerned. But of course in a normal year until, COVID but people of course know us for is the very large events. And if you're listening to this and you're not familiar , in  normal year we would have towards, you know, until COVID started in the last few years.

Yeah. We'd have about eight conferences a year round and these conferences have been often also described lovingly as a bootcamp because they're not a scientific conference and not a professional conference. There it's a weekend where people literally don't. Ever get to look even at their phones and they're just immersed and taken step-by-step through the process that would allow them to determine whether surrogacies for them are events.

Our organization is not advocating for surrogacy. It's advocating for ethical surrogacy, but it's not saying you should do surrogacy. It's not saying you should become a parent, but if you thinking of becoming a parent and you're It requires surrogacy and our events are not just exclusively for gay men.

Then this is a good opportunity to find out whether the service is for you and whether, and how to pursue it, whether you can afford it and how, and everything you need to know from a, you know, the medical issues to budgeting, you know, and other financial aspects of it. And ethicals psychosocial issues.

Insurance, you name it.  e have sessions for prospective, single parents people HIV issue B plus, et cetera, but those bootcamps, so to speak happen in different parts of the world. We have four. Really large events for usually about 300  plus intended parents in New York, San Francisco, Brussels, and type pay for the, for the Asian region.

And we have also events sometimes the ultimate in Chicago. Televiv Florida. Texas sometimes Canada we've had their various events. So that's, that takes of course a lot of the energy and a lot of the you know, That's a major part. Of course, if our budget, et cetera. However, the other silo GPAP, they gave parenting assistance program is almost the reason for everything else.

Of course, at least, you know, very synergetic, but it also takes a lot of our resources. We have three people working on it and between applications and case management at any point in time, we have several dozen Mostly couples, but also singles who were getting full assistance from us, which means that they're getting not just some cash, but also pro bono services facilitated by now more than a hundred providers, including many of the leading clinics and agencies in the field.

And we basically. Super case managed their journeys. They still have case managers. They deceased and take them all the way until they become parents. Even if they need additional contingency funds as we call them, et cetera. So, so it's a lot of work and to some extent it's as big of a area of activity we have.

And we also do advocacy.

Griffin Jones: [00:10:38] I want to talk about, I want to learn more about that advocacy, but I also want to learn about the strategic partners. You mentioned the providers and agencies that you work with. At what point did that start and what did those strategic partnerships form into? 

Ron Poole-Dayan: [00:10:54] It has been  an evolution and the nice thing that it's been an evolution, but it's also been a partnership.

So I always. You know, start with a disclaimer, especially at our events to explain to the prospective parents that we're not partnering with agencies and clinics in the sense that we are here to help them do business. We create the platform that allows them to reach out to the community and we created a platform that allows them to even give back to the community, 

Griffin Jones: [00:11:23] Isn't that helping them do business?

Ron Poole-Dayan: [00:11:25] So, as I said, we created a platform. That allows them to reach out to the community and that of course allows them to do business with the community. And we also created a platform that allows them to give back to the community which is the GPAP and the membership benefit I'll mention in a minute, but so the evolution of that idea started with the fact that even before we were an organization in order to provide the full spectrum of guidance and information that people needed at the LGBT center still we had of course, people from the professional community who came to speak.

And then we say, you know, why don't we let them have a little table for their clinic or agency, et cetera. And then much later they, after the LBG LGBT center say, why don't we have them pay, you know, for these tables. And when we created the organization, we when we incorporated the business model was supposedly.

A little bit, Robin Hoodish. She said, Oh, we can charge a lot more than $350 for those tables that the LGBT center was charging. Let's charge them more and we'll give this money tto people can't afford it.So it was just, the first idea was just literally, let's just. We didn't even think of salaries or overhead or anything.

I was, of course I've volunteered as the only employee of the organization in the beginning years. We said, okay, let's just charge money and give that to people. But then as much as we would have charged, even if we charge as much as we do today, because of course now it's been established it's much larger and we can charge higher sponsorship fees.

It wouldn't have gone that far. And it was. Somebody from the industry told me, how about you also get pro bono services? And that was, you know, you know, when the light bulb went on and I said, yeah, we need the assistance we need has to be something we do. In partnership with the professor community.

And the first step we did was to create a questionnaire after some research where we sent to all the providers, we already knew and asked them, what do they think the income threshold should be? What do they think that we should give assistance also to people that have kids or just people that don't have kids yet?

Do they think that they should be other countries and what, so we. Got their input about a lot of the building blocks that went into creating our gay parenting assistance program. And God helped me. We got a lot of their comments when he was time to write the contracts. So it was about a year and a half when those, because half of them are lawyers as you know.

And so thankfully, so it started as in that regard, it started as a partnership and because a lot of them told me and I totally believed them. They said, We want to help, you know, we do see those people can't afford it and we feel bad about it. It's just, it wasn't up to any one of them to create an assistance program.

A lot of them said, I'm going to start the program to help people can't afford it. They couldn't do it on their own. So it was our service, so to speak to the professional community, but saying we'll create the platform, we'll create the infrastructure that allows you to do what you are stating as something that you feel, you know, dearly about as well.

Griffin Jones: [00:14:32] They couldn't do it because of the resources and bandwidth required. 

Ron Poole-Dayan: [00:14:36] Yeah. It's just a simple, you know, organizational issue you want. You don't need, you know, 200 assistance programs, you know, we have, you know, you need one. And if somebody had to step up and create it and we did that, as I said, a lot of them see it as a service we provided because they really more than we wanted them to provide support and channel it through us.

They were looking for a way to. To bring that to bear. So, so that's really how th part of the evolution of that a member of that partnership was, and I'm saying another important part and of course, I mean, so we have several concentric circles here. If you may, we have more than a hundred providers.

Now we just passed the threshold a month or so ago that are giving through the gay parenting assistance program and a program that came later. Now we called the membership benefit program, which is a discount program just that is wider. It's for anybody that's a member, a supporting member of  MHB.

But then we have, of course, a providers who come just to our conferences, I would say two thirds of the providers who come to conferences are also part of GPAP a nd the membership benefit program, but not all of them. All of them have to abide by the baseline protocols that are part of our ethical framework.

Something that we also developed first and foremost with input from surrogates, but also from inputs input from the professional community. So that's another layer of partnership here. And I would say not important layer of partnership or formalizing that in a more structured way was I think about five or six years ago when we created our advisory board.

And we now have an advisory board that have several physicians on it. Some agency owners, and also people from related fields. And that is an amazing when created, we weren't even sure how successful it's going to be, but now those are approximately monthly meetings and a lot of input we've received from.

Where to do our next conference to, you know, definitely ethical issues as well as various other initiatives that we needed that kind of additional perspective for. 

Griffin Jones: [00:16:48] Okay. So here's the skinny, just as your fertility group has advantages over other groups, your competitors also possess advantages over your IVF center that you don't have access to yet. Now you can say their consolidation model won't work or their lab sucks, or their doctor's crazy, or that low cost model cuts quality, or who would ever get their fertility testing done from a food truck, but many of them are onto something.

If you're not maximizing your own natural strain and adapting to what the new patient demographic is demanding, then they start to do more cycles where you are, get better rates from an insurance and vendors. Take your patients and even your staff. We work to maximize those competitive advantages because fertility bridge is the only creative and business development firm that exclusively subs specializes in the fertility field.

We have an entire team of people who help fertility centers attract and retain the right patients and nothing else for a living so we can help only your competitors. And then they have an even bigger advantage or we can help you too. Our initial consulting engagement is the golden competitive diagnostic.

It's only $597, and we equip your partners and leadership with the foundation to leverage your competitive strengths, not mimicking someone else and not let your competitors have an unfair advantage. There's no longterm commitment whatsoever, and there's a 100% money back guarantee. Send your manager to www.Fertilitybridge.com.

Have them sign up for the goal and competitive diagnostic. And I will see you and your partners on zoom.

So With regard to those different levels of partnership and involvement, all the way from being a sponsor at an event at a booth to being on the advisory board, I want to talk a little bit about the role of clinics and how you interface with them and what the best among them do to serve not just the LGBT plus community, but specifically gay men.

There's a lot of executives that listened to the show on the industry side there's pharmacy o wners. There's there's definitely agency owners, but most of the people that listen to the show are practice owners or REI's. And so. You'd probably have a range of involvement from those clinics. You mentioned some people sitting on the advisory board, but what do the best do to get involved in the community?

Because it's one thing to sponsor something at an event. And then there's another thing to like actually be a participant. And I wonder if you can talk about that range. 

Ron Poole-Dayan: [00:19:26] If you may, I want to take a little you know, a side trip here to explain, I think what some practice owners and people in the especially in the medical field that are dealing with surrogacy and gay men.

Might not always realize or articulate for many it's what I'm going to say would be would sound trivial, but it's really important to answer your question. And that is a significant, you know, you know, very principle difference between Our community and the infertility medical infertility community, both of which a lot of the medical professionals serve at once.

And that is that we of course get to this very differently. The in fertile, medically infertile committee individuals, you can't even call them a community. They get to it as. Isolated individuals who've been escalating up, you know, the medical treatment you know, a ladder to the point that they also need somebody to help them carry the baby.

And it's already after a lot of treatments, typically, sometimes of course you have women that just know they don't have a womb. They have they'll need to have a surrogate, but one way that they've comes out of a, you know, of a. Medical condition and a sense of, you know, you need the healing, you need, you know, assistance medical assistance.

They don't think. That the first thing they need to go to do is to go to a very large hotel with a few hundred other people and start chatting about it and go to the, you know, welcome reception and do this and do that a happy hour. That's not what comes to mind and that's not also the right way to bring, because we always say our conferences are open also for intersexual in front of people and they don't come to conferences.

Maybe we will have, I don't know. 5-10% of that. And these are going to be it's better by the way, with virtual events, but you know, it's just not the same thing we feel when by the time. Gay men come to our events or become parent become members at our organization or reach, you know, access our online resources.

It's an act of empowerment. It's an act of, I'm going to take my faith in my own hands and I see a solution. I see, you know, a light at the end of this. It's not even a tunnel. It's a life affirming life changing event. And It is a very different mindset for doctors to have an initial consultation with patients that are like that.

It's a bit very different you know, Introduction and a completely different set of needs. So there are some practices who are very focused on this for whom this would obviously sound trivial by the time those practices are focusing and opening up and knowing how to address the needs of this community.

They also need to be opening up to much larger. Basin of patients. It's not going to be just your geographical area, where people are going to be sent by their OB GYN or smaller fertility clinics. It's going to be people from all over. It's going to be people who are gonna come from overseas. It's going to be people who don't always, you know English is not their first language.

Always. It's going to be people who are going to need to think about it in much more careful ways financially. So the financial consultation. There are people that are not eligible for insurance, even in the 13 or whatever States where there is IVF mandate. 

Griffin Jones: [00:22:48] It seems that there's like 20 doctors or so that are getting 80% of the gay male cases. Is that really the case? 

Ron Poole-Dayan: [00:22:56] If you're talking about practices, not individual doctors, I would say probably closer to 30 or 40 that are getting the 80%, but probably all of them, they're probably even, you know, 20 that are even more active. Our view might be biased just because, you know, people who come to our, you know, events to part of our program tend to come back.

So it means it's working for them. So we tend to see the same ones again and again, then must be probably out there. Some that I would say those are probably Well, I was going to say price much higher, but the price differences in the clinic side, and not as big as the price differences, the spectrum of costs is much broader on the agency side than it is on the clinic side.

Griffin Jones: [00:23:35] That's interesting. That's an interesting point. I want to explore for that a little bit, but with the distribution, the uneven distribution of gay male patients going to see certain clinics, and you mentioned it's a very different journey from those dealing with infertility is a medical diagnosis.

 For that reason, many gay male couples do go the agency route first many clinics would love to disrupt that they would love for them to come to the clinic first. And so they have a bit more control of the funnel of those patients coming through. It seems to be very. Uneven. And so what are those clinics?

You know, if it is 30 or if it is 40 that are getting that 80, 90% of the game outpatients in the nation, what are they doing differently? 

Ron Poole-Dayan: [00:24:24] First of all, I would say that from the population that comes through our organization, I don't think it is that universal. In fact, I wouldn't even, I wouldn't even bet that it's half of them that are first going to the agency.

It used to be that way. The people that are going to the agency first are. Typically the people that are not fully informed that did not get the full training and advice that they get from our resources and our conferences. And in turn, they depend on the agencies to educate them. So, because that would be, you know, perhaps the assumption of a lot of people, but by the way, not European so much, but a lot of Americans probably would say, I need to look for surrogacy agency.

And if they didn't come to an educational event, they would think that's where they should get their information. And that's the first step people come to our events. I know by now that fresh cycles, fresh transfers are. By far not the norm anymore. In fact, that many times they're not even recommended in the case of surrogacy and that they would know that it many times makes a lot of sense to create embryos and bank them while they're shopping around even saving more money.

And can afford also the surrogate and the surrogacy agency. So I would say a lot of people nowadays understand that this there's a decoupling there.  They don't have to first go to the agency, make sure that the surrogates ready and only then start the medical procedure that is, you know, at least 10 years old assumption.

But But yeah, I mean, people if you know, some doctors out there practices out there at wondering, you know, what needs to happen for them to be you know, catering more to this population, as I said, they need to be a lot more. I mean, I hate to use the word, but there's a lot more marketing involved here.

And a lot of doctors don't like marketing. They don't like the concept of marketing. And the marketing here is doesn't have to be like, you know, mechanical commercial type of marketing, but you need to have. People in your practice who are, you know, responsible to reach out to the community and know how to do it.

It's not enough even to just have a booth at a conference, you need to be able to know how to have a good list of your alumni. And. Maybe have a group of your alumni be your spokespeople, or, you know, spread the word that you're coming to Brussels next month. And, you know, Dr. X is going to be the doctor to help me.

He's going to be in town and maybe doing a little alumni event and post on social media about it, things that I think. A lot of the practices are more infertility focused, I'm not even equipped or geared, or they're not, you know, I'm not wavelength, you know what I'm saying? 

Griffin Jones: [00:27:13] The doctor have to do all of that marketing or can they put a rainbow flag on their website and have a physician liaison makeup pamphlet and distributed. 

Ron Poole-Dayan: [00:27:23] The doctor needs to be passionate about it. And that's another thing you can't fake it. You, first of all, a lot of doctors just like it more. I don't know why, but I mean, this is To some extent, as I mentioned you, you're not dealing with infertility loss with, you know, miscarriages and it's you just, you know, you have happy people coming to you.

You provide them, you know, most of the times it's, as you know, it works on the first try. Everybody's happy. So some people just like it better even A lot of doctors describe it as, you know, fertility treatments to do very infertile because you're working with a very fertile egg donor with a, you know, very fertile, a very suitable surrogate.

So it's to some extent, I'm sure that medically it's perhaps more gratifying, but you have to be passionate about third party reproduction. And you have to be passionate about the LGBT community. And people will know that you don't have to be gay. You don't have to be part of the community, but you have to have an understanding too, because I meant I might've colored it too, you know, brightly, you know, it's not as if we don't come from hardships, it's not as if we don't come with further hardships waiting down the road for us. But but you have to be you have to understand this. And as I mentioned, You have to be doing some things that you wouldn't otherwise do because some things that would look tasteless for the infertility crowd would be necessary here.

As I mentioned, events, you know, parties or something or, you know, newsletters, things that might not always work or are necessary when you work with the infertility segment. 

Griffin Jones: [00:28:59] Why is that necessary for courting gay men as patients. 

Ron Poole-Dayan: [00:29:04] First of all, it's not necessary. Of course there's always going to be somebody and we still have some people that say, you know, I live in Iowa. I need to find an Iowa clinic and. That's not true. There are some proximity considerations that we go over them when we do our training, but a lot of it is the geographical considerations are very different here, but the reason to go back to your question, the reason it needs to be done differently is that.

Our community is very sensitive to cues to know whether they will feel comfortable in your clinic. And so the first thing they're looking for is they don't want to be the only gay clients you have. They don't want to be the only gay clients you ever had. They, you know, so that's a very, so, which is why by the way, being part of our gay Parenthood assistance program is a very.

Real way for them to see that you're committed. You're not just putting a rainbow flag on you or side, but also. For a lot of us it's it is a, as I said, the act itself, the experience itself is something that they want to be positive, you know, for, I don't think that a lot of infertility patients think of this to be something that they want to put in a picture album later and go over.

But we do for us you know the first picture of I'm getting goosebumps. The first picture in our kids' album photo album is there as embryos. You know, and it's something we celebrate, it's something, you know, you know, we like chatting with people with the front desk, people at the clinic and it's all done is something that is more communal, more social, more open. We post on social media, you know, some people post on social media too much, you know, but they post every step of the way. It is, I think, I don't think that's the experience of the typical infertility patients. 

Griffin Jones: [00:30:57] I think that's at least in part that's right in terms of the involvement that docs need to have.

Some sort of authentic connection. I sometimes get prospects. I can think of a couple in particular prospects, not clients that reached out and their clinics and they want to increase their same-sex. Patients, and they don't have any desire or inclination to actually invest in the resource. And so essentially in providing the resources to actually make that initiative happen.

And it's essentially saying, I just want more money. I just want more. Of that patient base. I'm not going to do anything to give them a reason to come to me. And it sounds like what you're seeing from those that have been really successful because there's definitely, if not a predo distribution than not an even distribution, that they are doing a really good job of making that authentic connection.

Exactly. How would they do that through an organization like yours? Because I think there are some people that we interact with either clients of ours or. People we've done consulting with and they want to increase same-sex patients. And one of the pieces of advice that we give them strategy is getting involved with organizations like yours.

So how, if they came to you and said, listen, Ron, I'm, I've never really made an effort for this patient demographic before, but I'd like to, how would you get them started? 

Ron Poole-Dayan: [00:32:35] So, in fact, I don't think there's a better way if I may say so myself to do this than to get involved with Men Having Babies, I would say first come to one of our events, you know, attend one and unless of course it's very urgent, then they want to start yesterday.

But I would say come and attend one and you'll get a good education. I mean, people who I mean, some of our conferences arguably The providers, the exhibitors themselves can sit in the plenary session because. We're limited in space, but if you come, you can come, always is what we call it professional attendees so you can buy a ticket.

It's more expensive, but you can buy a ticket to it's a lot less expensive than sponsorship and just attend one of those. It'd be a great education for you. But  more, you know, practically of course being at our events provide you a lot of exposure, but I would say before you come to our events, have a section on your website for I mean, not just with the rainbow flag, but for LGBT people and more importantly about surrogacy. Of course, if you're not, if you're not doing a lot of third party to begin with, and then of course you're not even a good match regardless of what you do. So you need to know what surrogacy is and you need to have a section on your website of surrogacy with mention of same-sex couples or just about same sex couples separately. Of course people will take a look at that, you know, the very first time they go, if you don't mention surrogacy, why would they even come to you? And if you do, you should specifically make them feel welcome beware that most people use the same. Stock images of gay couples with a kid trying to be, you know, of course us, we never used stock images at all, but you know, really if you have alumni and they willing to use their photos, that's the best thing to do.

Maybe have an event like a pride event or pride party at your clinic and invite some people with their babies. Take some photos. You'd be surprised how much people would love them and would tag them themselves in it. The privacy issue is very different when it comes to gay couples. Of course they might not want their kids social security number posted on social media, but they're going to be very happy to be part of your, to, to really, you know, show how thankful they are by doing that.

So, And then if you have that you don't have to have special pricing. You don't have to have you, you know, I don't know. You might have, you  know, something different in the clinic. I mean, it used to be that you needed to have something else in the sperm donation room, but you know, everybody has a cell phone that is a smartphone now, so that's no longer a problem.

So you don't need to do anything. In the clinic, but you do need to think about the financial intake you know, consultation it is different. You don't want to, you know, throw at them some financial, you know, pamphlets that are not suitable on the one hand. On the other hand, you don't want to, you know, because one of the things I remember.

You know, almost as a trauma is that, you know, the financial person at the Brigham and women hospital where we had our children created, was basically telling me how much you know, disadvantage compared to the people who have insurance pay paying for their IVF. You know, that's not the kind of discussion you want to have with them.

Griffin Jones: [00:35:43] 

Maybe a little training for the, that might be something? 

Ron Poole-Dayan: [00:35:46] I mean, luckily nowadays, You probably not as likely to have a bigoted people on your staff, but you need to have buy-in from the staff and you don't want anybody to give anybody a cold shoulder, but I would say really just two things giving to the, you know, reaching out to the community's own.

Institutions on the one hand, on the other hand, reaching out to your alumni and those are the two major, you know, ways to get to the to this community. You must have, of course, if you're thinking about you, must've had at least one or two couples, maybe more that you already help reach out to them, you know?

Maybe one of them say I'm going to come with you to the booth, you know, that's usually helpful. 

Griffin Jones: [00:36:35] And featuring them in testimonials  is really important too, to make sure that, you know, when everyone needs to have video testimonials and some can be done, some can be done fairly cheaply. If you want good ones and have more of a story, then you spend more and invest more in video.

But if this patient demographic is important to you, you have to have, you have to include them in the testimonials that you're doing. 

Ron Poole-Dayan: [00:37:01] And you might want to get an Instagram account, or you might, you know, and not all clinics even have that, you know? And and you'd be surprised how many people would check you out through social media and wanna to see who, who likes you and stuff like that.

So some of you who take time, I'm not saying it's a. The other thing I would also advise against is. Well, first of all, I would suggest have a conversation with us. We always have compensation and even training with providers who are participating for the first time. We literally give them a lot of tips, you know, from.

Don't stand behind the table all the time, come in front of the table, engage with people and things like that. A lot of tips, even about virtual events. But and as I mentioned before, try to reach out to the alumni community group, et cetera. But I would say the other word of caution, I would say yes, commas in that 10 D if you want to just learn more, but don't come at a sub optimal participation level.

That's not just not effective. It might be counter productive. What am I saying? We have various levels of, you know, representation at a conference and the clinic can not be a bronze sponsor. They just can't. Those are the lawyers. Those are the escrow services. And you don't get a breakout session.

You don't get counseling. You're not part of the consultation system alot of other  things. We do our. Bootcamps are, you know, weekend long immersion surrogacy events have evolved with a lot of feedback from attendees. From providers. We have a whole system in place that allows people. We have different experience for the research people who are always, you know, five, six, Sometimes 10% of the attendees.

Then we have the people who are one to two years from a journey. We have the people that are six months from the journey. We have the people that are actively in the journey. So we have different experience for them all. And we have, so, you know, the people that are ready, they actually have consultations that signed contracts at the conference, the people who are, you know, just doing research, they're not going to do that, but they're going to benefit from other aspects of it.

If you're coming and you're not. Listening to what would be a good level of engagement here to you? You might be sending the wrong signal, not let alone, not getting the full value of your participation and always consider if you're not willing to give at least discounts to people with financial needs, you might be also sending the wrong message.

Griffin Jones: [00:39:32] So how does this all tie into advocacy and how can providers agencies join in the advocacy that you all are a part of? And to what extent should they? 

Ron Poole-Dayan: [00:39:46] We very much involve and receive a lot of engagement from the professional community in our advocacy efforts. First and foremost started with what we call the framework for ethical surrogacy practices.

Frankly it started at the days when a lot of people would still going to India, then the piled and Thailand and Mexico and other destinations. And we just needed to codify. What our, what we call now, baseline protocols that were our thresholds conditions for including programs at our conferences.

And And what we did is we partnered, as I mentioned, with a group of surrogates who are until today, not necessarily the same individuals, we have a surrogate advisory committee. And we had got a lot of input, as I mentioned, also from the professional community and. Something, I should've mentioned before.

We're not a local organization anywhere, everywhere we go. We have partnerships with local LGBT family associations. So we have dozens of LGBT family associations that are partnering with us and especially play a role in each one of the locations where we arrive for an annual conference and also liaise with us with regards to the financial assistance program and other things throughout the years throughout, throughout the year.

So, We had input from LGBT associations, from the professional community, from the surrogates. And we created a framework that includes principles, which guide us through legislation initiatives. We have what we call the basic protocols. I mentioned before that those are the. Minimum conditions for providers to be part of our program and they need to sign off on them.

And then we have best practices that go beyond that. So that was the initial round of advocacy. It led us, of course, also to be very involved in the legislation efforts, mostly the one in New York, where we were very closely associated with the effort and. You know, the entire part in our section on compensation of the New York bill has been written without input and reflects a lot of our values and our principles.

More recently, we focusing we created something, we call the advocacy and research forum because we realized that to some extent where the traveling circus. So, first of all, we are also terrific place for the, you know, for the professional community to just socialize. I mean, wherever we go, we have about 150 to sometimes 200 of, you know, people from the clinics, from the agencies, from the law firms, from the complementary services that are coming there.

Some of them come as that. And these, most of them are exhibitors. So we said, we have this amazing group of people there with us that don't have a single other, you know, a forum where they. Join us, such ASRM is not quite this and sees is not quite this ABA, Arthur, none of those are where all the people interested in surrogacy come together.

And then we also have partnership with research researchers and research institutions. So we said there's a lot of things happening with regards to advocacy and research. So first let's have this. Forum where we have in all of our, or at least most of our events such that we can share what's happening in the other locations, such that everybody can hear about the latest research, et cetera.

So that's one aspect of it. But then in every location, that was a little different aspect of of advocacy. They wanted to discuss, you know, San Francisco, they wanted to discuss advocacy, you know, surrogacy in the lens of social justice in Taiwan. It was mostly still from the LGBT acceptance prison.

New York one session was a force just making the case how you can do. Ethical surrogacy legally without really taking advantage of everybody, et cetera. And. Most recently, our focus is on trying to coordinate advocacy in several parallel tracks with the aim of eventually making surrogacy a lot more affordable, because the reality is that surrogacy is still out of reach financially to most people.

So almost as we. Finished the round of legal advances. Now that surrogacy is illegal almost in all the States in the United States. And first and foremost the glaring mission of New York was rectified. Now we have to realize that's not enough, it's still not accessible financially, and we need to do something about it.

So, it's starting with how alongside, with resolve, we're advocating for a redefinition of infertility to include not just disease and conditions, but also a status. And this is actually now being advanced in California is a bill that could open up IVF if they, you know, even Institute that IVF benefits, not just for heterosexual and infertile people, but also for gay people.

But also look at insurance issues. Look at benefits at the workplace. Look at. Possible initiative in now with the more favorable administration, perhaps changing taxation right now heterosexual and gay people cannot write off any surrogacy related expenses. So all these things together alongside with interest free loans, which is an initiative we have, and we can partner with clinics by the way, who want to provide interest free loans.

We can explain to them how we can do that through us. All these things together in a concentrated effort to chip away from the various cost aspects of it. And to go beyond our financial assistance program that still only reaches several hundred couples and singles a year and not more.  

Griffin Jones: [00:45:26] Ron, you've talked a lot about advocacy, about what clinics can do to better court gay male couples, about what they can better do to serve them.

How would you like to conclude and our audience isn't just practice owners. It is also agency owners and other folks from the field, whether it's in advocacy or service, how would you want or getting involved with men, having babies? How would you want to conclude. 

Ron Poole-Dayan: [00:45:50] So first of all, come to our website and sign up to be on our professional mailing list.

We have advocacy events that are, should be probably very interesting to a lot of people listening. One of them is about surrogates, stigma and stereotypes. That's coming up, May 14th as part of our MHB West virtual conference but also in New York where we are resuming our in-person conferences in September.

We're going to have conferences in New York, then Chicago, Brussels, and Tel Aviv. One each month September, October, November, and December the advocacy forum there. And maybe that could be some conclusion to our conversation is going to be about the intensifying commercial. Atmosphere in these field and how we feel that's not that, you know, welcome.

And there are bidding Wars on surrogates. There are mergers and acquisitions and a lot of equity marketplaces bounties referral fees, a lot of things that are happening that I think. A lot of us are being drawn into and maybe we can stop and say, do we really need all of those things? And what can we do to.

Stay connected to what is common to all of us in the nonprofit sector. And I know in this particular field, that what makes it so unique is that the professionals in this field are also feeling that they have a mission. They're very mission driven. How can we all get together and make sure that we're still mission-focused and not, you know, be drawn to thinking about it exclusively as a business.

Griffin Jones: [00:47:29] Ron Poole-Dayan, thank you so much for coming on Inside Reproductive Health. 

Ron Poole-Dayan: [00:47:33] Thank you so much for having me. 

Narrator: [00:47:36] You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action, to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society, visit fertility bridge.com to begin the first piece of the fertility marketing system, the goal and competitive diagnostic.

Thank you for Listening to Inside Reproductive Health.