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What do you do if your lab staff sees the value in a new technology, but your business leadership views it as too much of an expense and not enough of an investment?
This is one of the many questions we explore with Dr. Jason Barritt, Chief Scientific Officer of Kindbody. Dr. Barritt provides an inside look at how he leverages innovative ideas to make fertility care more accessible and affordable at scale.
With Dr. Barritt, we dive into:
Expense vs. Investment with new technologies (Using time-lapse incubation as an example)
Giving lab directors a voice through equity ownership (And how that positively shapes network growth)
Moving the subsidization of advancements from cash-pay patients to insurance (The process of how that could work)
How scale can drive down costs (What he's doing at Kindbody to reduce cultural media costs by up to 90%)
Dr. Jason Barritt
LinkedIn
[00:00:00] Dr. Jason Barritt: These things are not even discussed if the lab director or an owner or embryologist is not in the room. So you have to get invited in. And I found the best way to get invited in is have a very small piece of that pie. Now it doesn't mean as again, I get to make any of the definitive decisions. But I get to be in the room and or be asked the questions so that they can have the information to make the best decision, whatever that is.
But I also get to know how the decision is made and what the decision ultimately is, and how I'm going to then implement it.
[00:00:32] Griffin Jones: And later on in the conversation
[00:00:34] Dr. Jason Barritt: We do a lot of business with the IVF store. They will probably go out and find what you need if they can, additionally. I know this sounds weird to some people, but truthfully, it's very, very valuable for us.
And that is
[00:00:46] Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you, but the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
[00:01:11] Griffin Jones: What did Jason and I talk about specifically? When lab staff see the value in something, but business leadership sees it as too much of an expense and not enough of an investment. For that, Dr. Barritt drills into time lapse incubation as a specific example. Let me know if you agree with him. I'm starting to see a pattern among embryologists.
We talk about how equity ownership gives lab directors a voice and gives them a seat at the table in conversations they might otherwise be asked to step out for. This one talks about how advancements might be subsidized by cash pay patients at first, but then we might be able to force insurance's hand to pay for them and how that might work.
It talks about how scale can drive down costs and what he's doing specifically now at Kindbody to test reducing the cost of some of the cultural 90 percent. And then how embryologists Can persuade business leadership to not only put those cost savings into profit, but to use them to pay for investments that continue to grow the top line and improve the standard of care.
Enjoy my conversation with Chief Scientific Officer, Dr. Jason Barritt, Dr. Barritt. Jason, welcome to the Inside Reproductive Health Podcast. Thank you, Griffin.
[00:02:22] Dr. Jason Barritt: Happy to be here.
[00:02:23] Griffin Jones: I should say welcome back because this is the third podcast interview you and I have done. It's just the only one we've ever recorded online.
The other two have just been conversations between you and I. And initially you were thinking, Well, what would I talk about if I came on the podcast? And I said, Jason, we just talked about it. You have all of these really interesting points of view, deep insights. I wish that I had a microphone. And Now we've, we've got you on the, the show and I'm, I'm happy to do that because you've got a lot of insights into the IVF lab, and I think you also have insights into the business of the IVF Lab because you've owned equity in fertility practices and, and still do.
And so I'd like to just start with, you know, just a general, intro of what your views on IVF lab ownership are and, and lab directors owning equity in either the lab or the clinic.
[00:03:22] Dr. Jason Barritt: Well, nice broad beginning, and yes glad that we've had our, I'll call it pre conversations. Even though I am of course in Beverly Hills, we don't have cameras following us all the time for reality television and so not all those were recorded, but the good news is we can talk about all these things again now and put it on the record so that you can show other people and we can have good conversation about all these things.
So happy to be here and happy to talk about the the subjects that we'll hit today, including laboratory ownership. So I'll, I'll, I'll go down the first road of saying I really am for lab directors owning interest in the laboratory they run. I fit this category because what it does is it allows that individual to be in the conversation with the other owner or owners and therefore they have a seat at the table.
Now in my case, I'm a very small percentage owner, so I don't actually have any type of controlling interest, so my vote technically would never matter. However, being in the room when things are being discussed actually allows you to be a part. of the product that is then going to be put out. And when I say product, I don't mean it in a negative way, I mean it in a positive way.
Because most of the directors are really dedicated individuals who have come up the ranks, have done it with their own hands, made babies with other people, learned how to manage people, and figured out, basically, how to run a little business. And be successful at it and work with a whole lot of really smart medical doctors who want certain things for their patients.
Also at the same time meeting regulatory requirements in order to make sure that everything's done at least at a minimum at that level, if not so much better. And then you have to manage people at the same time. And oh yeah, you're handling multiple millions of dollars of liability, walking around doing things.
For others. You're there to protect those patients in every way, because they can't do this themselves. You are the surrogate to that. And so the people who are then in the room and directing these have so much experience and knowledge of, I'll call it business management, it just isn't always the business itself.
And therefore, having them in the room and being part of the discussion actually makes the laboratory better. A much better business overall. So I'm strongly in favor of lab directors owning pieces of the lab.
[00:06:05] Griffin Jones: I asked you, hey, Jason, I'm selling sponsors over here, who do you really like to do business with?
Why the IVF store? What the heck do you like about them?
[00:06:14] Dr. Jason Barritt: We do a lot of business with the IVF store. Not that we don't do a lot with other ones too, we're a big company. So we, we do get things from many, many places. So I don't want to try to say negatives about anybody. But the key thing is that we, we found that they are extremely.
Easy access to get the supplies that we want both online, by phone, through electronic means. They've coordinated with our hybrid ordering system, so they've made it easy for us to be able to get the supplies that they have. They are definitely a curated set of supplies that are very specific to IVF.
They will probably go out and find what you need, if they can, if you actually ask for that, and that's very, very hands on, wonderful adapting that they do for us on that. Additionally, I know this sounds weird to some people, but truthfully it's very, very valuable for us, and that is that they will respond to the request to minimize the number of lot variations between supplies.
So you say that you get the same dishes, one box is a different lot number than another box, which means then you have to test it and track it. It's actually a pain to do and so they will minimize that. Even on a small order where you're only ordering like three to five boxes, they will try to make sure that it's all the same lot number.
You can also Buy a bunch at once and ask them to get you a whole pallet of things if you really want it and that way you only have to test and spend the money and or at one place in order to know that is exactly what you want. Something they've definitely done for us is test and actually do the MEA mouse embryo assay testing for us and complete that so that we can buy directly from them and it's all pre done.
It's actually much easier than buying a whole bunch of things. Sending it to, in our case, like 18 or 19 different places and every place testing their own thing. It makes it very cost effective for us that they adapt on that. As I said, they will go out and find what you need if you really can ask for it and if you know what you want, they then make sure there's enough in supply.
COVID affected us all in really, really weird ways with getting stuff. They've done an excellent job in making sure that they have the supplies available when people need them.
[00:08:10] Griffin Jones: What specific concerns or interests are underrepresented when lab directors don't own a piece of the business, when they don't have a seat at the table?
[00:08:23] Dr. Jason Barritt: That's interesting, because you find that it's actually different with different groups, so I've been lucky enough to work and have Multiple other owners with me, and they have very different beliefs about what really occurs in that special little box that generally has no windows and has low light and everybody's wearing essentially pajamas all day and making babies in their pajamas.
They get up early, they they do their work as early as possible, and then they leave and try to go have a life outside the lab. So, they all wonder what goes on in there. And the truth is, most of the time, the owners, or the medical doctors, if they're the owners, or actual corporate, if they're the corporate owners, almost never actually go inside the laboratory and actually feel what it's like to do the work.
The understanding of what it actually takes to do a retrieval, And I'm not saying it's difficult, but you do have to get very good at it. And what ends up being found is they think it's just, hey, we just hand you a tube and everything's taken care of from that point. But the truth is, there's a whole lot of steps and a whole lot of adaption that's going to go on on the other side of that wall.
And if they don't have that clear understanding of how much is going to go into it, such as the timings, That are on the clock biologically that need to be met in order to optimize success. They don't understand that everybody's not wearing perfumes or certain nail polishes, and you're in an air handling system that filters out certain things and so you're breathing differently.
All sorts of different things go into the success of that room. They don't always know the level of detail that an embryologist will go to and that the lab directors will try to oversee. I'll give you An interesting example I've been asked multiple times by other owners yeah, you guys, you know, quality control the, the equipment and everything else.
And I said, yes, yes, we do. In fact, we monitor that every day, multiple times during the day, in some cases for different pieces of equipment that you're going to use. We do this for the safety and security of the patient's tissues, but to understand the level we go to, We actually, at the last location that I was at, which was one location that I was managing, it was a large one, but it was one, it took over one hour of a person's time every single morning to go through and mark down all the quality control of the equipment.
You think it's just as easy as, Oh, it's operating at body temperature, 37 degrees Celsius, perfect, everything's fine and good to go. Well, there were about 16 surfaces that needed to be done, 12 to 15 microscopes that needed to be verified that they were operating correctly temperature baths, incubator gas lines verification that switchers and backup batteries were working, fridges, freezer temperatures.
It is a lot of work to do this right, and not all ownership groups understand that. When, when I say that I need to afford a laboratory assistant to go around and do a lot of those things so that I optimize the dollar value of an embryologist's time instead on embryology duties, I have to actually justify that.
And so going into that room and having the discussion on why that level of quality control needs to be in place in order to succeed has to be discussed. Because if you're not in the room They don't even pay attention to what that takes. They just expect that something's happening there. The problem is when you expect something, it's not always going on.
[00:12:01] Griffin Jones: So is that really the difference maker? Just being present and having a financial stake in the company allows you to be present for those conversations? Is, is Because I was going to ask, why wouldn't just, you know, someone that is they're, they're the lab director and they're an employee, why wouldn't they also have this share of voice to be able to say, I need to be able to afford a lab assistant, we need to have these quality controls in place.
Is it, is, is the fact that when they have these things A financial interest in the company, that that puts them in meetings and conversations that they just can't or wouldn't be if, if they were only an employee?
[00:12:46] Dr. Jason Barritt: There's probably a few centers that they would be in the room or they'd be asked in during certain times and then asked out during other discussions because politely when money is discussed and, and I, and I mean this in the best way possible, you actually don't want everybody in the room.
You don't want everybody involved in those things. And some decisions have to be made up based on money. Some have to be made purely on quality and success. And then some are the mix and all sorts of other factors that come in. And unless you're invited into the room, even if you're not an owner, it's not going to happen.
They're not going to talk about which incubator to get. Or whether you need another one, because you don't want to max out the number of spots in one, and you want to distribute things more evenly. Or you want to switch the device that you're using for the freezing method. Or, you may need more storage area, or do you want to ship them out to a long term storage facility, and how that affects It's the business model of, okay, we're billing the patients and we're receiving it for that versus, okay, now there's shipping it out and somebody else is going to take care of that for us.
Those involve business decisions as well as actual physical hands on clinical decisions. Because politely, to ship materials out to a long term storage facility actually takes quite a lot of time and organization. And then you lose the revenue side of that. You also gain the space so you can treat even more patients.
And so these things are not even discussed if the lab director or an owner or embryologist is not in the room. So you have to get invited in, and I found the best way to get invited in is have a very small piece of that pie. Now, it doesn't mean, as again, I get to make any of the definitive decisions.
But I get to be in the room and or be asked the questions so that they can have the information to make the best decision, whatever that is. But I also get to know. How the decision is made and what the decision ultimately is, and how I'm going to then implement it. Because, politely, I will never win every single thing.
I shouldn't. I don't know all the information and I am not the smartest person in the room on many things. Especially business. I didn't go to business school. I didn't go to marketing school of how to sell something either. But I do know how to operate the lab. And so My little piece needs to be understood, but then I need to understand how it's going to work in the bigger picture of the business, and its operations, and its success.
And therefore, what I need to do, or what I'm being asked to do, why, and then can I get it done, can I get it done fiscally responsibly, in a timely fashion, and still maintain, or Even get better with success.
[00:15:30] Griffin Jones: That was a question that I had too, does it work both ways where, so you have the business making decisions that are more considerate of the lab, but you also have the lab making decisions that are more considerate of the business because it's, I see it all the time, there are business owners that are making decisions not fully understanding how it affects different teams.
Different team leads will make all kinds of decisions because it ain't their money, it's just, it's just magic money that comes from somewhere else. And so Or
[00:16:04] Dr. Jason Barritt: you never know how much of the money is being spent, you just ask for and, okay, maybe I get, maybe I don't.
[00:16:10] Griffin Jones: And so how does, how does it work the other way, where the how does it help lab personnel to make better business decisions?
[00:16:20] Dr. Jason Barritt: Okay, so, embryologists can go to these wonderful educational meetings, ASRM, College of Reproductive Biology, AAB other more local meetings you know, Southwest meeting embryologist meeting, or just talking with other embryologists and such. And they learn about, I'll call it, new technologies, new equipment, new ways of doing things.
They can bring those back and have discussions and think about or get vendors in touch and things like that. And so, New things can be brought to the table, but the truth is not everything can be done everywhere, especially all the time. That's an impossibility. No one can afford that. But what they learn is that when they do bring those things to the table, others are going to evaluate them from a different perspective than they had.
Oh, I heard about this great machine that is a time lapse machine and, you know, supposedly it can, you know, lead to more success. And well, here's the data from some studies and, you know, maybe we can get one of these. And then that goes up the chain, and then there's a business discussion as to, well, that's actually a very expensive piece of equipment, it actually costs a lot to maintain.
Oh, wait a second, you say you'd like one, however, I'm not quite sure we can just do that and how would we work that into the system? The embryologist then learns, oh wait, you could market it in a certain way. And use that data that's out there and the physician can then, per se, present that opportunity or that add on in a different way.
And then there's a pricing model. Is there a way to offset the extreme costs of the equipment, but increase the success? And is there a business model that works? They have to learn it's not a money tree that they go to and just happens to be there. It has to be justified. But when they can be a part of that.
And then they can hear it back as to, okay, we can consider doing that. We'd have to believe that we're going to be able to get a hundred patients that are going to choose to do an add on at a certain price point. And then we're going to be able to market to that. That actually costs us something.
However, there's a revenue source that may come with it. Are you sure that the data is there to support this and that this is the right investment? They become a part of that conversation, but now they've understood It isn't just, Hey, please write me a check and get me this beautiful box that I'm going to be able to play with in the lab.
And I'm going to be able to succeed with, although they want that. They actually have to understand the entire other side of it in order to actually use it in the right way, because otherwise you're just getting a toy. And I appreciate toys and I love the science side and doing new things, but the truth is it's not a money tree.
You actually have to run this as a business.
[00:19:05] Griffin Jones: So, on the scale of the spectrum of toy that is a nice to have, and on the other ha So, you know, I think the end of the spectrum, a must have that is necessary for the quality of operations in the lab and can return the investment. Where do you put time lapse on that spectrum?
[00:19:26] Dr. Jason Barritt: Oh, tough. So I've been, I'll call it, I've been I was lucky in the fact that I was able to have that sort of conversation that I just had with you approximately 12 to 13 years ago with the group of doctors that I was working with at that time. And I was able to convince them to give this a good shot and that we were going to be able to use this in a way to improve success and be able to use it as a marketing tool for us to be able to Per se provide to patients an add-on that would help them achieve pregnancy faster.
And so, they purchased one time-lapse machine for me and the team that I had. We used it, we did some we did some studies of the outcomes of the patients that had been in it. We actually saw better growth and development in the machine while we were using it in the first essentially couple months that we were using it.
And we started talking about more and more of, Hey, this thing even does better incubation, let alone. The success we didn't even know at that point. And we're like, wow, this, this has other advantages. We also learned that we can learn a lot from time lapse. The truth is when you can look at a video development.
of an embryo. You learn a lot more than taking a one slice picture every single day. So we actually found this was an unbelievable training tool and we could actually get much better at our uniform grading and realizing what embryos can do in a period of time and when they are a few hours younger or a few hours older, how different they can be.
So we actually learned a whole bunch of training positive things from making this investment that we never thought we would have learned. By just making the investment. So time lapse ended up being not just a, okay, this is, this is the top 10%. Okay, it's a toy, but it actually has some good things. It's a 10 percent investment to, oh my, we really should be doing this a lot more.
We should be using this technology to learn more, gain more, make better decisions. We ended up doing an abstract and showing that we had a 20 percent higher pregnancy rate from the first embryo transferred. When we used the technology, so it ended up being exactly what we said it was going to be an improvement in our ability to succeed for patients, but it had so many other benefits that now I put time lapse as much more towards the, yeah, you should be doing this.
As it improves the outcome for the patients, and yes, it does cost, but there are so many other benefits that come with it. So, it went from, okay, it was 10 percent of the thing to, I'd really like it to be at least 70 percent of the thing, because in 70 percent of the cases, It will help you pick the right embryo the first time.
That is success for a patient. And at the same time, everything else comes with it. You can rank the other embryos. You can learn and teach and train. You can have more information. And then you and I probably go down the road of AI and how much this can add to that. So it went from being a 10% Per se, need, want type thing to at least 70%.
I might even say in the future, it'll be 90 plus percent.
[00:22:45] Griffin Jones: Would you ever go back to not having time lapse?
[00:22:48] Dr. Jason Barritt: So yes, of course, there is a place for it for time lapse and there's a place for not time lapse. What's the place for not? So if somebody is going to be probably not doing genetic testing of the embryos, I'll call it even A at this point for those embryos.
So we're not looking at that. A standard general culture, if they're going to transfer whatever embryos are there, the best ones based on an embryologist's choice, and their intent is to transfer whatever the best embryos are in order, and they are not concerned with getting to pregnancy as quickly, it is more the what tissue I make, I'm going to use and attempt.
They're a perfect candidate for a regular culture, because I'm not going to go to the extremes of anything. I'm not going to biopsy the embryo and do an invasive genetic test to see if it's normal or not. We're just going to transfer it, and if nature is going to decide that was the normal one, it'll work.
If it's not, that's okay too, because I have the next one after that, and the next one after that. If they are willing to accept it, They are going to go with nature, even though IVF is, of course, not quite natural. They are a perfect candidate for the one at a time. And, and if you're not going to do the genetic testing, there's really no deal to need to do the time lapse.
Now, could it be beneficial? Of course. But, they are not the one who need that. Their intent is different than the, I need to get to the baby as quickly as possible with the first attempt being the highest chance of success, with all the knowledge about that embryo itself, its growth and development, and its genetics.
If they're not in that category, they're not a client for it. And it works, and it does work fine. It works actually quite well, but time lapse.
[00:24:39] Griffin Jones: I just sent out an email that said, who's your favorite vendor? So many of the lab people said IVF store, IVF store. Why is that?
[00:24:49] Dr. Jason Barritt: Well, they have some very, very experienced individuals running the company and some really Unbelievably, what I'll call happy to help you people type things there. They answer the phone, they will spend the time with you to find the thing and they will find what you need, how you need.
They'll look in their things, they'll find out which warehouse it's in and find out to verify that actually their ordering system says they have three. They'll make sure you have three before they tell you, okay, we got you three, and make sure all that's done. They are really good at the hand holding, they are really good with the positive interaction, and they have some unbelievably experienced people in this field.
They have changed the dynamic in the world. Being able to get the things that you need the way you need it when you need it. That's the other amazing thing. I actually ordered one item. I sort of needed it pretty darn quick, like the next day. They were able to accomplish that, of course. Other ones might be able to do that also.
But because I wanted to minimize my cost on it, I ordered 10 of them. They didn't have all 10. Available from that one place at one time, and they were going to have to charge me the double on the shipping and everything else. Thankfully, they worked with me. We found a way to ship them from the two places that we needed to do it at a discounted rate, because the truth is, it was actually going to be one price from one and one price from the other, and it was cheaper than what had originally been done, had I not been ordering as many, but they found a way to do it and do it cost effectively for me, even though I needed it in a rush.
[00:26:23] Griffin Jones: So, I keep hearing this from lab directors, and I'll ask them on the show, you, Jacques Cohen, Alison Campbell, and asking them, you know, do you see time lapse as a must have? And you say there are still scenarios where it's a nice to have, but increasingly, it's more of a must have. It seems to me that, that seems to be like a consensus that is forming, but it's Maybe 20 or 30 percent of the clinics in the U. S. and Canada have time lapse, and so that's a big delta. Is the only thing that's going to close that delta having more lab directors and embryologists own equity in their companies? Because what seems to be happening to me, lab directors and embryologists saying, yeah, we want to have this, and then at the business level, they're saying, Yeah, but on the P& L, it's just, it's not going to return the investment that we need in 18 months.
[00:27:20] Dr. Jason Barritt: Oh, it's not in 18 months. No doubt about that. If you have a, if you have a time window that's 18 months, and I'm going to call that short in the IVF world you're not going to get it back. It's just not going to happen that way. It's got to be a longer term thing than that. So I'll say this. I think it's transitioning.
Thanks That there is a balance between greater success or time to pregnancy. So success is one thing, pregnancy, but there's also time to pregnancy or how quickly you get to that pregnancy. Either first attempt time, or time on the clock, how many months. Both of those are actually important things for patients.
At first, in these discussions, they wouldn't have been so big. You're just going to get whatever treatment, as quickly as we can do it, and the success when it happens. That's not the client who comes in the door all the time anymore. They're on their clock, and it's moving quite quickly, and in fact, the later they come to us, that clock is ticking faster.
Politely, eggs don't get better with age. Wine does, but not eggs. So you don't want to take forever getting there, and you want to know what you have and all the information about it, and timelapse allows that. It allows it in a much faster timeframe. So yes, being in the room helps. Yes, having the knowledge of the expense of it helps, but I'm going to throw a little bit of a wrench in here.
And that is, I'll call it mandated coverage, or insurance based coverage. This is a challenge. When it is a cash pay patient, they can add this on without an issue, as they can make that choice. When it's an insurance based situation, they could be asked to add this on if they wish, or could be that insurance won't cover it, and therefore that's not something they're going to get.
However Is that providing the best thing for that patient, or was the insurance based client just getting access to care? But then the clinic has to make a choice. Let's just do everybody in time lapse so we do everybody the same and we get the greatest success for everybody. And then let's just do the cost averaging across everybody.
And even though insurance isn't going to reimburse for any of it, let's just do it for the reasons that we want to do it better. And we want to succeed more and that's a tough decision to make because it is so much more expensive. The truth is that it probably adds somewhere around 250 to 500 per cycle.
Depending on which machine you have, how much work you do, how much time you spend on it, preventative maintenance, how many you have, all these things. Politely, that's an expense. In an insurance based model, if you've made your contracts and don't have that included, that's a hard one for a clinic to eat, unless you have enough cash pay on the other side.
So when you have a group that is 10 percent cash pay and 90 percent insurance, probably not going to be able to offer this. Or at least not offer it to everybody. Whereas if you have a better mix of 50 50, you might be able to have the cash pay, afford to actually put the machine there, and that everybody else gets the benefit of it.
And that they also get to go in that same incubator. And therefore, they get to succeed and get that benefit because the clinic has decided that this is what we're going to offer for everybody. So it's a really tough thing to do because insurance is not going to cover this type of add on. And often, they won't even cover PGT A, the genetic testing of embryos, for standard screening of chromosomes.
They have to pay for that in order to get the normal one transferred. That's actually an upfront expense to them. Whereas they'd rather pay for a couple rounds of frozen embryo transfers, whether it's known or not to be genetically normal, and because that's cheaper than it is to do the testing. And that's the same thing that's being done with time lapse.
It's great. It will actually increase and get you to a pregnancy faster. But at what cost and are they going to be able to and willing to do that? So mandated coverage, insurance coverage is going to change this drastically into who gets it. Some places are just going to do it for everybody and eat part of the cost.
That's cost of doing business. You want to do the business the best you can and more patients will come to you because of the success.
[00:31:58] Griffin Jones: Well, if that happens, Jason, is there also a play to then. Get the insurance companies to pay for it, so let's say you are, you know, 50, you're 50 50, you, like you say, you decide to average the cost, do it for everyone, is it, if that brings success rates up sufficiently and or if that allows Patients it reduces time to baby more quickly because you're picking the embryo, right, the, the first time.
Does that then allow the, the network at that level if they're, if they're doing enough to, to approach the insurance companies and say, this is why we're a center of excellence, or this is why this reimbursement rate needs to be higher. So, so initially they're, they, the cash pay patients are the ones shouldering that.
Cost, so to speak. But can they then use that to make, to, to raise the standard of care that the insurance companies have to meet? Or is that, is there's too many obstacles in between that the, that the insurance company would ignore.
[00:33:01] Dr. Jason Barritt: So they don't ignore it, but they resist. Right now, however, what we seem to understand is they're already.
Basically asking us to do it because they actually want to get down to single embryo transfers of no normals. They actually really want that. It minimizes their overall cost over time and they are mandating, many of them, single embryo transfers. Well, you can do them one at a time, but this way you get to choose it better.
It's actually less length of service, less procedures that need to be done if you do it this way, with this technology up front. They want that. They just don't want to pay for it right now. But they will learn, as you just said, as they find those centers of excellence, the ones that are actually doing it better, succeed more often with the single embryo transfers, are giving the take home baby rate faster.
Those places will be looked at and said, what are you doing differently? And I'll reimburse differently because I know that my client, the patient, will get that service and get to a less expensive overall thing for me by doing that. And so they actually are asking us to use the technology and are asking us to get there.
But they want to. Let us self select. You be the
[00:34:25] Griffin Jones: guinea pig, you figure it out, and then I'll pay you for it. Well, generally insurance doesn't
[00:34:31] Dr. Jason Barritt: give you the money unless it's absolutely needed. Right. And that's the business of this.
[00:34:37] Griffin Jones: Yeah.
[00:34:37] Dr. Jason Barritt: The truth is, when this was all cash pay, and you were going into your local clinic, and you were getting the best care that you could there, there was no, I'll call it, middle, Person taking whatever percentage, and I, every state is different, every insurer is different at what percentage they take out of the total money involved here.
But the truth is, if you take, this is purely an example, I don't know if this is exactly right, but 10 percent of the money out for the insurance company, that's 10 percent that isn't being spent. At the local level, in the clinic itself. Now I'm not saying that it didn't give access to more people for the care, it did.
When we cost average that in, that is a choice that's being made and people are voting for it and wanting to mandate care and I understand why. Access to care, being able to help more who are in this difficult situation. Totally get it, no problem with it. But we're also Putting a lot of money out of the thing that would have been used for technology advance, or other access to care that would have been provided to those locally.
Not at the insurance level. So this is all a big balance. The polite answer is this isn't just medicine. It's also not just business. We're not making a widget. Right. And it's gotta be balanced. Everybody has to be a piece of this and one can't dictate the other completely. And there's a back and forth and technology as they advance, sometimes they get included.
And that's, what's actually happening with PGT A testing, their genetic screening of embryos. More insurers are realizing it's better for me to pay, and please don't hold me to exact dollar values here, it's better for me to pay 3, 000 for the biopsy and analysis and get the right one, two embryos to be able to be put back.
In a more timely fashion, rather than not paying for that and having three failed transfers or four failed transfers that are costing me more money in the long run. So they are starting to get there. And some are starting to say, okay, we will, we will insure this or cover this. We'll make deals, of course, to reduce the cost, but we'll cover this and we'll especially cover it for those who are, 40 and above, or 38 and above, if female age, I'm sorry is what I'm meaning.
Because it'll actually help us in the long run, less total cycles will need to be done, because we will find out whether we have a normal embryo or not to even transfer. I know that sounds, Tough. But the truth is, if you do an IVF cycle and don't know if you have anything that's genetically normal and you attempt to do, let's just say there's three embryos, three embryo transfers one at a time, there's an expense with all that.
There's also time on the clock. But if I did a genetic testing of those three embryos back in the creation cycle and none of them were genetically normal, I don't do three. Frozen embryo transfers at the cost of those three that probably had very low chances of success. And I don't spend that time on the clock.
I get to the next cycle. There's actually money and time involved there. And those have to be looked at. Insurers are starting to come around to that and get that understanding. It is not going to help them to spend money on a procedure that has extremely low chances of success. So find out. It costs a bit more at the beginning, but find out.
[00:38:08] Griffin Jones: What are those things that are also in that, that realm of time lapse where the embryologists and lab directors generally feel pretty strongly about them, but maybe the business side isn't convinced yet or doesn't see the return on investment yet? Like Electronic witnessing sample management automation, cryo storage, maybe some of the AI tools.
What else is in that, that neighborhood of things that most of the embryologists and most of the lab directors really see the value on but most of the business side doesn't yet see the ROI? Hmm. You nailed a few items there.
[00:38:46] Dr. Jason Barritt: I'm going to sort of go down the AI one only because I'll call it the newest. There are multiple models out there for AI use in the laboratory. Technically it's actually probably being applied on the clinical side too. But because my experience is on the lab side, I'm going to talk much more about that.
It's technically expensive. However, this is a knowledge game. Best choice made in the most timely fashion. Right now, let's just say adding time lapse to a cycle costs 250. I don't know whether that's an accurate number or not, depending on what technology is being used, how it's being used. It could be double or less, who knows.
But where's your actual ability to sell it? It doesn't exist now. Now you can market and say you're using AI, okay? Maybe you can get more clients in for that, but are you actually going to earn anything for it? No. Probably not. However, it's going to help your team succeed more often for your patients. And actually that has a longer term, better return on investment.
You'll be able to sell that success or that time to baby in a different way. You'll also be able to show even the insurers who won't pay for it, probably at the beginning, you'll be able to show them it actually is worth doing for everybody because they will spend less money in the long run. In order to be able to do it for a small investment up at the beginning.
So AI is definitely that thing that a lot of lab directors are coming around to. Now, there is a lot of resistance on AI in the embryology lab also, and we could probably spend two days on that discussion. However, I'll nail it. I'll nail at least one. They think AI is going to eliminate the jobs of the embryologists.
I will say that it is going to eliminate some of the things embryologists do now that they don't need to spend their time on because AI can do it more accurately, more repeatedly, faster. Such as? Grading an embryo. Therefore the honest answer is an AI system, and there's a few out there, the truth is they will be able to see, in their micro lifetime, a million embryos.
I will probably never see a million embryos in my lifetime, not even close. Maybe a hundred thousand, maybe 200, 000. And my team will see something like that also, but one AI system sees a million and it's learning every single day from every single picture being added to its system. Yes, my embryologists learn every single day when we look too, but we'll never have the same.
Scale to be able to learn it as quickly as an AI can. Additionally, that AI has taken all the information in about that embryo and everything it learned about that embryo and every embryo before that and is going to be after that, and it put it in its bank, and then it uses that in the calculation for determining the next embryo and its grade and success estimates.
Well, a human can do that, and we actually do that in our head without really thinking of it in that way. But the truth is, it actually takes us much longer. And we don't have as much ability to put all that data in our head and extract it in microseconds. It can grade an embryo faster, more accurately, more repeatedly than I will ever be able to.
And it will be better than all of my team members. And it will have no variation between team members because it doesn't have team members. It knows everything. Additionally, a more junior embryologist with less experience And a more senior one may grade things slightly differently. In fact, we all have slight variation that's based on our experience and our knowledge, and that's why we get better with time.
Well, the AI does the same thing. It just does it at an exponential pace of learning compared to what we can. The amazing thing is an AI system can learn to grade embryos probably in two days that I have spent 20 plus years learning. That is a scale beyond anything I'm going to be able to ever do. So instead of thinking it's going to eliminate me or my job, how can I use its ability to do my job better?
And that's where we have to get. Not the, it's going to take somebody's job. No, it's going to do the grading for me. Hey, congratulations. Now I don't actually have to do that. I just have to use the information it now gave me to give best care to the patient. And right now, AIs. technically don't have sets of hands and can't do a retrieval, can't process a sperm, can't put things together in a dish.
If you put things in front of their eyes, per se, microscope in this case, and put data in front of them, that it can translate to 1s and 0s, and it can think about it, it can do that job, and it can probably do it faster and better than I can. But we are still absolutely going to need embryologists because there's a lot of us that need to do things before it can do its thing.
[00:44:26] Griffin Jones: How do you test this now, Jason? Because you were, you were the lab director at SCRC for many years, which is a big practice in Beverly Hills, does a lot of cycles. Now you're chief scientific officer at Kindbody, which has practices the size of SCRC and then many more in many different cities. Yes. So now you're at a place where it's like, well Do I, do I, do I test something at a small level across the whole network?
Do I, do I test something here in this city at this lab? And so how, like, whether it's AI like this that you're describing or any of the other solutions, how do you prove, how do you prove, how do you prove them as you decide if they're something that you want to scale?
[00:45:12] Dr. Jason Barritt: So, yes, so you mentioned my my new position.
I am very happy to have joined Kindbody because of the scale that it will be able to treat and help. The truth is, Yep, running one center, although a very big one, and a very successful one. I was able to per se touch a whole lot and help a whole lot. This is 20 or more times bigger with, as you said, I think we're running right now 19 embryology labs and 39 endocrinology and, and, and andrology laboratories across the country.
When we make change or when we make a move into something like time lapse or into something like AI use, we'll allow it to help more at a grander scale. Technically, it also allows it to be cost averaged down much quicker. Which actually then allows it to be used more and actually increase care and increase the number who have access to that technology.
So, I've moved up, but that doesn't mean I've reduced the challenges. In fact, it means I've added way more challenges. However, when change occurs, it has a grander scale of success. So, you sort of described the different ways of attacking. How technology gets put into a, I'll call it a a larger scale corporate network of laboratories.
So, usually the corporates have a slightly bigger piggy bank than at single locations. However, That doesn't mean you just go spend it. It does what you just said is you sort of try it out a little bit. Now, some of these technologies are so expensive and so difficult to initially put in place that you really only want to try it at one place and see if it's really working out.
Some, as you said, you want to try a little bit everywhere, but the truth is the cost for implementation, the training, the time, the knowledge, and, and I know this sounds really weird, but When you have 19 different embryology labs, you have 19 other variables than if you controlled it all within one. And there's a lot of variables in the embryology lab.
And the more you can control, the more you can be accurate with what your intervention is actually being successful or not being successful at. So generally you roll these things out at one. So I am very lucky at Kindbody. I have who are on my team, eight regional lab directors below me, who all have great years of experience and knowledge themselves.
And so we can get together, we do a couple times a week, and we discuss technologies, current challenges, Future challenges, how we want to implement these things and what we want to do. And the thing is, now I've got myself included, nine of us in the room, we all meet by, you know, of course, virtual meetings anyway, now we never actually get in the same room but we actually gain more information and more perspective and see more opportunity, and then we can help each other with designing a better experiment, designing it, and then implementing it at one place and then Asking the tough questions and figuring out the solutions at one, instead of one off trying these things all by yourself in a little box, I'm actually using all nine of us.
To evaluate something, one is hands on doing it, but all the rest of us are getting to be a part of that and learn from it. And then when we scale it, it is a grander change that is able to be done. So, on something like AI, technically, Not really being done at Kindbody at this point in the way that we really want to get to in, I'll call it, embryo grading.
However, would it be possible and how much data would be able to be collected, how quickly, on how it could change things? And the truth is, at some of our very large centers, we could These words easily determine its application and its ability very quickly. And a whole lot of our other places who are not so large, they would never make the investment or the time investment in it.
However, they will gain from it. And therefore, if we find it's valuable, Pretty sure we will. They will be able to have it implemented in their thing even though they would never have been able to afford to do it or do it by themselves. So the scale of success will be much quicker because we can do it this way.
I guess it's getting back to the business side of it too. You got to make the investment to get the technology.
[00:50:02] Griffin Jones: So when you have your, your nine including yourself, I guess, lab directors that are, Reviewing maybe one of their, their trials, you know, one person is, is doing that. Do you start off with that so when, whenever somebody's doing new for the first time, it's letting the other eight know, here's what I'm gonna, here's what I'm gonna start doing and here's what I'm gonna measure?
Because I, I could see if it was retroactive of, here's what I've been doing the last six months or whatever. Here's what I've been doing the last 12 months, that people might be a little bit more resistant to change or more interested in what they're currently doing, but if it starts off as, hey, now I'm going to begin doing this, I'm going to let you know what it's like in June, I'm going to let you know what it's like in October that You might have the other eight get more invested, because I could see that a challenge is not just proving what works, you can do that, but getting everybody else to actually implement it is really difficult, and implement similar things, so how do you approach them getting on the same page?
[00:51:08] Dr. Jason Barritt: I'm gonna recall right back to the beginning of our conversation and say, If you're in the room, you're part of the discussion at the beginning. By being a part of the discussion at the beginning, you are invested. And I don't mean just monetarily, I mean in the chance of success. So you design the experiment, not just yourself.
But with eight other really intelligent people, you actually ask all the other questions that you wouldn't have come up with yourself or how to apply it, and therefore you design it better, or you say, you know what, we need to put that on the side for now, and let's just get at it. A and B. Is A and B different?
Are A and B two different letters? Yes, they are. But wait a second. In Arkansas, A matters. But that really doesn't matter in somewhere else that A is not happening. Therefore, I don't really care whether A and B are different. You have to design the experiment. By having the people in the room, you design a better experiment.
You also get to be a invested in its success. Now, one person's going to go hands on per se do it, but everybody else will help design it. Everybody else will help review it. Now, I admit, the one who actually goes and does it, Absolutely a huge, huge part of the wheel working, but the truth is you need spokes on a wheel, otherwise it'll collapse.
So where the rubber meets the road, sure, great, you can be that, but you need a whole lot of spokes to support the wheel. And the truth is by getting them to buy in with being present in the room and their knowledge being brought to the table, them being listened to and being part of the design and the solution.
You actually get buy in, and buy in, and we haven't really talked about this, is extremely important in large systems. When you're running a one off, you pretty much can get buy in, you know, in an hour, all of you getting in the same room, looking at each other. At this scale, you need a lot more to get that buy in.
And when, as I said, I virtually meet with them every week a couple times, I'm not actually sitting beside them all day. That's a very different way of operating. And it means that I actually need to empower the people. That's the other big part of the networks. Empowering the people to succeed. Giving them the tools to succeed.
And then when they succeed, that It makes you succeed, which then opens the door to the next thing. And so this is a, you know, you got to manage up and down. You got to give the people above you a chance at showing success in something. If you're going to go to them, don't go to them with something that isn't going to provide them with an opportunity for success.
It's going to be a waste of time, or it's not going to work out for them. Why are they making the investment in you? And then managing down and giving them the actual opportunity to succeed, giving them the tools to do it, and making them a part of the solution. They get the buy in, and then they apply it down to the next person, and they apply it down to the next person, and when you get that buy in, everybody's rowing that boat the same way.
In fact, You might have a motor on that boat at that point.
[00:54:18] Griffin Jones: That's what makes a motor on a boat, is when you do have all of those people rowing in the same direction you're, then you're finally starting to go at a much faster speed, more powerful speed than, than going it alone, where initially it might be going alone makes you go faster, but over time, you'll go much farther.
Yes. Going with, I think there's a proverb about that.
[00:54:41] Dr. Jason Barritt: Yeah, sure, but that's the fun part of the scale, I'll call it. So I'm driven by wanting to be successful, not only at the patient level, but also at the employee level, because the truth is I've probably in my 20 plus years, helped train or actually trained physically too, well beyond 30 embryologists who are out there working.
Some still work for me. Some worked for me before and now are working for me again. Some don't work for me anymore, but they're off working for others and succeeding. And the truth is, that octopus, that those, that tear, that tree of all these other opportunities and more things that are occurring at a scale like I'm doing now, There are so many more effects that can occur by me and my team working together and affecting more patients in a more positive way in a time frame.
And so I take this as a huge challenge because scale is challenging, however, it also allows me to scale things better and have more of an effect in a smaller time frame.
[00:55:54] Griffin Jones: Do you involve those eight regional lab directors in, or I should say, do they come to you with the business case for what they are seeing the value in, or are they typically coming with the, the clinical outcomes or the lab outcomes case, and then you have to make the business case to the, to the, to the board or to, you know, to the rest of executive leadership?
[00:56:22] Dr. Jason Barritt: Well, sometimes it's challenges they're having, sometimes it's, hey, here's our, you know, key performance indicators, and it's, it's dipping or it's rising differently than, than it's been before at that location. Sometimes it's, hey, my one location is doing something different than my other location. And then sometimes, and this is where I'm going with your question, they are bringing to the table things that Yeah, I may have had on my back burner or heard about or been, but hey, can we give this a little shot?
I got a tiny little bit of time and I got a couple of these, I want to give it a shot. And the great news is, some of those eight leaders that I have, have already given it the shot on a couple things. And then they bring to the table, the group, not just me. Hey, I'm, I'm going to give this a try. I'm going to try to freeze sperm slightly differently, or I'm going to do a different cooling rate, or I'm going to mix this slightly differently, or I'm going to use this, I'll call it microfluidic sperm separation device that is a different one on the market, and I want to see if it's different to that.
And we can run these tiny little experiments because all of us Can run these things and then they bring it to the group and then I can per se take it up. One, find out whether we need to do more investigation of it. Two, find out if, hey, one place in Texas tried something. Can we also try it in Chicago?
Does it matter what the latitude is or does it not? Does it matter what the sea level is? Can I do it in California and New York also? Or do they have a limitation that doesn't allow it's an only Texas thing? I can have those discussions and I can find those things out so that when I want to sell it. Or purchase it per se, I can sell it up the chain the right way.
And I know this sounds interesting, but the truth is when I go up the chain and ask for money to be spent on some new technology, generally, I'm not asking for a one off, I'm generally asking for a network off, which means it's more money upfront, but it has a bigger scale for success and therefore it has to be sold.
And justified very differently. Then, if you're at a one off type place, and that's the good thing. These eight come to me with things, and each other with things, that they've heard, they want to try. I'll give you the example as the very, very fast, we'll call it lightning thawing, or rapid thawing, or I think Juergen Lieberman is now calling it fast and furious warming.
The technology that allows us to do a procedure in essentially a one off type place, and that's The technology that allows us to do a procedure in essentially a 10 percent of the amount of time before and at 10 percent of the material that we needed to do before the media. Those are huge changes in percentages.
That's a lot of money saved by not having to spend time and to spend it on material.
[00:59:23] Griffin Jones: That's a different technique or it's a different media or, or something else.
[00:59:27] Dr. Jason Barritt: It's actually the same media. It's just changing the protocol. And Juergen and his team and others, please, I'm not just trying to say Juergen have given this the shot of the very rapid warming procedure of embryos.
He's actually playing with eggs now too, but let's just talk about embryos for now. He's found that you can do it essentially, you can do it essentially nine times faster with nine times less media used. Well, that is huge, I'll call it time and money saving. If your success is at least equal, if not better, and he's actually showing it might be better, when do you transition to something like that?
And the truth is, if you were a one off little center, you have to basically go all in. But when I have 19 embryology labs that can give things the shot and patients have donated materials to testing. And research on a grand scale like this, I actually have access to be able to run this experiment, run this technology, and figure out whether it's going to work in scale or not at our place much quicker than most would.
And then when I apply it, we haven't quite applied it yet because we're still investigating it, but when I apply it, the significant savings of time and of money will actually allow us to then serve more patients. And be able to treat more patients in a more timely fashion. Because I just didn't spend all that money on something that I don't need to spend it on anymore.
And I can get to that answer much faster by having a huge network to be able to do this in.
[01:01:09] Griffin Jones: It could be the case that the network says, great, we want to take that money and then lower our bottom line with it and so that we have so that we're increasing profits. But it could also be the case that you can say, Listen, I saved this, we saved this much money, let us try this thing that I think is going to return the investment.
So let us take this and, and we've removed, we, we've cut this expenditure out, but let us use this expenditure as an investment that we think is going to increase the top line.
[01:01:38] Dr. Jason Barritt: Yes, the business of it, yes. So the amazing thing is when you're not in the room. They'll just say save the money. When you're in the room, now you can say, hey look, technology has advanced, we've learned from it, we actually became more efficient with it, and actually saved money.
Please, let's all not just add it completely to the bottom line, let's please use please. And sometimes this is the right argument, sometimes it's not. Let's use half of that savings and make an investment in AI technology. Because that's the next one that will have a mass scale ability to, I'll call it, affect.
Money, and time. If it can grade every embryo that will be graded in a single day, in a single lab, in under one second, because it does it in microseconds of course, but it's going to take four embryologists two total hours to do all that grading in a morning I'm gonna use the technology pretty quickly.
Because all that time savings can be used on treating more patients. So your first one, I'm going to call it warming technology, uses part of the money to invest in the next thing. And the next thing will also have scale and have ability to save. And then that one will have ability to increase patient care.
And so that's the other one. I'm now in a company that was built on and really is driven by access to care, treating those who weren't going to be able to get it. Or didn't have the access in that place, or it wasn't cost effective for them to be able to get the care. Those barriers caused them not to get the care and not to have the joy of having a child.
And that's just not right. We actually should give them that access to care. So this company is also driven by wanting to be able to make this efficient, cost effective, so we can keep the cost as low as possible. So we can treat as many as possible. Because the truth is. There are way more people not getting the care that they, they need because of the barrier of money.
And the problem is, this is medical care. You didn't generally cause infertility in any way yourself. Therefore, why aren't we treating it as other medical care? We have to work on this. We have to get the insurers to want to pay for it. That means we have to make it cost effective and show them why it would be successful for them to want to make the investment in this and give a good enough reimbursement that we can treat more patients or more are covered.
And therefore we can see more. And then we talk about AI and its ability. to learn and the fact that embryologists are not going to lose their jobs because AI is now grading embryos. In fact, there's going to be twice as many patients in the laboratories coming in and needing the care because now we're not taking the time on the grading anymore, we can actually do more retrievals, we can treat more patients, we can succeed more for more.
So that scale is also amazing. And it will come. So it sort of wraps back to our beginning of that there's a business side to this, and there's the clinical side to this. And as efficient as we can be inside that laboratory will allow the business to grow. It'll allow that access to care and us to concentrate on medicine as the number one thing.
It will operate as a business. It's true, this is a business, but it's going to operate as the best medical care possible for the most people to succeed for those who can get there and can get the access. So reduce those barriers and let more people have this great success of having kids.
[01:05:42] Griffin Jones: I really look forward to having you back on sometime halfway through end of 2025 to see the scale, to see how you've been able to scale many of these changes, to see what expenditures you've cut, to see what investments you made.
I can't wait to have you back on. This has been a pleasure to finally have a microphone and record the darn thing, Jason, and I think people are really going to enjoy it. Thank you so much for coming on the Inside Reproductive Health Podcast. Thanks for the time. This podcast was brought to you by IVF Store.
I hadn't even heard of them until you lab directors and embryologists told me how much you like them. If you agree with Jason, tell him, tell me, or tell the IVF Store. I'm still learning about these guys. You seem to know a lot about them. We really want to know, if you've had a good experience with the IVF Store, will you let either them or Jason or myself know?
[01:06:34] Dr. Jason Barritt: Thank you for giving me the opportunity to talk about one of the great suppliers.
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