Today’s Advertiser helped make the production and delivery of this episode possible. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, nor does the Advertiser's sponsorship constitute an endorsement of the guest or their organization. The guest's appearance is not an endorsement of the Advertiser.
What are the most important KPIs for your fertility clinics? How do you define them?
We explore that with today's guest, TJ Farnsworth, CEO of Inception Fertility, as he shares his best practices for establishing KPIs to obtain reliable data, and how to use it effectively.
Tune in as TJ provides his perspective on:
How a small group text turned into the Fertility Providers Alliance (The field’s first trade organization)
The differences between trade organizations and medical societies
Can we expect potential FPA guidelines?
Leveraging political resources in light of recent legal decisions (Dobbs & the Alabama Supreme Court)
Griffin questions if private equity’s timeline is bad for investment in innovation and resources
TJ Farnsworth
LinkedIn
[00:00:00] TJ Farnsworth: The data, you know, once you look at it, as long as you know it's consistent, as long as you know it's right, we'll tell you the answer. And I think what we're trying to do with the FPA is then create a platform of communication and collaboration where we can take that information that we're collecting at a At an individual provider level, whether you're a, you know, single clinic or whether you're a, you're a small group of clinics or whether you're a large platform and share them with each other in a way in which we can improve all of us, I guess that's ultimately the goal.
[00:00:28] Kevin Ali: Hi, I'm Kevin Ali, CEO of Organon. And at Organon, we're committed to engaging with leaders across reproductive medicine. So I'm excited to introduce today's guest, TJ Farnsworth, founder and CEO of Inception Fertility. TJ has built Inception into the largest provider of comprehensive fertility clinics and services in North America.
[00:00:52] Sponsor: This episode was brought to you by Organon. Organon is committed to championing care equity in fertility. By elevating education, expanding resources, and investing in innovative solutions, Organon stands with aspiring parents on their unique journeys. Learn more at fertilityjourney.com.
Announcer: Today's advertiser helped make the production and delivery of this episode possible. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, nor does the advertiser's sponsorship constitute an endorsement of the guest or their organization. The guest's appearance is not an endorsement of the advertiser
[00:01:45] Griffin Jones: Guess who's back on the Inside Reproductive Health Podcast. That's right. Kevin just told you, you might know TJ Farnsworth from being the CEO of Inception Fertility, but he also helped found the Fertility Providers Alliance, the FPA. Have you heard of it before?
Do you know what? This is something that we haven't had in the field. A trade organization, and you might be thinking, we have trade organizations, TJ explains the difference between what a trade organization does versus what a professional or a medical society does. He talks about sharing political resources in light of things like the Dobbs decision and the Alabama Supreme Court decision.
It tells the origin of how a group text with a few other fertility clinic CEOs and founding doctors turned into a conference call of 50 people turned into a trade organization with a charter and governance and a board of directors. I asked TJ if he thinks that the FPA will one day issue operational guidelines.
He said they won't issue clinical guidelines, but this is what he had to say about the shortage of providers. Managed care contract negotiations, sharing protocols, sharing supplies, if we ever see ourselves in a gnarly supply crunch. He talks about best practices for how to, how to establish the right key performance indicators, like what percentage of patients are cash pay versus managed care, what's the average time to treatment, and then how to get consistent, reliable data, and then what to do with that data, and how the FPA might be able to establish accurate, impartial benchmarks for its members.
I think this data problem plays into the chicken and egg problem of a lack of adoption of new technological solutions in the clinic and in the lab, and not just startups, but ones that probably should be blue chip by now. I press TJ on those investment timelines, not just venture capitals, as he points out, but also private equities.
Hear his response and more and enjoy this episode of Inside Reproductive Health with TJ Farnsworth. Mr. Farnsworth, TJ, welcome back to the Inside Reproductive Health podcast yet again, again, again. Good to see you, Griffith. You know your way around here by now. I, do you know how many times that you have been on the show counting this time?
I do because I just went back and counted. I don't know, three times? This is number five. You were five. Alright, cool. You came and since we've done about 30,000 episodes now, it's you, you, and we've been doing this for five years, so you have probably been on an average of once a year. And so first time that was page, that was episode 45.
I went and looked at all of these before our conversation too, so I could try not to ask you questions I've already asked you. So number 45, was that, was you talking about your experience as a. Patient, and then how that brought you into the field, and talking about how you use that to inform giving your team the type of decision making authority so they don't do the same bozo thing of we can only take the credit card this way when you and your wife are in distress.
Episode 166, that was a BUNDL episode, and the, uh, That's where you came on with your team, talked about shared risk and what the type of scale you need in order to be able to share risk and reduce risk for patients and get patients in a paying program that works better for them. Then you came on episode 188, you talked about compensation models for REIs.
You, in that one, you were, I really, I liked you before, I liked you even more after that episode, because I felt like you You opened up a bit about just being like, Hey, these were some mistakes I made in the past. Here's a much better way I think is doing it now based on some hard lessons learned. And I think that people should go back and listen to that episode.
Then there was a live special edition episode where you came on with Dr. Beltzos, with Dr. Alvaro. That was in April, 2020. This is like everything shutting down, I'm soiling myself. I'm so freaking scared of what's happening. The MDA just closed and then that episode was about can clinics support new docs and staff while this is going on.
I thought, you know, private equity money, this is going to dry up. You know, there's going to be, demand's just going to drop for a while. I was wrong. You were more optimistic at that time. And so while I want to talk about a different topic today, I do think it It is interesting, four and a half years later, to go back to that moment and kind of think about why were you optimistic?
I just remember, I didn't even go back and listen to the episode recently, I just remember you saying like, no, I think like, this is where the field's going, we're going to have plenty of demand for docs, we're going to have plenty of demand for staff. Why were you so optimistic?
[00:06:42] TJ Farnsworth: I think a lot of it is because I look at things from the perspective of a patient, you know, just going back to that very first episode we did together, and you know, when my wife and I were going through this, you know, there was nothing that was going to deter us from having the family we wanted, and yes, I think COVID interrupted a lot of patients journeys, but the patient that wanted a baby in April of 2020, They still wanted a baby in August and, you know, October.
And so, while it might have delayed their journey depending on where in the country they were and where in their journey they were, it didn't change anything about what they wanted. And, frankly, probably long term created a greater degree of patience for us because people were putting off creating families because of a lot of uncertainty, which was unfortunate, but we didn't know what we didn't know back then.
So, yeah, it's easy to be standing here four and a half years later saying who was right and who was wrong.
[00:07:35] Griffin Jones: Well, you were right, righter than I was. Maybe it's just that, you know, being from Buffalo and the, the sky's always falling type of attitude, but you've got that entrepreneurial spirit and that, that optimism.
And it was around that time that I don't, I think you had started FPA, the Fertility Providers Alliance, a bit before that, but I feel like that's when it caught on. Let's zoom out for a second. I remember when the FPA was just, was an idea that you had, you had texted me about prior to you even starting it, and then you, and then you started it.
What is the Fertility Providers Alliance? What was the idea behind it originally?
[00:08:20] TJ Farnsworth: Yeah, I mean, we were sort of talking about it before, you know, the COVID, you know, crisis, but I think, you know, uh, any good, any good crisis brings people together in unique ways in which, you know. I've been in other specialties in healthcare before, and like many people have, and, and there are industry trade organizations, you know, for lack of a better term, that exist in other specialties that are, that are maybe a little bit more mature than fertility, and one of the things that I know you've heard me say before is the lack of collaboration and, and, and, you know, sort of coordination and, and shared effort that exists along various different providers within our space.
It's something I've never seen in another healthcare space before and it's, and I think, you know, my goal originally was to say, was to create a platform, a forum for people to be collaborating You know, ASRM was an amazing organization, one which we're not trying to, what FPA is not trying to replicate or replace in any way, try to be complimentary to, it operating as a professional society, but there, there hasn't really been a forum for people to come together on, on, you know, political lobbying, business topics, all kinds of things that I think were necessary just to start a dialogue and, you know, it turns into whatever the membership of it decides to turn it into over time.
But. I just think I always thought there was a, there was a lack of something missing there, which I think I may have even mentioned on that very first podcast we did pre COVID. And I think, you know, what COVID did was it brought a bunch of people together that needed to try and figure out how to solve some problems together.
And I think it was, you know, wasn't until during COVID that we actually technically named the organization and sort of brought everyone together. But Certainly the idea of creating a platform of, of collaboration was, was really what it was all about. Cause it's just, it's better for all of us and it's better for patients if we're working together to better the industry.
[00:10:12] Griffin Jones: You talked a bit about the differences between a professional society and a trade organization. I think those differences might not be immediately obvious for a lot of people listening. You're not replicating ASRM, you're doing something different. In your view, what is the difference between this is what a professional society does versus this is what a trade organization does?
[00:10:35] TJ Farnsworth: Yeah, look, there is always some natural overlap and, you know, we, you know, we, you know, You know, taking my, putting my FBA hat on, FBA talks regularly with ASRM, and Jared and I have a great relationship. He's done a really great job of, of cementing that collaboration between the two organizations. And I think a lot of it is around the idea that look, the professional society has limitations in the fact that it's, it's focused on clinical and which is, which is what, which is really what.
This is actually, frankly, more important. It's the clinical and scientific advancement of the specialty. And, you know, not as important, but still top of mind is, you know, what type of, you know, is there, are there, you know, business operational best practices that we can share with one another? And are there, You know, are there opportunities to collaborate in ways in which we can advance the sort of the operational side of the business operation side of the specialty?
And you know, ASRM has done some of that in the past with the, you know, the Association of Reproductive Managers, which I think is fabulous. It's something that I think is a great aspect of what ASRM does. But I think there's something larger and more, more formalized and not, not just, you know, you know, in terms of collaborating, you know, whether it be COVID or whether it be, you know, post dob situation, you know, we get focused on these crises, but, and we'll, and just to, you know, focus on them for a moment, you know, how do we get the, the, you know, pharmaceutical companies, the device manufacturers, the clinics, everybody in the room together talking about ways in which we can share resources.
So that we can be as efficient as possible with the use of those resources, rather than everyone just sort of reacting in their own way of throwing their own dollars and time and energy and effort at trying to solve a problem. And then in the middle of times, which is, you know, you know, uh, crises are one thing, but, but, you know, there's times between crises, which sometimes it seems like there's not, but, uh, well, there are times between crises where there's opportunities for us to talk about, you know, uh, ways in which we can help each other.
And. You know, I use this analogy a lot. I, you know, as I think back on our prior podcast, I think I may have used this example before, the oncology, the specialty I came from, the specialty as a, as a field felt like, it feels like it's at war with cancer, not with each other. You know, when we, I, I remember the time I opened the cancer center in a new market and the competing clinic down the street came by and brought us cookies and told us if, Hey, if you, if you're.
You got a delay on any of your supplies or something like that, let us know, we'll loan you stuff, you know, that level of, you know, I've opened a lot of fertility clinics and new markets in my career, almost 10 years now in the fertility space and nobody's I just think there's a, there's a, there's a feeling that people don't want to, people don't want to be playing in other sandboxes that I think has really gotten a lot better in the past five or six years.
And it's, it's going to continue to get better as we talk more and create that, that platform for dialogue.
[00:13:36] Griffin Jones: Times Between Crises. TJ, when you do, when you authorize your end of career, tell all business biography, consider that for a title. That'd be a pretty cool title to see at the airport. So you think it's gotten better in the past couple of years.
I want to ask you about that, but I want to ask about the resources that you saying, like, if we could get the pharmaceutical companies, the device companies, the clinics, et cetera, sharing resources. Now, I was thinking you meant like political lobbying resources. But it sounds like in the example of when you were in oncology and a different system came to you all and said, hey, if you're running low on supplies, we'll lend you some.
You might not just mean political resources. So what types of resources are you envisioning or were you envisioning that could be shared?
[00:14:23] TJ Farnsworth: Yeah, I think, obviously, I think, you know, political lobbying is a great example in terms of, in terms of, you know, why am I hiring a lobbyist in all of these states, and then Cooper's doing the same thing, and, and, you know, Faring's doing the same thing, and, and, you know, ESRM is doing the same thing, and, Can our dollars be stretched even further by, by collaborating with each other in a way that we weren't before.
But I also think it's things like, you know, I'll just use the COVID scenario as an example, you know, all of us at clinics, we're trying to keep open during a pandemic, which we, you know, we're either closing, reopening, or, um, trying to keep open, um, in some cases, uh, during the pandemic, depending on what each of us individually decided.
And, you know, we were sharing amongst the different clinics, whether you be a, you know, single doc, two doc practice, or whether you're one of the large networks, we were sharing Bye. You know, infectious disease protocols, consent forms, all kinds of things that, you know, from my perspective, why not share them with each other because if we're helping each other survive this, that's better for all of us.
And it's easy to point to these things or these crises, but there's always these opportunities to exist, you know, you know, between crises, as I said. And I think there's always an opportunity for, for us to be consistently, you know, I'm really dissatisfied with the level of work we're doing and ways in which we can improve upon it.
And if I can improve upon, you know, what someone else is doing, if I can learn from what my other large network colleagues are doing, if I can, you know, not every clinic in this country could or should or will be a part of a big organization, but if we can share resources to make them just as successful as the large networks are, or even more, all the better.
You know, the, the, the rising tide lifts all boats. There's a whole lot of capacity for treating fertility patients from an access perspective that we've all been talking about that's necessary for us to unlock. And so if we're collaborating with each other to figure out ways in which we can do that, all the better.
[00:16:16] Griffin Jones: Do you think it could be the case that one group shares supplies with another group or trying to
[00:16:25] TJ Farnsworth: Absolutely. We've never been in a scenario, at least that I know of, that's happened, but we would do that, no question. Because again, I think, you know, my example in the oncology thing was more of an acute example, but, you know, whether it be, you know, if there was a supply shortage, I mean, you know, of some kind, due to supply chain disruption, if ways in which we can be collaborating, purchasing between clinics in a way that allows us all to operate and meet the needs of our patients, All the better for everybody.
[00:16:55] Griffin Jones: We talk abstractly now, but we are entering this world where the future of global commerce is very much in question of what's going to be possible to be sourced from which countries and which regions, and what further down the line supply chain affects will happen. So what you're talking about is being open to an idea.
There might actually be concrete examples for in the next.
[00:17:20] TJ Farnsworth: There might be, and it's a great, the great thing about it is, is if you're trying, is, we got to create the platform because, you know, we were trying to build the plane while it was taking off during COVID and trying to create an environment where we can collaborate and work together.
And we need to be building that, that platform community for communication and collaboration long before the next crisis comes along. And, and, and again, there's a lot we can do, you know, to better each other and improve before that crisis comes. I'm not smart enough to predict what that next crisis will be, you know, whether it be, but I mean, just in the past, you know, five years, we've had COVID, we've had the DOMS decision, we've had what happened in Alabama, that whether, whether you're operating in Alabama or not, had an impact to you and your patients, all of these things are things which we, we're going to see something else come, and we'll never predict what that is, but if we have a platform for communication and collaboration amongst all the providers, And the nano organization amongst device manufacturers, pharmaceutical companies, ASRM, SART, otherwise so that we're, so that we're, you know, doing our best to meet the needs of the clinics and therefore our patients, all the better.
[00:18:29] Sponsor: Organon is dedicated to delivering impactful medicines and solutions for a healthier tomorrow. Guided by its mission of being here for her health. Organon proudly recognizes fertility providers around the world focusing on care equity. We believe everyone should have access to fertility education and treatment.
By collaborating with providers, advocates, and communities, Organon is working to elevate fertility awareness, expand resources, and invest in innovative products that help more aspiring parents access the care they deserve. Every journey to parenthood is unique. Organon stands with you. Learn more about Organon's resources at fertilityjourney.com
[00:19:19] Griffin Jones: What was the reception like in the beginning? And so was it, was it in March of 2020 when you started approaching other groups and other founding docs and other CEOs of, Hey, this is what we're trying to do? Or was it, was it prior to then? And what was that like?
[00:19:36] TJ Farnsworth: It was a little, it was a little funny.
I actually remember we, there was a text stream going between myself and You know, a handful of others, people at, at Shady Grove and, and various other different clinic platforms, you know, that, you know, sort of say, Hey, let's get on a call tonight. This is, you know, right after the MDA shut down, the whole crisis, things have, let's go on a call tonight and, and let's discuss how we, ways in which we can, you know, collaborate and strategize together and help each other.
And, and it became, Hey, I'm going to add this person, I'm going to add this person, and then it would be like, I don't know, 50 people on a conference call and, and, you know, talking about how we're going to create these things, you know, and, you know, we're talking about strategies like, Hey, listen, we need to be going to our landlords and talking about rent abatements and our lenders and talking about, you know, covenant holidays and payment skips and all the things that we needed because I was a big believer of the time.
And I think there's not just me, but this was shared by everyone else that was, you know, sort of leading the charge at the time that nobody should, we wanted no subject to fail because that would be bad for all of us. And, and that sort of sense of, you know, when you're, when you're, when you're being, you know, when you have an external force attacking you, it sort of brings everyone together in a way, in a way in which.
is, uh, is a unique opportunity. And what happened after COVID was y'all wouldn't have been sure went back to say after COVID. It was a long time, but I was all sort of went back to, Operating, and then, you know, the DOMS decision came along, and we're all sitting around the table at ASRM talking about it, and, and, and, you know, several of us said, listen, we can't look for an opportunity to collaborate and work together and communicate only when there's a crisis, because we will not have the institutional framework in place necessary to be as successful as we could be when these crises do come up.
If we're doing this just as a daily, you know, part of our operations of our business, and frankly, that's part of the evolution and maturity of what we do. of the specialty, because, again, you know, I've been in three or four different specialties in my career, and they've all had this, and so we need this as an industry, it'll make us all better, and, and it's not just for large networks, it wasn't until, if it wasn't during COVID that way, and It shouldn't be for the future, it should be about how do we advance this specialty for all of us.
[00:21:53] Griffin Jones: Do you think it would have been possible without COVID for one reason is the unifying force that you mentioned when you've got an external force attacking upon the group, it unifies the group, but also I don't think there's ever been a time in human history where that many ultra busy people have been synchronously available.
[00:22:14] TJ Farnsworth: I'll say that on behalf of my peers in the space, I assure you, none of us were available. We were all figuring out how to, you know, keep our clinics open, furlough workers, preserve our balance sheets. I was working, you know, you know, 10 plus hours a day, 12, 18 hours a day, some days, just trying to, And, you know, just figure out how to keep
[00:22:32] Griffin Jones: But all on that issue, because I was the same way, too.
There was no There was It was an extremely stressful time. There was no, like, sitting on and watching Netflix, but everybody was thinking about the same thing.
[00:22:44] TJ Farnsworth: There was, you know, finally some grip on this. I think eventually the specialty would have gotten to a place of having FPA like organization around it, but I don't, it may have taken, it may have been just in its infancy right now.
If our baby first started, we talked about, right, I'd certainly accelerated the timeline around all that extraordinarily. And it looks like it did for a lot of things. I mean, look, we're standing here, In a time in which I don't know what percentage of our new patient consults happen via video, but you know, it was negligible prior to COVID and it's common post COVID.
So COVID accelerated a lot of things and I think this is just, you know, one of those components of it.
[00:23:23] Griffin Jones: Let's move on to the institutional framework because you said, you know, it can't just Text thread of 50 people or a Zoom of 50 people. You have to have a sort of framework in order to make it an institution and give it life.
How did you set that up?
[00:23:41] TJ Farnsworth: Well, I think in the beginning it was just about who wanted to step up and take a leadership role or doing this during COVID. It was all just sort of A little bit of chaos. I think as we began to formalize things later, it was really looking at, you know, the, you know, the larger networks that had some institutional capacity to be able to start to set this up.
And right now, even the FBA is still in its early days. I mean, we're, we're really just creating the governance framework that's been created, sort of what the value proposition the FBA would have to any clinic, I think, is still being, is still evolving. It will always evolve. You know, right now, I think.
It's really all about sort of putting the framework together, which the large networks have the, you know, resources and capacity to do that. But ultimately, long term, it has to be for the benefit of everybody within the industry. It can't just be for, if it ends up becoming and evolving into a large network fertility providers organization, that's, that's not, that's not to, it certainly wouldn't be the vision and goal I would have had originally.
[00:24:41] Griffin Jones: So you're working on the governance now. Do you have a charter yet?
[00:24:44] TJ Farnsworth: Yeah, the charter's in place, you know, the mission statements are in place, all those things are in place. I think, you know, when I think about if I'm a, you know, three or four doctor, independent practice that's going to stay that way, you know, for long term, what is the value proposition for an organization like this to me?
I think, you know, if I'm in Alabama, I was spending all kinds of time and energy and effort, all of a sudden, political lobbying, And, you know, but if I was in California, I might not have paid much of attention. I'm obviously dealing with patients around that, but I certainly wouldn't have thrown resources at it.
And how do you create a scenario where everyone can be feeling like they're at the table with regards to voice being heard and understanding that what happens in Florida or Alabama or Texas or New York or California or Ohio or wherever has an impact On a national level, I think the great thing is the Alabama decision actually helped solidify that.
So I think, I think, you know, we're still collaborating as a group and obviously, you know, the, I would say the current FPA leadership, which is the CEOs of all the major networks, you All have day jobs. And so, you know, it's really right now, it's around, you know, sort of figuring out how to put those pieces together, obviously, political lobbying, especially in today's environment, is on the top of everyone's mind.
But then, you know, once you get that in place, yeah, and doing that in a way, again, the share of resources, because, you know, there's resource limitations in terms of dollars that can be spent. And if we can do it in a way It's efficient and maximizes that spend so that we're advancing, you know, fertility preservation for oncology reasons in states in which that's an opportunity where we are, you know, protecting access to IVF in places where that might be a peril.
That's to everyone's benefit. And then I think you start to get to things like where can we be sharing best practices? Where can we be collaborating on sort of operational processes that drive a greater degree of efficiency and benefit all of us, which. You know, we're, we gotta lay the foundations first though, so that's what we're working on now.
[00:26:48] Griffin Jones: Are we starting to see some sort of consensus on what operational processes need to be made more efficient? Not, not which need to be made more efficient, but really how they need to be made more efficient? Are we starting to see some consensus, or right now you're just hosting the debate?
[00:27:07] TJ Farnsworth: I think you're always going to have, um, various opinions.
I think everyone can align themselves with the fact that, you know, there's a shortage of providers. You know, we need more nurses, we need more embryologists, we need more physicians. How do you get there? Those are different types of debates. The administrative overhead of providing nurse services. I mean, one of the benefits of a greater degree of insurance coverage is access, which presents a clinical challenge.
How do you meet the needs of those patients in a timely way? And then also all the other components of this is, you know, just like other parts of healthcare, when you have a greater degree of commercial insurance coverage, you're going You've got a greater degree of administrative overhead associated with that in terms of, uh, obtaining prioritizations, you know, managed care contract negotiations, billing collections, all these things that are the sort of complicated sausage making that exists in all of healthcare and, and some clinics have the level of sophistication necessary to meet those challenges, some don't, some are choosing to say to themselves, I don't want to take insurance, so I'm just going to take cash, which is obviously It helps from an administrative perspective and each one of those clinics should do what they think is right for them and for their patient base.
I think it's about creating a platform by which you could say, here's the path I'm going down and the resources for me and the ways which I can share with others that may have gone down this path or may have been down this path or may are going down this path and we can collaborate with each other. I don't think that there's ever going to be an opportunity to sort of, Coalesce everyone around a single opinion, that's actually, I don't think that's a benefit, I think people going down different paths and trying different things and seeing what works, and then sharing what works and what doesn't work, is how you're getting approved, right?
If we're all doing the exact same things and not trying different things, Then, you know, there wouldn't be a whole lot of opportunity to see what was, what could be different and what could be better.
[00:28:57] Griffin Jones: Does or will the FPA issue guidelines in the way that ASRM will issue guidelines on the clinical or scientific side, does FBA or will they issue guidelines based on, here's what we think are operational best practices?
[00:29:15] TJ Farnsworth: Potentially, I would say that we're, you know, that's something I think, you know, we're going to need broader membership as we, as we get this foundation put into place in order to decide some of those things. I think it's certainly a potential that will, something that will come. But what I can say is that the FPA will not do is issue clinical guidelines.
You know, FPA looks, is not in any way interested in competing against ASRM as a professional society. For physicians, offering advice around, around, around clinical processes and clinical guidelines. It's, it's more really driven around what we can do around creating, you know, business operational best practices on the administrative side.
[00:29:53] Griffin Jones: She said, people are starting to share what's not working, what is working. What is working, TJ? What are the couple operational things, the one to three really specific things that have made a big impact in different groups in the last couple years in terms of operational changes?
[00:30:10] TJ Farnsworth: I think we're all getting a greater degree of, of handle on our data, and so, you know, it's, it's hard to know what's working and what's not working as you, as you operate and tinker with different operational practices at the clinic level, if you're not tracking KPI data, and so I think all of us, you know, that are running networks are getting, have over the past few years gotten a better and better handle, hands around, You know, the data, like how much, how much of a clinic in a given market is, is, is cash pay versus managed care?
You know, what are we seeing in terms of the time it takes for a new patient to get to treatment? What are those barriers? You identify those barriers and, and remove friction points. I think data is, and, and consistent data and, and, and reliable data is, is one of the critical things that we're all coalescing around and getting better at.
I would also say that, that, that the most of us are, I, all of us are, have really sharpened our pencil and improved our muscle memory around the commercial, commercial insurance side of things. We, you know, you know, 10 years ago, the vast majority of clinics were primarily cash pay. And now, you know, 50 plus percent, depending on the market.
Some of it's 70, 80% even in non-mandated markets have commercial insurance. And so you're seeing a scenario where, you know, where places like Boston, IVF, uh, they, they, they've had this institutional knowledge forever because they've, they've, yeah, forever, but for a long time because of the mandate that's existed in Massachusetts.
But you know, a practice in Florida might not have that knowledge. Yeah, I think everyone is, is sharpening their pencils and improving their muscle memory around everything related to commercial insurance, front to back end, which is the front end being, you know, how do you negotiate with commercial insurers?
How do you, you know, what you should be looking for? How do you deal with prior authorizations and benefits verification all the way through? Then how do you submit claims, adjudicate those claims? And execute on collections. I think that's a knowledge and skill set that a lot of clinics just had to refine over the past few years.
[00:32:20] Griffin Jones: With regard to the data, figuring out these important KPIs, like what percentage is cash pay versus managed care, what's the time to treatment or Uh, and making sure the data is consistent and reliable. How do you get that data just from, just from the EMR or are there other software, other methods that you need to do get that type of data?
[00:32:43] TJ Farnsworth: I mean, the vast majority of it's going to come from either your, a combination of your EMR and your practice management system. And then, you know, whatever you're using from a CRM perspective to manage, you know, the new patient pipeline, those sort of three things together are going to, you know, no matter what you're using, no matter, you know, I think everyone is coalescing around whatever their technology platform they're going to use is, and then how they're going to track that data.
And that, that consistency of data within providers, It's giving those providers an opportunity, all of us, to have insights that we can then share with each other that can make us all better.
[00:33:22] Griffin Jones: I find that even when people have all, and almost everybody has an EMR at this point, most people have practice management systems, some people have CRMs.
When they have all three, I still often find that it just Don't have the, like, maybe there's some way of them being able to pull those KPIs, but it doesn't, like, live in a place that they regularly use or that they know how to get immediately, which makes me wonder how they're using it. So, in order to get it, you have to, you have to have those three things, but then, do you need to assemble a specific team that gets that information?
Do you need to train the people who are already using it? to get information. How does, how does that work?
[00:34:06] TJ Farnsworth: The first thing is creating consistency of data. So what I would advise, uh, a clinical provider, whether you're, whether you're a single practice or whether you're a large network, And that's what we're going to be talking about today is creating consistency of data, and that has to be a multidisciplinary approach that's got to be administrative, lab, clinical, physician, let's all agree what we believe this KPI means, because you'd be sort of shocked and surprised to know that a new patient consult means different things at different clinics, right?
And so, and you probably wouldn't be shocked to know that, but, but it's, it's, it's It's wild. And so you, first of all, you need consistency of data. Here's how we're going to track this data. And here's where we stack our hands on what this data means. Because if, if the, if what the definitions of that data changes over time, it really creates a difficult, how do you create your, over your trends?
How do you see, is the, is the change to the data because you change the definition of the data or is it because the data is actually changing? So I think that's foundational before you even get to like, how do I present it? How do I track it? And many, I would tell. You know, there, there are lots of different choices in terms of automating the production of KPIs, uh, for small to medium to large practices, um, and platforms that, you know, you don't want a bunch of your staff, you know, reporting KPIs up the chain.
That's just, uh, that's an administrative headache that they don't want, that they don't want to deal with. You got to figure out when to automate that. But before you even worry about trying to automate it, you got to make sure that the data is right. Otherwise you're just presenting wrong data.
[00:35:35] Griffin Jones: So you have to get that consistency of the data you wanna automate it be because you don't want people just hunting down data that they're having to pull.
So it's gotta be automated, it's gotta be at the top. It's gotta be consistent. Then what are people supposed to do with it? How are they actually supposed to get their teams to make any sort of meaningful change or informed decision because of it?
[00:36:03] TJ Farnsworth: Well, I think, I think whether it, you know, whether you've got dedicated professionals who this is what they do is they look at the data and analyze it and then report back on it or whether or not you're going to create a multidisciplinary team of people that looks at the data.
I mean, what do you do with the data is usually told to you by the data, right? So, so, but I think, you know, generally speaking, our healthcare in general tends to be a Made up of a lot of people, whether it be business people or clinical people, who are data driven individuals. And so, if you know that the data is right, you know it's consistent, it's not something you can really argue with.
Now, you can argue about what you, you know, what your reaction might be, but if you're seeing, you know, X, Y, or Z, if you're seeing, you know, one, One embryology lab you have is got a materially better, you know, outcomes rate in some kind than another, there's a best practice to go find there, right? There's an opportunity to learn and, and, you know, what the answer to that would be, the solution that would be, would be way above latte grade, but, you know, that's one side of things on the side, well, it's all the lab side of things.
There is unquestionably the same example to be given for a clinical physician driven data that would come. And then obviously, you know, you already see how long does a patient sit between a new patient consult and a benefits authorization? Okay, what, where are there opportunities for me to automate that or streamline that or reduce friction so that I don't have patients waiting and that's one of the A couple of dozen examples that we can come up with on the sort of, um, you know, administrative operational side of things.
But the data, you know, once you look at it, as long as you know it's consistent, as long as you know it's right, we'll tell you the answer. And I think what we're trying to do with the FPA is then create a platform of communication and collaboration where we can take that information that we're collecting at a personal level.
At an individual provider level, whether you're a, you know, single clinic or whether you're a, you're a small group of clinics or we're not your large platform and share them with each other in a way in which we can improve all of us. I think that's, that's ultimately the goal.
[00:38:12] Griffin Jones: How do you keep that communication consistent?
One thing that I noticed, so I'd sit on the board for a while. For the Association of Reproductive Managers, which is a subgroup of A SRM, and we've got a forum, and I think the different professional groups also have their online forums. And every once in a while someone will pop on and be like, what do you think of Engage md?
What do you use for this? What's your take on this EMR? Or how do you calculate this metric? And then you'll get people, that answer is just kind of random. Like there isn't, we haven't. Ben, really able to find a way where, you know, consistently we've got people sort of sharing that communication. We have our meetings that are well attended, and we do virtual events that are well attended, and maybe that's the answer, but have you found a way to keep that sort of, that, that communication consistent rather than just when one person has a problem and then, you know, tweets it out in the ether for advice?
[00:39:06] TJ Farnsworth: Yeah. So what we've done so far, again, it's early innings. And so there's a lot of truly you've learned with ARM that we could probably take and adopt, but right now, you know, the FPA board is meeting monthly and then we've created subgroups of the board, you know, one, you know, aimed at different things.
For example, you know, you know, just using an example, we talked earlier, public policy and lobbying efforts and saying, and there's going to be a subgroup that meets more frequently as we advance that. And then the board itself as a whole is going to be monthly. Well, the, the, what the, the, the key evolution of the FPA is gonna have to be is how do you then extend that outside of just that core group?
And as we begin to develop a value proposition to a broader and broader membership, I think that's where the, where the challenge will come. And, you know, the problem is, is that, as you've seen you, I'm sure what these, with these, you know, these forums, you know, we create that internally even within Inception.
So let's, you know, we create a. Yeah, we have a team's channel for all the lab directors, we have a team's channel for all the nurse managers, we've got a team, you know, and, you know, some of them are more active than others, but the problem is everyone's got a, everyone's got a job to do, right, so they get busy, and it's hard to really try and drive that engagement.
I think you're going to have to, you know, the most successful strategies around that are really pulling, right, which is, you know, You know, which again, one of the gifts of COVID is this rare degree of acceptance over virtual meetings and, and everyone gets busy. But if this is a priority, we all agree is important, but it's something we'll make time for.
[00:40:39] Griffin Jones: What you do with the data is usually told to you by the data. It's a good quote, TJ. If I steal it, I'll give you credit for it. Okay. And I think of some of the challenges that companies selling into the fertility field are having is there are people who are really trying to solve the problem of patient wait times, of patient engagement, of time between consult and treatment, time between scheduling and consult, number of Phone calls that the nurses and providers get, adherence to protocol, etc.
And some of these solutions look pretty good. I think one of the things that they're struggling with is a convincing story to be able to show to the patient. People like the members of the FPA of this is exactly how we're going to, our solution reduces these wait times and this is exactly what the wait times are costing you and this is exactly how we're going to reduce the wait times, this is exactly how we're going to save you XX million dollars and we're only charging you Y million dollars.
It seems to me like they often miss that scale of, of data and partly because each different member has their own data, so, so each network, each clinic has their own data, and why would I give it to you startup? You know, you're trying to charge me and you want my data. That seems to be a catch 22 that is preventing the field from scaling faster.
Do you see. Is there any way that the FPA might be able to play a role in this where there's some sort of data that people can use as benchmarks or ways of being able to share and get information so that we can actually see who's providing value and who isn't?
[00:42:24] TJ Farnsworth: Yeah, I think there's no question there's probably an opportunity for, and we've talked about this, is the creating, you know, Benchmarking data that we could share and that wouldn't be the, you know, U. S. Fertility giving Inception their data. It would be an independent organization that would be able to, we'd all be able to provide our data to you and that could then provide benchmarks for all kinds of various different metrics that would be important to various vendors and to each other to say, Hey, you know, why am I, you know, outside of this, you know, benchmarking norm and where it may be identifying opportunities to improvement that we didn't necessarily see on our own because we're only have around data to work with.
So we've actually, no question, we've talked about that, but I think that strategy of, you know, vendors who take, one of the things I will say is I've, I've found unique some of these sort of, sort of startup, startup startups that are trying to solve some of these problems is. What I've seen in other specialties is a willingness to come in and prove it to companies, and I haven't seen that from most of these new entrances to our specialty yet.
I think that'll come, but I think part of it is, you know, raising money is hard right now, and so the idea of giving something away for free for a period of time to see And prove that it does what it says you gotta do is tough.
[00:43:35] Griffin Jones: But I think, you know what, so this is what I mean by the, the catch 22, and I wanna stay on this point for a second because I think you hit it on the head.
I do think that they just don't have enough proof. Like they've got some proof of concept. They've done a couple of small case studies, they do see the need, like working really hard. I think they often just lack the like, here's the, like the real proven example. Let us come in and prove it first to your point.
That probably does have to do with fundraising, and I don't know that it's just because capital is a little drier now. Two or three years ago, capital was not dry, and there still wasn't a ton of VC influx into the fertility field. And very often, what these founders are telling me is that the VCs are telling them, field too small.
Opportunity is too small, TAM is too small. And, you know, I think you and I are both on the David Sable train of, we don't think it's too small. We think we could be doing 10 times the volume that we're doing in the United States alone just to catch up to European countries who all, who themselves are probably not doing as much as they're going to need to be doing as It's a very strong, but everybody gets it.
100%. And as society starts to think about demographic collapse, just wait until that's the thing that economists are talking about, demographic collapse, and all of a sudden, IVF gets more important. So, you and I see that picture, but I think what VCs are looking at is, well, all you're doing is 250, 000 cycles, therefore, you know, that's TAM's not big enough, therefore, you're not getting this money, which means that they can't prove it to you, which means that solutions can't be implemented to scale to make that addressable market actually addressed.
How do we, how do we solve for that?
[00:45:25] TJ Farnsworth: It's a tough one because I think a lot of those professional investors have, you know, a shorter time horizon than, you know, UIF in terms of why we think about this industry. And, and, and so it's, it's important for founders and for CEOs of those smaller businesses to understand that, you know, yes, this may be the size of the market now, here's where I need it to get to.
And, and look, there are going to be some investors that understand that this is a longer term horizon than, than others. And, and You know, whether that's limiting their ability to invest in improving their product or not, I don't know. I don't run those companies, so I don't, I don't have any idea, but I do think, you know, you know, for us, for us, you know, they are taking, uh, you know, for taking my hats on and off here, but, uh, from an Inception hat perspective, You know, someone's willing to come in and prove a product that, you know, I think, I think if I was a CEO of that company, I would want very clear metrics that we're all going to agree on in advance, how we're going to collect that data, how much time we're going to collect that data, and what that means, but what does success mean?
Like what, how are we going to define success? Again, just be able to do a trial and see if it's successful. How does it, how do we define success? And then if it is successful, what does that mean? Does that mean I have a new customer? Because then you just think of it as part of your customer acquisition costs.
And I think that's the challenge for some of these smaller companies. You know, you know, whether it be software companies or product companies or technology businesses that are entering the market to try and solve some of these problems, especially, especially in the cases where they're, they're pretty young and they're pretty new and they don't have a lot of examples that they can point to and say, look what we did for that company.
Cause you know, it doesn't take much to, to, to build a few examples. I mean, EngageD is a great example of that in terms of the fact that look at their market penetration and it's that way because they've proven over the years what the value they proposition they bring to the other clients in the space.
[00:47:16] Griffin Jones: The customer acquisition cost is real high, and that makes it a challenge, but it isn't just the startups, and so, therefore, it seems to me like it isn't just venture capital whose timeline might be too short. I wonder about private equities timeline being too short. Many of the groups in the FPA are, for Our private equity back groups and when you have solutions like, you know, it could be, it could be time lapse imaging.
It could be, it could be cryo safety or cryo storage solutions that aren't really like startups or many of them aren't anymore. They're established. They have proven themselves, but their penetration still seems to be Pretty slow, and it seems to me that that's very often the case because they can't convincingly show this is going to return the investment in 18 months, therefore, that's too short for a private equity three to seven month timeline.
Now, you run a private equity group, the one you're currently running, the one in the past, you work with other folks that are Our private equity group, so like, is this a challenge for having too short of a timeline to be able to implement some of these solutions?
[00:48:28] TJ Farnsworth: I can't speak to, you know, everyone, private equity partners, like Will City is the most private equity funds have a sort of somewhere between 5 and 10 year time horizon on their investments.
But I've never once been in a board meeting. Both my own companies and the ones I sit on the boards of with a private equity firm is preventing or resistant to investment in something because it will be outside of their time horizon, because they, they realize that the, you know, you know, the continued momentum of the business is part of what makes it,
[00:49:01] Griffin Jones: I've asked you a bunch about the FPA and so I want to let you have the concluding floor whether it's about the leadership coming up, whether it's about new initiatives that you want to take on, whether it's about what you would like to invite prospective members who are listening to know so that they join up.
The floor is yours, TJ. How would you like to conclude?
[00:49:22] TJ Farnsworth: Yeah, I would, I would encourage anybody who is a provider in the space to come talk to us, understand what we're trying to build, what we're trying, we have not made a major membership push yet, although that's coming, mostly because we want to solidify the value proposition that we can bring, because it's an organization that has to be a part of, you know, everyone's small, medium, and large clinics.
Not every clinic, some clinics are going to be academic forever, some are going to be independent forever, and that's the right thing for them. The important thing for us to do is to build a platform for collaboration and communication that lets us all be better. And I think if that's something that's of interest to one of your listeners that's a, that's, you know, running a small clinic or medium clinic or larger clinic, reach out to me, reach out to anyone in the membership, the leadership of FPA, reach out to FPA directly.
We do have independent operations of FPA. We asked an executive director that's independent of any one of our networks. It's, it's, it is being stood up as an independent organization. I think it's really important to know that. And I think it's something that, you know, as there's more and more, you know, anxiety within our industry, whether it be from political winds changing from here to there, We're just from the perspective of the fact that we're trying to figure out how to meet the needs and the demands, the growth to your example of being 10 times the size of where we are now over the coming years, we're going to have to do that in a way that, that, that, that is us working together.
And if that's something that resonates with, with someone, they should reach out and see how they can get involved.
[00:50:51] Griffin Jones: TJ Farnsworth, I look forward to having you back on the program another five times. It's always a good time talking to you. Thanks for coming on the program.
[00:50:59] TJ Farnsworth: Do I get a jacket like Saturday Night Live?
Like they get like a five timers jacket they used to do on Saturday Night Live? I feel like there should be something.
[00:51:05] Griffin Jones: It's got to be double digits before you get a track jacket, but you're getting in shape. So we're gonna, we're gonna have to get the right size for you. And, and we might have some cool t shirts coming out for it.
So thanks for coming back on TJ.
[00:51:18] Sponsor: This episode was brought to you by Organon. Organon is committed to championing care equity in fertility. By elevating education, expanding resources, and investing in innovative solutions, Organon stands with aspiring parents on their unique journeys. Learn more at fertilityjourney.com.
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