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Private Equity and Venture Capital

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78 - Is Private Equity Putting Money Ahead of Patient Care? An Interview with Dr. Francisco Arredondo

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Wall Street has been moving into healthcare for several years and it has been making its mark in the fertility field. Some practices have taken advantage of the influx of money in the field, but several haven’t. But several docs have some concerns, specifically when it comes to decision making.


Do private equity firms or people who invest in fertility clinics and businesses really have the best patient care in mind?


On this episode of Inside Reproductive Health, Griffin talks to Dr. Francisco Arredondo, founder of RMA of Texas and author of his upcoming book, MedikalPreneur. Together, we dive into the pros and cons of money entering our field in the form of private equity.

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70 - How HRC Came to be an International Publicly-Traded Fertility Group, an interview with Dr. Bradford Kolb

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HRC Fertility is one of the largest providers of Assisted Reproductive Care in the United States. Started in Southern California in 1988, the clinic has grown immensely, serving thousands of patients every year. In 2017, HRC took their success globally, joining forces with Jinxin Fertility and listing on the Hong Kong Exchange. Despite the booming expansion, HRC never forgot its roots: providing quality, personal care for its patients and giving physicians the opportunity to have full control of patient treatment.

On this episode of Inside Reproductive Health, Griffin spoke with Dr. Bradford Kolb, President of HRC Fertility. Dr. Kolb joined the practice in 2001 and worked through the IPO process with his partners, making HRC what it is today. Not only did we talk about the process of going public, but more importantly, we talked about how HRC was able to maintain their patient and physician culture in this rapid phase of growth. He shares the structure of the clinic and what they do to maintain a small practice feel for such a large organization. Plus, Dr. Kolb offers advice for young fellows and physicians entering the world of Reproductive Medicine and what they can do to be successful in the field from both a personal and professional standpoint.

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61 - Financing a New Business in the Fertility Field, An Interview with Jeff Issner and Taylor Stein

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Entering the fertility space outside of owning a clinic is challenging. Entering the space as a tech company, well, that’s a whole other story. On this episode of Inside Reproductive Health, Griffin spoke with Jeff Issner and Taylor Stein, co-founders of EngagedMD. Together, they developed software that helps to educate patients and provide informed consent in clinics across the country. They share the story of how they got started in the fertility space, from idea to execution, without any commercial debt.

Jeff and Taylor also talk about how they got doctors and clinics on board before their software was even fully developed. Plus, they discuss the ever-challenging hiring process and what they do to make sure they are getting the best people on board.

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59 - Retaining Patient and Physician Focus While Growing a Clinic, An Interview with Michael Alper

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Boston IVF, one of the largest IVF centers in the nation and one of the first free-standing clinics in the country. What started as an independent clinic grew into one with a well-respected academic affiliation, and now has partnered with a worldwide hospital group. Through it all, their mission remained the same: bring state of the art technology to a patient-centered outpatient clinic. On this episode of Inside Reproductive Health, I talk to one of the founders of Boston IVF, Dr. Michael Alper. Dr. Alper shares the history of Boston IVF, but more importantly how they grew into what they are today. His story teaches important lessons to any doctor-owned clinic curious about academic affiliations or partnering with outside equity groups.

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54 - Improving Patient Experience by Building an Empowered Team, An Interview with Dr. Peter Klatsky

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There’s a challenge in finding the balance between keeping both your staff and patients happy. On this episode of Inside Reproductive Health, Griffin gets Dr. Peter Klatsky’s take on managing everyone’s satisfaction while providing a new standard of care. Working with his partners at Spring Fertility in California, their goal is to provide their patients a level of service that isn’t seen anywhere else, all while keeping their employees happy and in for the long haul.

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46 - Can Innovative Practice Culture Drive Patient Satisfaction? An Interview with Dr. Alan Copperman

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Building and growing an IVF practice can have numerous benefits for both the owners and the patients they serve. But growth can sometimes lead to loss of patient-focused care. On this episode, Griffin Jones, CEO of Fertility Bridge and host of Inside Reproductive Health, talks to Dr. Alan Copperman, Co-Founder and Medical Director of RMA of New York, one of the nation’s largest IVF centers. Together, they discuss how RMA of New York was able to retain their patient-focused culture while exponentially growing the practice. Their approach to delegating important tasks, understanding the “new” patient, and finding the right, compassionate employees has greatly contributed to their success today.

To learn more about Dr. Copperman and Reproductive Medicine Associates of New York, visit their website at https://www.rmany.com/.

Visit fertilitybridge.com to learn more about what Griffin and his team can do for your fertility clinic and take the first step in building your marketing system with the Goal and Competitive Diagnostic.

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45 - From Patient to Fertility Entrepreneur, An Interview with TJ Farnsworth

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While outcomes are so important in the field of fertility, the patient journey can easily be lost. After going through his own journey, TJ Farnsworth founded Inception Fertility, a group of fertility practices across the country hoping to provide positive experiences for their patients. On this episode of Inside Reproductive Health, Griffin and TJ discuss the culture of Inception Fertility and how empowering your employees to be champions for your patients can have a meaningful impact on their experience. TJ also shares his thoughts on increasing collaboration between fertility clinics across the country and how that can mean success for everyone.

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36 - Maintaining Clinic Culture Amidst Continental Growth: Is It Possible? An Interview with Michael Levy, MD

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Deciding to expand your practice, either by acquisition or starting new, is an exciting time. But, adding new staff, physicians, and equity partners can come with a handful of problems. On this episode of Inside Reproductive Health, Griffin Jones, CEO of Fertility Bridge, talks to Dr. Michael Levy, IVF Director and President of Shady Grove Fertility. Shady Grove Fertility is the largest fertility group in America and has over 25 equity partners and almost 1000 employees. Griffin and Dr. Levy discuss the implication of having such a large staff base and just how they manage it, all while keeping the patient at the forefront of their culture.

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33 - Building Consensus in a Multi-Partner Physician Practice: An Interview with Louis Weckstein, M.D.

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Growing your practice is exciting and adding in new Physician Partners can mean a lot for both your business and your patients. But adding to your group of decision makers can be intimidating. In this episode, Griffin Jones talks to Dr. Louis Weckstein, Medical and IVF Director and Managing Partner at the Reproductive Science Center of the Bay Area in San Francisco. Dr. Weckstein discusses the importance of building consensus amongst Managing Physicians and three simple ways to help facilitate easier decision making.

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Fertility Company Profile: The New Marketplace for IVF Patient Acquisition

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By Griffin Jones

Consolidation.

If you had to reduce the water-cooler talk of our field to one topic, it would be exactly this: the consolidation of IVF centers, fertility pharmacies, brokers, genetics companies and others, purchased with private equity money.

I wrote about these players, and the collective unease about them, in 2018. I have talked about it on the IRH podcast with guests such as doctors John Storment and David Sable. I hear the apprehensions and I share some of them.

Are we capable of betraying our patients’ best interest because of obligations to financial stakeholders?

That’s a very sound concern for the delivery of fertility care. Furthermore, it’s very likely that there are examples wherein this concern is justified.

I own Fertility Bridge outright, 100%. I often make decisions based on what I want for the relationships of our clients and employees. If I had to answer to many different shareholders, we would likely do things very differently.

Conversely, I also see examples where this pressure disrupts the status quo and forces innovation and efficiency when we have to compete to earn patients’ selection. Sometimes, the independent centers with the least competition are the least likely to invest in patient experience and team culture.

Either way, I do not see the consolidation of REI practice groups as the single greatest disruption coming to the field. Not by a long shot. In 2018, I also wrote that technological revolution dwarfs any disruption caused by the sale of IVF practice ownership to private equity.

While others are looking to Wall Street, I have my eye on Silicon Valley.

Consider it this way:

The independent REI practice is the local, 100 room hotel.

 

They’re worried about the Marriott building a 1,200 room, mid-rise on the waterfront.

I’m worried about AirBnB.

One view looks at larger and more dominant competitors in the same marketplace. I’m looking at a whole new marketplace.

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The model for the delivery of healthcare, including fertility care, has become too estranged from the conveniences that patients are used to when researching, considering, receiving, purchasing, and evaluating goods and services as consumers.

Our patients under age 30 have conceivably never called by phone to invite a friend over, break up with a significant other, or even order food. Yet, for virtually every fertility center, there is ultimately no other way to schedule a new patient visit.

Please take my next admonition as commentary on the mechanics of patient relations and not on providers’ devotion to service; I know the depth and sincerity of so many practitioners’ vocations.

We’ve been too slow to adapt and have grown out of touch with our patient demographic. For some, it’s already too late.

I don’t envision large fertility groups or boutique REI practices going away, but another class is emerging to capture the middle, the entry, and everything around.

There is a wide opening to provide the user experience of patient acquisition and patient retention that the current demographic demands. With the right application, and/or scaled acquisition strategy, one or two platforms can become the gateway through which patients enter. Many companies are jockeying for that position. Some of them may win, or the winner may not yet be in the marketplace. The extent to which they’re able to scale is the degree of leverage they have over providers.

Put frankly, someone is building a better mouse trap than you have so they can sell (who would have been) your own patients back to you.

Many have tried and not (yet) succeeded, but it would be hubris to think that others won’t.

Here are some of these players now, and what they’re up to.

Important disclaimer: Neither I, nor Fertility Bridge, have a direct commercial relationship with these companies at time of writing, though we certainly may in the future. No information in this article comes from conversations that I have had with the executives of these companies. This profile is not a revelation of insider knowledge. Rather, it is a curated synopsis of public information. My observations and opinions are exactly those, based on information that has been publicly released by these companies or covered in the press.

CONSUMER APPS:

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GLOW

The tech-forward platform for serves fertility patients and connects them with clinics by providing:

  • Glow- Ovulation and fertility tracker

    - Includes:

    • Fertility Calendar

    • Daily health log

    • Health insights

    • App syncs with partners app

  • Glow Community

  • Glow Nurture - Pregnancy app

  • Glow Baby - Baby Tracker

  • Eve by Glow- period tracker and sex tips

Glow Fertility is segmented into a direct-to-consumer programs and a separate employee benefits program.

  1. Direct-to-consumer programs:
    Glow predicts ovulation patterns and fertility probability based on user data inputs and supports women with services such as egg freezing and IVF. In addition to helping clients navigate the process of getting pregnant, Glow also facilitates access to healthcare providers (with whom the Glow team negotiates discounts to reduce the financial burden of historically expensive fertility treatments).

  2. Employee benefits program:
    On the employer side, the Glow Fertility Program negotiates contracts between employers and fertility care providers.

Millions of women input data on menstrual periods, doctor visits, sleep habits, sexual activity, and birth control (in addition to over 35 additional basal health data points), and Glow has all of that data.

Although Glow does not publicly share the full details behind it’s business model, the firm charges businesses for the employee benefits program, and is also able to charge a fee for facilitating access to services from preferred healthcare providers. Glow also offers women personalized consultations through its direct-to-consumer channel, offering one free session before converting to a charge for service model.

History and Funding:

  • Launched in 2013 by Max Levchin (co-founder of Paypal)

  • Glow originally spun out of PayPal Co-Founder and CTO Max Levchin’s business incubator, HVF.

  • According to Crunchbase, Glow has raised over $23 million in venture capital, $17 million of which was raised in a 2014 Series B round that included Founders Fund and Andreessen Horowtiz, reports Vox.

EMPLOYEE BENEFITS:

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CARROT

Carrot is a startup out of Y Combinator working with employers to offer fertility care like egg-freezing and in vitro fertilization (IVF) as a workplace benefit.

Provides affordable options for those struggling with infertility by partnering with employers to add coverage for fertility services. They offer customizable plans to employers to include varying levels of fertility coverage at a sliding, per-employee dollar amount.

Founded by:

  • Tammy Sun, CEO

  • Dr. Asima Ahmad, Medicine

  • Juli Insinger, Growth

  • Arun Venkatesan, Engineering

Funding:

  • Total funding: $15.2 million

  • According to CrunchBase, Carrot has raised $15.2 million over four rounds, one angel, two seeds, and a series A. Their lead investors have been UnCork Capital with 3.6 million and CRV with $11.5 million.

 

NU BUNDLE:

A benefit system employers can add to attract top talent.

Also offers services to help members understand their options, with guidance before, during, and after treatment. Services for members include:

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  • Their family planning concierge, which reports to provide members with caring, live guidance, and support at every stage of the journey.

  • Help for members maximize existing benefits.

  • Access to preferred pricing at top clinics and pharmacies.

  • Access to customized fertility payment options.

Nubundle offers its products as a voluntary employee benefit, limiting the costs to employers. Employers pay a flat annual admin fee.

Founders

  • Chris D'Cruz

  • John Ciasulli

Funding

  • Total funding: $1.5 million

  • In a seed round, NuBundle raised $1.5 million from three investors led by Lightbank.

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STORK CLUB

Family/fertility benefit suites for companies.

In 2018, Stork Club expanded their core offering by introducing a comprehensive suite of Flexible Family Benefits that include both Fertility and Parental programs designed for large enterprises.

Stork Club advertises to be the only enterprise-ready family benefits provider designed for self-funded employers. They process claims and pay providers directly, letting your team focus on more important goals.

They have employee-facing web and mobile apps to help employers on-board, manage, and validate new programs with vetted provider partners.

History

  • Founder, CEO: Jeni Mayorskaya

  • Early Stork Club investors and advisers include key employees from LinkedIn, One Medical, and Facebook .

Funding

  • They appear to be funded by slow ventures, but it is unknown how much money they have raised.

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PROGYNY

Right now, Progyny is the fertility benefits company.

They provide fertility solutions for self-insured employers.

Some may remember, Fertility Authority, the consumer facing company and fertility clinic review platform that negotiated reproductive health benefits. The company changed its name to Progyny in 2015 after acquiring, or being acquired by, Menlo Park-based Auxogyn, the inventor of Eeva. They quickly sprinted ahead to lead the race of fertility benefits broker.

In my opinion, this is a one-horse race at the moment, with their young, new competitors looking to be the person who can disrupt their early lead as Lyft did to Uber.

History:

  • Founded in 2008 as Fertility Authority, became Progyny in 2015

  • CEO: David Schlanger

  • Headquarters are located in New York, New York

Funding:

  • Total funding: $99.5 million in ten rounds from six investors, as documented by CrunchBase,

    • Who led the rounds has not been released.

    • Though we do know they raised $15 million in a new round in 2016.

THE FINANCIERS

Now this group is different. They’re not a new wave of tech companies launched from or by Silicon Valley serial entrepreneurs. However, by default, they do serve as lead generation and another entry point for patient acquisition from which they can bring new patients to fertility centers.

Also, I speculate a potential scenario in which one or more of these companies are acquired for easier, quicker, and more expansive entry into the fertility field.

Think about it. Many of these companies have an outdated user experience and some of the founders may be ready to cash out of the game rather than reinvest and overhaul. Again, this is Griffin Jones putting his Jim Kramer hat on and being purely speculative.

 

WIN Fertility:

Maybe they belong in the employer benefit group, but a few things set them apart:

They have been in the field for two decades.

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WIN offers benefits through employers and affordable options for treatment through practices for those without insurance or for those who have exhausted their insurance benefits.

WIN integrates with national and regional insurance carriers, as well as the nation’s largest pharmacy benefit managers to procure fertility services. WIN patients are qualified prior to fertility treatment.

Available 24 hours a day, 7 days a week, WIN’s Nurse Care Managers guide patients through every step of their fertility journey.

History

  • Originally founded as an independent women’s health management company

  • Founded in 2000

  • President and CEO: Roger Shedlin

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Attain Fertility

ATTAIN FERTILITY:

Attain makes themselves known for being the original multi-cycle plan provider. They offer bundled IVF cycle plans, called Multi-Cycle Discount Programs, that include multiple IVF cycles for a one-time, discounted fixed fee.

Being owned by IntegraMed they are affiliated with 40 practices, 130 locations, and more than 180 Reproductive Endocrinologists in their US wide network.

How it works:

  • Some patients qualify for their Multi-Cycle Discount Program + REFUND. This offers patients who meet certain criteria the potential of getting a refund if their IVF cycles are unsuccessful.

Estimated revenue:

  • $15.4 million

History

  • Founded by Pam Schuman

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ARC Fertility

ARC says they are the access point to the “nation’s largest network” of fertility professionals and offer innovative financing options.

More specifically, ARC offers fertility treatment packages, refund guarantees, and finance options to people living with infertility.

Value proposition to clinics and/or patients:

  • Largest network

  • Most trusted

  • Doesn’t own/operate clinics -> looking out of patients best interest

ARC’s fertility care packages can be bundled with medication and genetic testing services and bundle the cost of services into one monthly payment.

History:

  • ARC was founded by David Adamson, MD.

THE WILDCARD

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Fertility IQ

The most comprehensive review platform for fertility specialists and fertility clinics.

With FertilityIQ, prospective patients search by location or by a specific doctor or clinic name. Doctor profiles are detailed with aggregated metrics including communication quality, degree of individual attention, responsiveness, and overall recommendation. Patients’ summarize their experiences with doctors and clinics -- from the doctor’s approach to diagnosis and treatment protocols, to the nursing staff’s level of organization, to the competence of the clinic billing department.

History and Funding:

  • The founders of Fertility IQ, Jake and Deborah Anderson-Bialis, say they will never take marketing dollars from clinics. Rather than seek capital from outside investors, the couple decided early on to self-fund FertilityIQ.

  • Founded in 2015, went live in 2016

One of my clients once told me that they were weary of Fertility IQ because they thought they were building a mousetrap and they didn’t know what it was. I’m not weary because I believe Jake and Deborah have built their platform from an authentic ethos and are serving the market in a genuine and desperately needed way. Where the mousetrap will lead, I have no idea but it’s already a darn good one. Fertility IQ offers the best user experience for fertility clinic selection and has some of the best consumer generated data in the field.

Conclusion:

Up to now, I have presented private equity backed consolidation and venture capital backed innovation as two separate phenomena, though they certainly don’t have to be. What will happen when the largest fertility networks, their parent companies, or private equity firms, acquire the largest scale platforms for patient acquisition, financing, distribution etc? Vise versa?

Resilient businesses survive revolution and later thrive because they adapt to capitalize from these disruptive forces rather than be replaced by them. There is more opportunity for the independent REI practice than there has ever been before, but it isn’t coming from doing business the same old way. It requires new strategy, paying close attention to the new players in the market, and using them for their benefit.

If you would like help in adapting to these forces and benefiting from the disruption rather than being pained by it, learn more about how to implement the Fertility Marketing System.

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16 - What Does Wall Street Want with the Fertility Field? An Interview with David Sable, MD

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Today, Griffin Jones spoke to Dr. David Sable, who directs healthcare and life science investing for the Special Situations Fund in addition to acting as the portfolio manager for the Special Situations Life Sciences Fund and the Life Sciences Innovation Venture Fund. Dr. Sable’s deep background in reproductive medicine and his interest in entrepreneurship led to a fascinating discussion about the future of reproductive endocrinology and IVF, with a focus on the fear of a private equity takeover and the realities of the large population of underserved people experiencing infertility in America today.

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7 - Does Selling Your REI Practice Help Patients or Limit Care with Dr. John Storment

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In this episode, Griffin talks to Dr. John Storment, a successful REI practicing in Louisiana. Dr. Storment talks about the potential pitfalls of accepting an offer from a private equity group, and how that can impact the way that you practice, as well as the importance of understanding the business side of your medical practice.

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The Battle for the IVF Market: 5 Wall Street backed companies vs. private practice

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Part 3 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

Multi-million dollar private equity firms offer fertility practices an ultimatum: sell part of their practice, or have their market-share siphoned away.

Major firms spend hundreds of millions of dollars nationwide because they are in a race to consolidate as much of the fragmented IVF market as they can. This is only to speak of companies who own and operate networks of fertility clinics. In parallel, in 2017, PitchBook tallied more than $178 million invested into startups developing fertility products. In our series about fertility practices’ tectonic shift from small clinic to entrepreneurial venture, we’ve detailed the challenges that independent fertility practices face that their big new competitors don’t. So who are these new titans, and what are they up to?