Inside Reproductive Health guest, Andrew Mintz, shares the evolution of Pinnacle Fertility on this week’s podcast episode with Griffin Jones. The fertility network which now owns ORM (Oregon Reproductive Medicine), SRM (Seattle Reproductive Medicine) and others, seemingly came out of nowhere. Is their model scalable? Will it stand the test of time?

Tune in to hear:

Andrew Mintz detail the Pinnacle Fertility model, including how they constructed their Medical Director and Lab Director Councils, and how they contribute to the overarching success and development of their network.
Griffin press Andrew on the efficacy of Pinnacle Fertility’s physician buy-in program, and how it could potentially implode.
Griffin question whether or not Pinnacle Fertility’s private equity backing equally beneficial to physicians across the board, or only those stepping into retirement.
Griffin ask how Andrew Mintz and his team approached the selection of the ever-challenging EMR system, and how they decided on just one.

Andrew’s information:

LinkedIn: https://www.linkedin.com/in/andrew-mintz-712a999/

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

Facebook: https://www.facebook.com/PinnacleFertility

Website: https://www.pinnaclefertility.com/

Transcript

Griffin Jones 00:04

Nobody says we put the patient last, Andrew, and nobody says we're a bunch of dishonest dirtbags that are going to stab you later. So how were you able to actually demonstrate that almost every Fertility Center in North America is going to be owned by one of two companies in the coming years. It's one of the things that I talk about with our guest, Andrew Mintz. He's the CEO of Pinnacle fertility. If you're like me, you didn't know about Pinnacle fertility last year until he was ASRM last year, maybe even PSP CRS this year that that name really took off, they acquired six groups at the end of 2021. They have acquired more since including Seattle reproductive medicine. So they're quickly becoming a big group. And we talk about their model for making protocols uniform, raising the standard of care in their view, including having a council of lab directors, a council of medical directors, which I think that concept is interesting for you to listen to. I push Andrew on the criticisms that people have of private equity is it really just for the benefit of the retiring Doc's? I asked him that question of do we think that this is going to become a two horse race in the future? I talked about brands, that Kindbody style of brand versus this network style of brand and tell him which side I think is better, and ask him for his opinion. I also asked him to talk about choosing an EMR what goes into that process and should go into any that process and why they chose the EMR that they did. I asked about the model of doctors buying into the parent company and not into not not the equity coming from the at the practice local level. So we get some good answers in there. If you feel that I can go deeper on a specific set of questions, email me, let me know and our next guest will be the victim for that. In the meantime, enjoy this interview with the CEO of Pinnacle fertility, Andrew Mintz. Mr. Mintz, Andrew, welcome to Inside reproductive health.

Andrew Mintz 02:21

Thank you, nice to finally meet you in person.

Griffin Jones 02:25

I had never heard of Pinnacle fertility before the winter of 2022. And then by the time I got to PCRs, it was all the buzz, it was blue Pinnacle liquid pinnacle is doing now. And it's and so here's a company that, as far as I know, didn't exist a year ago, or a year and a half ago, maybe you'll correct me on the timeline. But then, in short order, started making a splash in the field. So why don't we start with the timeline of Pinnacle. And the the opening or need that you all saw in the marketplace to to state your own existence?

Andrew Mintz 03:05

Sure. So we actually started in December of 2019, with the acquisition of Santa Monica, fertility out in California, and then you know, COVID, hit kind of right away, and there wasn't a lot done for the year 2020. But come 2021 We started to reengage in the market. And we closed six practices in 2021. In the second half of 2021. We didn't actually create our name of Pinnacle fertility until like October, which is why no one's ever heard of Pinnacle before. But we brought on first RGA of Ohio, which is out of Akron and Westerville. And brought on a Dominion fertility and Virginia ihr. In Chicago. We brought on advanced Fertility Centers in Arizona, California fertility partners in in California, and ORM in Portland, so a really good group. And I think, you know, there were a couple of things that we saw as an opportunity to partner with groups, and that was that I had this conversation with Richard Morris, who runs our medical director Council, which I'll tell you about in a minute. But years ago, the way the fertility industry used to work is that doctors were very collaborative with each other not competitive. So they would go to their meetings, and they'd really start sharing all kinds of information about what they did in the lab, what their clinical protocols were, what they were seeing in terms of outcomes, how they're trying to improve outcomes. It was a very collaborative approach. I think that over time, as more clinics were created, especially as those that were created in the same markets, it became more competitive and The willingness to share the secret sauce started to whittle away. And so I think we had lots of people who were doing their own thing, and seeing what their outcomes were and, you know, comparing themselves against national benchmarks, as they saw in SART or the CDC database, we really wanted to bring back the concept of doctors working together, sharing what they're doing in the lab, reducing the variation in care, and to really improve the outcome. And we saw that as an opportunity that we didn't see happening in this marketplace as much as it could have.

Griffin Jones 05:42

Well, what do you feel that you can do to facilitate that happening that many of the existing networks aren't or can't?

Andrew Mintz 05:50

Yeah, so I mean, we've done a several things. So one, we started a couple of councils, which have real teeth behind them. So we have a medical director, Council and a lab director Council. And those councils have a representative from each one of our clinics. And more as we brought in this year, we brought on another few practices this year. And what we do is we talk about in the lab, for example, we talk about making sure embryologist are using same techniques and protocols, the media that we're using in the lab are the same, that the equipment that we're using are the same. And really just starting to compare the outcomes and talking about what people are doing. So we actually have lab directors that are going from one lab to the other, to look at what others are doing and then sharing that in in a forum under which they're making decisions about how to reduce that variation and improve the outcome. And I don't know that we see that in a lot of other clinics, I think there's a lot of talk about it. But we've done a lot of that and, and the other piece that we've had to do is come out of the lab director councils, the fact that as we continue to expand, some of the problems that we're facing in the lab have to do with just what you can fit through the lab from a volume perspective. And there just aren't enough embryologist. And so our lab director console, for example, started our own embryology school. We're looking now at a certification for the students in terms of how they become certified which doesn't really exist outside of ASHRAE. And really trying to get a lot more embryologist out into the marketplace. So we can they started the school, we do it in two places. One in Arizona, one in Ohio. We have four students at any one time, we get them trained in about 100 days. And we can train about 30 embryologists a year. And so we're really dedicated to one being able to have more embryologists available for the industry, and also specifically about making sure that we are teaching them the kinds of processes that we think lead to the best outcomes, and to ensure that in fact, we see that across our network.

Griffin Jones 08:18

Are you doing the same thing on the clinic side with a council of medical directors or practice directors?

Andrew Mintz 08:26

We are so we do have a medical director console as well. They making decisions in terms of you know, what kinds of genetic testing are we doing? Where do we send it? Who do we do it on? What kind of Mosaic embryos are we going to transfer? Which ones are we not? They're looking at safety protocols. They're looking at recruitment and retention issues. So there's a whole set of initiatives that our medical directors looking at as well, including clinical stimulation. So, you know, what are we doing to, you know, really reduce that variation, make sure that, in fact, we're doing the right thing for the patients and being able to maximize the, you know, their outcomes. And so there's a lot of sort of deep dive data that we pull and start sharing and discussing in those consults about the ways under which we're going to be practicing medicine within within pinnacle.

Griffin Jones 09:25

Is each practice represented by one medical director in the council?

Andrew Mintz 09:31

Yes. So we have one medical director regardless of size, so we brought on Seattle reproductive medicine just a few weeks ago. They have 14 rei physicians, but they only have one representative on the council, and then we've got Dominion fertility, which only has two physicians. And so they have one representative as well. It's a little bit like the Senate having two representative from each state. But But yeah, I mean, because the reality is, is that regardless of whether they're just talking to one other doctor or 12, they really need to make sure that that information is brought forward. It's discussed locally, and they are able to provide feedback in terms of what those what those protocols are.

Griffin Jones 10:12

Do they offer an equal vote and how the protocol comes to be?

Andrew Mintz 10:16

Yeah, so I think it's more of, you know, I think it's more of a discussion. And they come to consensus as opposed to voting things up or down. So you know, everyone recognizes that you can adopt a guideline that you think is going to be best for the organization, and then look at those outcomes. And if those outcomes aren't what you want, then you need to adapt your, your guidelines. So I'm not sure that we've actually taken a vote as much as there's been conversation and debate about the right thing to do. And, but everyone is dedicated to following the guidelines as they're created within the organization. So I don't think it's a majority rules type of, of atmosphere.

Griffin Jones 10:59

So that's my second question is, is how is the council governed, then, who makes the final decision who who releases the document, who drafts the document after, after the consensus is reached?

Andrew Mintz 11:16

Yeah, so we have the head of our medical director Council is Richard Mars, out of CFP. And he's the one that helps set the agenda. Um, he's collecting information from the clinics, and then coming up with recommendations to be discussed at the meetings. And so he is really kind of the driving force behind helping us prioritize what's important to the outcome, and the kinds of things that we're going to be addressing first, and how we're going to get there. So that's really how that's kind of organized, it's, it's a very, it's a free flowing set of conversation. So there's not a it's not a I wouldn't call it real formal, but they do come to decisions. And they do decide, you know which direction they want to go to. And we're just starting to scratch the surface. I mean, we're a new organizations, so they're addressing a handful of items, and they've got a handful or a long list of items that they really want to address going forward as well. You are

Griffin Jones 12:15

just scratching the surface, because now you've got a couple you your congratulations on that SRM acquisition, by the way, now you have a couple of dozen doctors across the, the the group thus far across the organization. Now, and, and, and people can come to consensus, but inevitably, people do not come to consensus every time in any organization. And we work with five Doctor clinics, and Dr. Nixon and I, I hear them not on the same page as each other. And very often, one doctor will be practicing a protocol in in office a and Dr. B is practicing a different protocol in office B. And and so when you inevitably run into, okay, there isn't a there isn't a complete consensus, maybe 70 or 80% are really on board and really feel strongly inevitably there's going to be a couple of people that feel strongly the other way. What do you do when you have established that protocol based on what the majority of the council sees it as best given the evidence? But there are a couple of people involved that don't want to practice that way.

Andrew Mintz 13:27

Yeah, so I mean, the first step is to create the protocol, the second step is to measure who's following it and who's not. And that's what we're in the process. So one of the things that we've also done is we've converted everybody to the same electronic record. So it makes it easier for us to be able to set things up within the system and for us to measure whether people are following the process as it's been decided. And so, you know, those are conversations, doctor to doctor, look, it's not a matter of whether they follow the protocol 100% of the time, there's no such thing as someone following the protocol 100% of the time, the issue is, are they documenting why they are not following the protocol, and there's going to be good reasons for it. So if there's a specific way under which we want to be stimulating a patient with a certain condition, and a doctor does not follow that protocol and does something else, if they're documenting why they're doing it, that allows us to be looking at that to understand how we need to expand our protocols to take care of different variables. So, again, being new, we have not yet I mean, we've created a handful of protocols and working on more. But really, these are long term studies for us to really determine whether in fact, they're giving us the outcomes we need, and who's following them. But we're really at the first step here of just making sure we create those protocols and and then we're going to start looking at who's following them and who's not and why.

Griffin Jones 14:50

And he talked about getting that measuring that as part of the EMR. You got everyone on the same EMR which is also not easy to do, which EMR did you choose? Did you make your own

Andrew Mintz 15:00

No, I mean, we don't start from scratch. So I mean, you know, there are, you know, everyone talks about using evidence based medicine. But the reality is that there's more than one protocol that's considered evidence based medicine. So I think there's not a lot of variation to begin with. And so I think

Griffin Jones 15:17

we're now referring to the protocol referring to the EMR that you chose your own proprietary, did you create your own proprietary EMR you chose another,

Andrew Mintz 15:26

we did not know, we, we moved to an assistant called Enable. And so we put everyone on enable, which we felt was has, right now the best capabilities to help us really connected with other technologies. So we've been really working hard on trying to use all the components of that system, to allow us to automate processes, and to really enhance the patient experience. So I've been talking a lot about, you know, creating and improving the clinical outcome. But the other piece of this is that we also really need to focus on the patient experience. And I think by having everyone on that same system and using technology to help us and the patient get through the process, I think that we're going to we're laser focused on that piece as well. So we need to make sure that patients are able to communicate to us effectively on time, we can be responsive to them, and there are the right people available to them. And the technologies are there to be able to interact with them appropriately get the information together and be able to present that to the patient, as well as recommendations and next steps. So we have not, at this point create our own electronic health record.

Griffin Jones 16:45

Well, let's talk about that shopping process. Because I think it'll be interesting to people. I'm not plugging one EMR over another. I am not I'm not qualified to do that we our clients use a number of them some of our clients use enable. But I think some people will be interested in to how you made that decision. I imagine there was a bit of a shopping or vetting process.

Andrew Mintz 17:06

Talk to us about that. Yeah, so we did that through all the IVF specific EHR systems out there. So we eliminated the ones that are more general electronic health records are used in the healthcare industry. And so there's a handful of ones in there. And we've actually done a review last year, and we recently did another one and just felt like it would meet our needs the best, especially in the way again, that it can integrate with technology, how some of the security issues that are, I think, available to it. And so really, we have a specific operational model that we have been employing in our practices. And we felt that this was just the best fit for that. And it's so far, it's, you know, it's worked for us because we're able to really collect the data. So at the end of the day, it's about how you use the electronic record system, as opposed to necessarily which ones you pick, this had features that we liked better that we think worked for us. And so that's how we made that decision. And that's what we're have moved are moving everyone onto that platform, what were those features that you liked? Oh, again, it was, you know, they have like two way texting with patients that gets embedded in the medical record and interfaces with the phone system, certainly in the way that it is built for the cloud. So it's not a server based system that was put in the cloud. It's a true cloud based system. So it has, we think some good security pieces in there. We felt that it was able to interface with vendors and and equipment more easily, giving us some good information, allowing us to bring it in and present it to the patient or want to, we'd like the patient portal, and the way that we could communicate to the patient. So there's just a bunch of things in there that sort of check the boxes for us. And, again, for the kind of operational model we use, I think that it just was a better fit. And so you know, the other ones have their I'm sure it have their advantages. We just felt like all the ability to use technology, all the think all of the capabilities that are built into the system that we are trying to take advantage of. We're just, you know, slightly ahead of, of where I think the other sports are there.

Griffin Jones 19:41

You mentioned wanting to improve the patient experience at a process level. What are some of the points in the process that you see is in need of fundamental repair?

Andrew Mintz 19:57

So there's there's a A fair amount, I think one is, you know, a number one has access. So, you know, being able to get patients in and get them through a IVF cycle that's efficient, that can make it efficient for the providers as well as the staff, I think is, is keep. So the biggest, I think hurdle in this industry for any practice is the fact that we still have a significant greater demand for services and supply of physicians and other providers to provide those services to them. And I believe that there is a room for innovation within practices that can allow for us to be able to service more patients in a very friendly way to get them through the system. And we can really sort of maximize the ability for patients to get in. So we still have clinics that have appointment, wait times that are three and four months out. It's too long, it's really unacceptable. And we need to solve that problem. So we think that the system will help us with automating processes and communicating to patients in a way that will make them more efficient. And so that's the first thing that I think needs to happen. The second thing is, is that I think we also need to meet the patients to where they are. So, you know, obviously, since COVID, you know, telemedicine has really caught on and it's here to stay. And I think patients like the convenience, I think a lot of them like the convenience, I think that they want to be communicated in a way other than a phone call, especially for the patients that we serve and the age group they're in. And so having the technologist that's allowed that we can text them to weigh that we can make sure that they're getting the information they need, we can embed the, the the videos that we have the educational materials that we have, and make sure they're getting through the process without someone having to call them and check in and we can sort of look at electronically will also help with that. So a lot of patients get lost through the process, they get lost at the beginning, because it's so overwhelming. And then they get lost through the process. And so to the extent that we can create processes, and have technologies that support getting these patients to understand what they're entering, and to help them get through the system efficiently, without being confused without being you know, without anyone falling through the cracks without missing something. Those are the things that I think are really key. And there's you know, story after story that I have seen where you know, patients, they get, you know, they get lost in this and they end up dropping out when they really need to continue through their IVF process or whatever fertility process. And

Griffin Jones 22:59

I have to say that I have to disclose that they're a sponsor before I ask the question, so it doesn't sound like a shameless plug, what are you using EngagedMD and all of your centers?

Andrew Mintz 23:10

Yeah. So I mean, we are rolling all these out and all of our practices. So they will all B have, they will have similar ways under which they are going to be processing patients. Obviously, there are differences from clinic to clinic, but we will be you know, we are continuing to roll out and refine our processes to make this efficient.

Griffin Jones 23:35

For those clients that are there, excuse me, those clinics that are three, four month out booking waitlist, and it's usually it's a couple physicians that are booking, it's often not the whole clinic unless it's a really small clinic in a really busy place. But for those that are booking out 12 plus weeks, is making that process more efficient include bringing some some of the testing that normally would happen after the first visit, and between the first visit and the follow up before the first visit.

Andrew Mintz 24:08

Yeah, so we are looking at the total process of care. And some of that is also, you know, some of the testing that we maybe can do in house to make that efficient as well. But we are looking at, you know, what's involved in a new patient visit what's involved in a follow up consult. And what information do they get between the first and the second and then before they start their cycle? What information do they get? And when do they get their medications and, and on and on. So we are looking at the whole process of care. We have mapped this out. And so we have a sort of a very specific philosophy about what should be happening at each step through the process. And the more consistent we can make that the better job we're going to do, of making sure that the patients aren't getting caught in the middle, you know, or Last,

Griffin Jones 25:00

can that also include some places the nurse does the follow up visit and the Ri does the initial visit, sometimes the REI does both. But some places the nurse does the first visit. And and so is that also part of this solution is a we? Well, maybe we used to do testing after the first visit. But now with this, with with booking this far out, that would mean that people can't get into the care system until that point. So we can we can do our testing before they come in for their visit we can we we can maybe have them meet with a nurse earlier so that that 12 week isn't isn't the first time they're seen. But it's the follow up with the RBI does does having either a nurse or an AP do the first visit is that in the playbook?

Andrew Mintz 25:50

Yeah. So I mean, we are invoking a type of license model. So we do not want physicians doing things that really only physicians can do we want advanced practice nurses to be able to do the things that they can do, we want RNs to do the things that they can do. And so we do have a general, a core set of services that we want each level to be to be doing. It depends on each mark, and, you know, each clinic. So in some clinics, we employ OB GYN who are doing some of that work as well. Some are have a really used nurse practitioners a lot others less so. But we do have a, a top a license philosophy. And so as we continue to integrate the practices, we will continue to be working on making sure that, you know, we're able to get doctors to do what doctors can do, which will help with the access issue. So if they're doing for example, you know, every single ultrasound, you know, that's not necessarily the most efficient use of physicians time.

Griffin Jones 26:57

I want to ask about the the inherent financing models of private equity, I'll let you know, Andrew, that I've been chewed out more than once by each side of being accused of being shill for private equity, that, you know, I'm in bed with these new private equity companies coming in and just using them to help buy clinics, which I'm not. And I've also been accused of being anti private equity and that, you know, I'm anti network and which I'm also not, I just I'm not qualified to evaluate the business models at that level, yet, I'm not strong enough in the finance piece of business in order to be able to say that maybe 510 plus years from now we'll be but right now, I'm very strong in the sales and marketing side. And I still feel like I have some pieces to shore up on that. And I and we are as a firm and so that's what I feel comfortable evaluating people on and I just ask people questions and I try to get them to respond to the counterpoints and, and so but I do hear a lot of the the model is inherently flawed, partly because of the debt that they have to service. And partly because I was stacked in favor of retiring doctors, and one of these folks that that mentioned, these boys is Dr. Ben White, he's a radiologist. And he's not in in Rei, but he writes about this a lot. And he says that the only doctors who can reliably benefit in private equity, are those senior partners close to retirement who can take their money and retire. So I'd like you to respond to that point.

Andrew Mintz 28:36

Yeah, I mean, to toe the truth grip, and I think it depends on who the private equity sponsor is, and what they are, you know, what are they trying to achieve? And what are they allowing the company to do? And so, so on one hand, I think there's two pieces to this one is, you know, and we see the stories is private equity, you know, destroying healthcare. And I can say that, in my experience working with Webster, which is the private equity, that company that controls, Pinnacle, is that they are very supportive of the strategies that that have been created. And that have been, you know, rolled out to the practices. And so we find a very, we have a board that is really pushing towards the successes of clinical outcomes, and patient experience, and caught and trying to find cost efficiencies for the patient. And I think that it creates a company that is sustainable strategy that's sustainable, that goes beyond who the private equity firm is. And so depending upon who it is, and I've worked with some that I think are very geared towards what's my return And I've quickly come to get it. And there are some that are really geared towards how can we build a great company? And what is it that we need to do to make that happen? I think we're gonna see more advances in healthcare is in fertility, particular, because of the investments being made. So I actually am very much in favor of allowing for investment in the industry, which I think it needs, when it comes to who does it benefit. I think it depends on how you define the benefit. But if you're talking about creating a company with with longevity, that is going to be competitive in the marketplace that has, you know, the latest technologies and equipment and provide the best outcome to the patient, I think that's a benefit to all physicians, whether they are near retirement age or not. And, in fact, those people who are younger will benefit from the investments that are being made now, that others may not in terms of the buyout that's going it goes out, you know, the buy up those towards the partners who own the clinic at the time. And so there is a one time, you know, financial gain to those positions. But I think if it's structured, right, you ensure that there, everyone's incentives are aligned. And that really, everyone's going to benefit from that. So we give, for example, we give equity to physicians that are, that did not own the practice, at the time of the sale, who have either we're either employed at the time or even employed after the transaction, we actually grant equity towards those associates. So they're tied into the whole value and, and the strategy, because the more successful the company, we want them to benefit from that as well. So

Griffin Jones 31:49

I think Woody in the private industry, me equity in the practice, or in the parent company, the parent company, for every associate or just for some associates that look like those are the ones that you want to stay on,

Andrew Mintz 32:02

for every Rei. So we give it to every REI has, is either been granted or is in the process of being granted equity in the parent company. And so they will own, you know, shares in the company, as does the private equity firm, as does the physicians who, you know, who bought who sold, you know, we're partnered with Pinnacle on that. So we find that an important aspect of tying everyone in. And for us, I think it helps with some of the some of the issues with turnover. So you know, the last thing that clinics can stand in this industry is to have physicians who are coming and going, it's disruptive, they're hard to find, access is already at a premium. So the better you can tie them into the success of the company, I think, the better chance you have of them staying and, and if you also create processes, and given technologies that make it easy for them to do their job, and they enjoy that and you create a culture of collaboration. And then they get to create a peer network of other physicians within pinnacle in this in this instance, I think it creates a winning strategy for doctors,

Griffin Jones 33:19

the investments that you talked about making it even if they all work, at the end of the day, it's about those investments are in service of getting our eyes to see more patients to be able to do more procedures. How much is there left to squeeze? Do you suppose before you're actually just squeezing?

Andrew Mintz 33:45

Yeah, it's not necessarily about the doctors working harder. Remember, we really want to move to a top a license model. So we really want them doing things that only physicians can do. So if they're working a 10 hour day, and, you know, they're doing, you know, consults for a few hours and and ultrasounds for another couple hours and then procedures for another couple of hours. The question is, what's the best use of their day? And how can that work? As opposed to how can we make you work harder, so that our support systems, more staff, more nurse practitioners, they may be able to assist and alleviate the work that are done by the doctors. And so the problem is still this imbalance between supply and demand. So the more that we can get people through the system, and the smarter we can work, the better we're going to be servicing the patient population.

Griffin Jones 34:41

I know a lot of doctors are seeing by 30 new patients a month it depends on how many partners they have and what kind of systems they have. But if we weren't to add hours into their week, and we were to do it with efficient processes, investment what What do you do? What do we suspect that that number is? Is it 50 new patients per month? Is it 60 new patients per month that we can, that we can get them to with pure efficiency and not hitting them with a, with a stick and dangling a carrot in front of their face?

Andrew Mintz 35:17

Yeah. First of all, I think that differs by doctor. So you know, they each process, you know, differently. I think we also need to be thinking about, you know, other ways to bring patients into the system. So, we talk about top of license, but the question is, can we train OBGYN is to do things that we aren't allowing OBGYN to generally do? Can we train nurse practitioners to do things like new patient intake, or to handle patients for cryopreservation, or for egg banking or some of those other things? So, again, I think we need to continue to innovate to make sure that people who want the service that they need can get it. But I'm not sure that that necessarily means that doctors have to see more patients in their day in order for us to significantly increase the ability for people to access and get through the process.

Griffin Jones 36:13

I want to shift gears for a second. Because I've had two different guests on with with different views on this. And I think it was back in episode 100. I had Mark Segal asked about he was asking about my opinion on what do I think about a network brand or partnership brand versus individual practice brands? And then I also had Gina bar tz on from kind body to talk about her brand, the global brand, that kind bodies building? In my opinion, Andrew is that I think that you all meaning that groups that have different brands from the parents organization and individual markets SRM in Seattle, or, or I'm in, in Portland. And I think that that I think that you all are at a disadvantage. It's like the IGA true value model where it's hard to scale brand to become a consumer brand. That is the pretty green lady from Starbucks that I think kind body has that advantage. Some people disagree with me, they think that it's better to have the local identity. Ultimately, I don't I don't think so in the in the longer run, I think you still have local reputation. Reputation is different from brand. But the whole point of brand is, is to be able to scale and identify. So you might think differently than I do. So I'd love to hear your side.

Andrew Mintz 37:44

Yeah, I mean, I think the branding strategy is to us not necessarily top of mind, in terms of some of the things that we're trying to accomplish. The reality is that these practices have local reputations, and the doctors themselves have local reputation. So there are some of our doctors who I think are known more so than for the name of the practice that they're in, let alone the national network that they're part of, I think that we will see over time that we'll be putting in some kind of tagline to our practices, such as, you know, a member of the pinnacle family, or something along those lines and create that, but I don't see the need for you know, the Starbucks of fertility, I just don't know that, that we need to create that kind of patient experience where they feel they can get the same thing when they go one to the other. If they're in Seattle, and they're going to go to LA and they want to go to Starbucks, they want they want to, they want to know that they're getting the same coffee made the same way. With the same process. I don't think that that's necessarily holds true in fertility, that what we do in Chicago, and what we do in Phoenix has to be exactly the same because we're not really servicing the same patient population, I think we will eliminate variations, but I'm not sure that that's going to be important to patients who are going to be accessing those services.

Griffin Jones 39:03

That's a good point from the repeat, you know, from the the repeat visitor, the repeat patient or in other fields, repeat customer side, it's not as necessary, which is part of what you want in a brand. You want people to just know what they're going to expect next, and they and they keep coming back. But in some areas like social media, especially, lots of people have lots of friends and they follow people in different markets. So to just being able to say I went to this place in New York, it was great. I went to this place in Chicago, and oh, there is one by me here in LA that that is useful. But also I think one thing that's just tremendously underused on the clinic side in our field is influencer marketing. We've seen the tip of it, but part of the reason why we haven't seen more is because up until very recently, there hasn't been somebody with one name that justifies a there a big price tag or a big Campaign for, you know these influencers to say, Yeah, we use x company.

Andrew Mintz 40:08

I just think that if we can provide the patient with the best possible outcome better than our competitors, and we can provide them with a good experience, I don't think that name is going to make a difference. And I think we're just going to stay focused on really those two aspects of the business and worry about the branding as time goes on. But at the end of the day, I'm on a much more sort of focused in on, how can we improve our outcomes? How can we improve our live birth rates? How can we make sure that patients are feeling like they were cared for through the process? And if that feels the same from clinic to clinic over time? That's great. If they're not called the same thing? I it, frankly, not that important to us.

Griffin Jones 40:51

You're doing something right, because you move very quickly, you said October of 2021 is I think, is when you decided on the pinnacle name, and it was in the second half of the 2021 that you closed on? Is it six practices. And and some of those are are ones that all of the other groups would have loved to have closed down. And so talk to us about your courtship process. Why was it successful in that short amount of time?

Andrew Mintz 41:22

I think that they buy into our strategy and our value. So our core values that we have around, you know, putting the patient first collaboration, integrity. These are I think, what speak to them. So we have

Griffin Jones 41:38

nobody says we put the patient last Andrew and nobody says we're a bunch of dishonest dirtbags that are gonna stab you later. So how were you able to actually demonstrate that?

Andrew Mintz 41:47

Yeah, I think that when we talk about not just that we have values, but that we live our values. So the creation of our lab director Council, and our medical director Council, for example, is a tangible thing that they can see that we're actually living our values. And so I think that's important when we go and have conversations with them about, we have these values, and this is how we live them. Here's our strategy, here's specifically how we are achieving these goals that we set up for themselves in terms of outcomes in terms of, you know, patient care, in terms of, you know, the patient experience in terms of all kinds of things. So we have some very specific goals for ourself. And, and we tell them specifically how we're going to get there, and what their and what their role is. And I think they get excited about it. Frankly, there's a there's more than one several practices that we had conversations that either we didn't think that they would fit well into our strategy in terms of them really participating it or they didn't like our strategy. And so from our perspective, that's okay, too. In that we think that we are partnering with those that are really dedicated to making that happen. And they have to take actions to make that happen. So the fact that they are participating on these committees, that they're adopting our protocols that they are, you know, we announced a partnership with genomics for our, our PGT testing, and everyone's now going to be sending to a genomic so that we can get consistency in terms of results. I mean, these are things that we are doing tangibly to make sure that we're getting the best outcomes. And I think that they see in the early days, they saw the vision and they bought into the vision. In the more recent days, they're seeing that we're actually executing on our strategy. And I think that speaking to who are partners in?

Griffin Jones 43:41

Yeah, so how did you how did you paint the vision? Because you, you did it before you even had a company name in many cases? So did you did you like bring a handful of people with you? Did you have Did you have some kind of storyboard? How did you you're successful in bringing some pretty big groups in before you even had like a cohesive exterior identity. So how did you How were you able to articulate the vision without that,

Andrew Mintz 44:12

so we set our we set a strategy and our strategy has some very specific goals. And so we were able to bring that out with us in terms of what we were going to do and how we were going to get there. Some of it is definitely leap of faith. So they looked at this and maybe they just saw something different than what others were doing. I can't speak to what the other networks are doing or what their strategies are other than what they share on your podcast or or on LinkedIn or something else. But I think that they really liked the concept and you know, selling the, you know, the whole collaboration piece you're going to work with other clinics are going to have peers, you're going to be sharing information and you're going to be making changes and making improvements and those be Pull to recognize that, in fact, that needs to happen. Even though some of our clinics have some of the best outcomes, I think in the country, the reality is that they all know that they can do better. And so the those that are more entrepreneurial, and spirit, those that are really understanding that, you know, change is not going to be avoided, that they have to embrace it. I think those are the ones that are really sort of gravitated to our strategy and our and our values, our mission, in terms of, you know, the thing that the steps that we're going to do to take to make some change now, you know, some of that is also, you know, comes with changes in process and changes and in partnerships and those kinds of things. And everyone recognizes that all that has to be reevaluated. So I think the clinics that we've been able to partner with have that same mindset, and those that have decided that we're not the best partner, maybe just have a different view or, or buying into, you know, the, you know, the mission of, you know, a competing platform, which is fine, too, there's plenty of that to go.

Griffin Jones 46:14

So you mentioned sometimes that it isn't a good fit, either. They don't think you're good for you don't think they're a good fit, what are some of the things that that tell you fairly early on or not even early on, at some point in the process, that it's not going to be a good fit.

Andrew Mintz 46:31

So two things are real red flags for us. One is, when they're only discussing money, then we know what the motivation is. And I'm not saying that money is not an important part of the conversation, but when they're fixated on the money and only the money, then then we know that they're really in it for the money. And that's not really the partner that we're looking for. The second thing is that we have a specific business model, you know, we when we ask them to roll equity, they roll it into the parent, not into the local. And so when they start when they start having conversations with you about changing the way and your philosophy about how you're approaching your partnership, then we recognize that maybe that's not there, too. And then, you know, we also do our own reviews of that as well. So, you know, we are looking at operations in the lab before we, you know, before we sign, you know, our definitive agreements, and we really need to make sure that, you know, they have a basis that we can build from, and not all clinics that we saw necessarily.

Griffin Jones 47:43

So they're getting equity in the new so part of you taking equity in their group is that they are doing that in exchange for equity, some partly, your cash is involved, too, but equity in the in the parent company, is that what you're

Andrew Mintz 47:59

talking about? Correct? That's correct.

Griffin Jones 48:03

What's the advantage of doing it that way?

Andrew Mintz 48:06

I think, you know, it allows them to buy into the full strategy of the organization. So if we are going to be building their own egg bank, for example, then they're going to be interested in figuring out how to make that as good as possible. And for them to be participating in the building and the use of an egg bank, as opposed to well, that's a separate financial, it doesn't really hit me. And therefore I'm sort of less invested in the outcome of how some of these, you know ventures are doing. So from our perspective, we like them to be supporting the strategy as a whole and them to be, again, part of that collaboration is that for all on the same page, so if it's good for, you know, if it's good for the organization, it's good for them, as well, as opposed to maybe advantage, one group over another for whatever reason. And, you know, we certainly don't want there to be competition within the organization, regarding who's getting more profits, we really want that ball to come into pinnacle. And for them to be incentivized to the pinnacle level.

Griffin Jones 49:19

I can see the upside of that. And sometimes there's a downside if people don't buy into the parent organization, and then it's just, it's just flipping the current. It's just flipping that the current practice, it's like, well, how much efficiency was really added and how much did we miss out on by not being a part of the network? So I can see the advantage of that does that put them at more of a risk for an Integra mat situation if my equity is here in this parent company now and then this parent company just took? Yeah, just bit the dust and, and now I don't have anything over there.

Andrew Mintz 49:53

Well, I think there's a lot of learnings from Integra med that I think everyone has taken with them Whether they were part of that network or not work, I mean, I think that because we have so many physicians involved at so many levels in the organization. So it's not just the medical director and the lab director concept, but we got someone who, you know, one of our physicians acts as a part time cmo for us. One of our physicians is leading a, our, our efforts on research and clinical trials, we have a physician who's leading our efforts on international marketing and other kinds of activities that sort of get them engaged and how it's going to work for the network as a whole, the more they participate in that, the more excited they are for it, and the more they're sort of willing to, to make it work. You know, I can see on the downside, which is, you know, what I do individually doesn't have as big of an impact to the whole organization as if it was just my clinic, but really don't have people thinking that way, at this time, at least. And so for us, it's been nothing but exciting to see the growth and the engagement that we're getting from our physicians and our practices to help Pinnacle be successful. And, and there were, they're starting to refer themselves as Pinnacle clinics, you know, over the name of their local brand. And, and, you know, internally, I mean, we don't clinical is not a patient facing brand, but it certainly is speaking to them in terms of what we're trying to do. So we're just loving the engagement that we're getting. And we're finding new ways to engage more and more physicians in the process.

Griffin Jones 51:45

For the audience that doesn't know Al Ries and Jack trout were two of the the like marketing thinkers of probably 80s, early 90s. I think Donny Deutsch, David Ogilvy, nowadays, Gary Vaynerchuk, they have that many books, they have a book called The 22 Immutable Laws of marketing, which I don't think is as relevant, I don't, I don't think they're I no longer think they're immutable, or at least many of them. I think some of them are mutable, but one of the rules that they have is the law of the category. And, and in that if you can't be the leader of a category, you create a new category of think of, well, you know, I'm not going to be the top personal injury attorney in my marketplace, but I can be the top personal injury attorney maybe for workplace accidents, and I'm going to own that category. And so, as long as we're speaking of just IVF centers, Fertility Centers is one category that hasn't fragmented in that way. Another one of their laws is that every in the end, every category becomes a two horse race. There's no RC Cola anymore. It's Coke and Pepsi. And, and I think there's, I don't know that that's true in every category. But do is that what we're going to see in the fertility field, is it so we've got pinnacle, we've got inception, Prelude we have. We've got us fertility, we've got the fertility partners, we've got IV somebody's gonna be really pissed at me for forgetting, you know, first facility, Boston, IVF, you know, somebody's gonna be mad at me. I'm going to forget somebody. But we have, you know, 678 network groups now. And is it inevitable that there's two of them and a number of years?

Andrew Mintz 53:33

Yeah, I mean, I think we'll see that we saw that with EDR. Ma. Right. So that was there an international play, and more so than, than local, but I would think that over time. The network's you know, there's only there's only 450 Some clinics in the United States. And, you know, some of them just are, you know, maybe investable. And so I think at some time, there will be conversations, if they're not already happening among the platforms to be combining their efforts into, you know, a single play, it would really, really have to show the advantages to making that happen. And I think that there, there is an could be. And so I would expect over the next few years, we may see that we may see platforms starting to come together. So if that's

Griffin Jones 54:25

the case, then it seems to me like some platforms would be incentivized to get gobbled up rather quickly. They they acquire a number of clinics, all of a sudden they are a company with a healthy balance sheets, they can get a multiple of the multiple that they purchased on which returns what their obligation to their limited partners. And so I could see some companies that may be where they were in business as a network partnership for a year or two. Become acquired by another one and And if that's the case, our practice owners not missing out on something because it's like, well, should, I should I could have just tried to build that multiple, that we ended up selling for more by myself.

Andrew Mintz 55:18

Welcoming, hindsight. 2020 So the reality is though, the woulda, coulda conversations I'm sure people have with themselves all the time, I think that we are going to see that. I think that in this industry, what we're going to find is that strategy, and and I think culture are going to win out. You know, we're, we're working in a very niche healthcare environment, right. And so certain, there are certain things that we don't see in fertility that you see in many other areas like, like burnout. Burnout is not nearly as prevalent in fertility as it is, let's say, an OB GYN. And so I think that we're going to find that people will continue to engage and stay engaged. And I think that these as these platforms come together, you'll find that you'll find a lot of interest from the partners to make it that much more successful. So if they have rolled equity or granted equity, I think that they will continue to want to have a stake in the game, and make sure that the kinds of collaboration and strategic initiatives that need to happen will happen. And I think we're going to continue to see that, at least in my lifetime.

Griffin Jones 56:46

I've, I've grilled Jaya, and you've been a great sport and and showed people what what they can consider with Pinnacle the our audiences, almost all practice owners, fertility execs, peers of yours, how would you want to younger Doc's? How would you want to conclude with them? Andrew?

Andrew Mintz 57:06

Well, I think what we really want is we want physicians to step up. So we are plagued infertility with a whole set of physicians that are called in or close to retirement. And what we need is we need future leaders. And I think the time is better now than ever. And so being able to go into a platform, such as pinnacle, or any of the others that you mentioned, and and be able to create opportunity for themselves in terms of leadership is never been stronger. And so I would really encourage physicians who are already in or about to enter the rd by field to really think about how to make it better. What can they do that their predecessors haven't? Haven't done? What kinds of ways can they take advantage of new technologies and investment that can take it to a whole different level, and I'm eager to see what some of these new strategies and some of these new adopters are going to come forward with and, and then see what happens. So I'm excited for the future and I can't wait for you know, seeing what's next, what new competitor comes in and what our existing competitors are doing to raise the bar.

Griffin Jones 58:33

We will link to Pentacles website in the show notes and as well to your LinkedIn profile for those that want to get in touch with you. Andrew Mintz, CEO of Pinnacle fertility, thank you very much for coming on inside reproductive health.

Andrew Mintz 58:48

Thank you, Griffin. Appreciate it.

58:50

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