A COO’s Perspective on Successful Fertility Clinics with Steve Rooks

About the interviewee Steve Rooks
Steve Rooks has channeled his expertise and unwavering commitment toward fortifying the landscape of reproductive healthcare. In an exclusive interview, he peels back the layers of his strategic insights and hands-on approach to optimizing the experience, efficiency, economics, and overall effectiveness of IVF clinics.

What, in your opinion, defines a successful fertility clinic and sets it apart from others? How do you measure success?

To borrow from Dr. David Sable, the table stakes for a successful fertility clinic is enabling patients to have the number of babies they want to build their families – in the shortest period of time and at the lowest cost.
However, to truly set itself apart in delivering on these primary objectives, a successful fertility clinic needs to thoroughly, truthfully, and transparently engage patients throughout their journey, so that they fully understand, are informed about, and are involved in the decisions and progress being made. The true measures of success in delivering that experience and outcome are the demonstrated trust and loyalty of patients returning after failed IVF cycles and how strongly they are willing to recommend the fertility clinic to friends and family in need – otherwise known as the Net Promoter Score.

Which factors are the most crucial for clinic success, and have they evolved or changed in recent years? If so, how/why?

I like to call the key success factors (KSFs) the 4Es of fertility clinics: Effectiveness, Efficiency, Economics, and Experience.

Effectiveness – Accurate diagnosis and treatment to deliver successful outcomes is the foundational KSF in order to achieve at least top-quartile results. In the US, this constitutes an overall live birth rate (LBR) per embryo transfer (ET) of >60%, and LBR per retrieval of >64% for <35 yo, >49% for 35-37 yo, >34% for 38-40 yo, and >13% for >40 yo. Over the last 20 years, LBR has doubled due to improvements in embryo culture, stimulation protocols, eSET, vitrification, and embryo selection. However, we’ve seen the rate slow down over the last 5 years.

Efficiency – Under 20% of fertility treatment needs are being addressed in North America today. So, a critical factor for success is increasing efficiency throughout the fertility value stream. Leveraging operational efficiency frameworks, such as Lean thinking, is one way to do this. However, the most important lever is enabling REI efficiency to maximize the number of IVF patients they can effectively support. For me, the most important efficiency KPI for an IVF clinic is REI appointment hours consumed per IVF cycle start. Why? Because that focuses attention on optimizing the most constrained and valuable resource – the REIs’ time, and frankly, the patients’ time. This is best achieved by making consults as effective as possible by ensuring all necessary patient history and diagnostics are completed, analyzed, and summarized beforehand. A digital AI platform, such as LEVY Health, can automate, augment, and advance this process to save valuable REI time.

Economics – While effectiveness and efficiency are key drivers of improved economics, other factors contribute to a clinic’s economics. These include strategic sourcing, a staffing model with APPs and OB-GYNs who support REIs and maximize “practicing to top of their licenses,” and leveraging technology, such as LEVY Health, to automate, augment, and advance all staff’s capabilities. With the total cost of an IVF cycle rising ~10% per year to the point that the average cost per baby, using 2021 CDC data and FertilityIQ average rates, is $101K, successful clinics in the future will be those that fully leverage these factors to drive down their unit costs and their prices to enable more people to afford the treatment they need to build a family.

Experience – The quality of a patient’s experience during their fertility journey is increasingly becoming the key differentiation factor for successful fertility clinics, all things being equal. A fertility clinic that is truly patient-centric (not just paying lip service) employs several elements, including education, engagement, expectation setting, empathy, empowerment, and enhanced services (such as mental health and wellness, nutrition, acupuncture, massage, etc). Combined, these factors enable a patient to be, and feel, fully involved and supported in their journey, with greater understanding and less stress. They also increase patients’ trust and loyalty to the fertility clinic, motivating them to return for multiple cycles to achieve their family-building objectives. Measuring the Net Promoter Score and understanding any experience gaps from the patient’s perspective is critical to driving improvements.

How is patient management detrimental to success? Which role do early diagnostics, triaging, and preparation play?

Effective management of patient referrals, intake, diagnostics, and triage to prepare for an effective REI consult plays a crucial role in shaping positive first impressions with the patient to support conversion. The way a fertility clinic promptly processes and coordinates self-referrals and referrals from primary care providers or other specialists significantly impacts the patient’s initial experience. A streamlined process for capturing patient history to enable quick and effective diagnostics, triage, and chart prep demonstrates professionalism and respect for the patient’s time, concerns, and their unique needs and circumstances. In particular, expeditious diagnostics combined with providing patients with education and explainers to put the results in context can enable an effective and complete REI consult. These initial interactions lay the foundation for trust and confidence, influencing the patient’s overall perception of the clinic. However, when intake, diagnostics, and triage are done slowly and poorly, leading to delays in the REI consult and requiring follow-ups to complete diagnosis and treatment planning, patients have reasons to go elsewhere for treatment.

In your opinion, when is the right time for a fertility clinic to consider major changes and implementations? To consider its gtm approach and pricing?

There is no better time for a fertility clinic to consider and implement major changes than the present! The second-best time to initiate major changes in pricing, process, and workflow is when a clinic sets up a de novo clinic in another location. Making changes at a de novo would allow them to implement new and improved approaches from the start to help accelerate their patient ramp and learn best practices. Then, management could implement those improvements at their existing clinics.

How can advanced practice providers (APPs) and OB-GYNs increase efficiency in fertility clinics?

Utilizing APPs and OB-GYNs who are properly trained in fertility treatment allows REIs to truly “practice to the top of their license”, meaning they can focus their valuable and scarce time on establishing the most effective protocol for patients requiring IVF to succeed. Doing so enables a fertility clinic to effectively drive 3 of the 4E’s – Efficiency, Economics, and Experience across the value stream in the following ways:

1. Comprehensive Initial Assessments and Triage:

• APPs can conduct thorough initial assessments, gathering detailed medical histories, reviewing systems, and assessing lifestyle factors. 
• OB-GYNs can collaborate with APPs to finalize the preliminary assessment for triaging and requisitioning diagnostics.

2. Patient Education and Counseling:

• APPs excel at patient education. Even if a clinic provides digital education to patients, APPs can follow up with them to ensure they fully understand their options with respect to fertility treatments, medications, and procedures.

3. Low-Complexity Fertility Treatment:

• APPs can manage timed intercourse, IUI treatment and egg freezing cycles.
• OB-GYNs can supplement REIs by managing simpler IVF cycles for normal/ better responders as well as egg freezing cycles.

4. Monitoring and follow-up:

• APPs can manage routine monitoring visits, track ovulation, and perform ultrasounds. They can also address common queries and concerns.
• OB-GYNs can focus on critical decision points by interpreting test results, and adjusting treatment plans based on progress.

5. Procedures:

• APPs in some jurisdictions can perform embryo transfers with appropriate training and initial supervision.
• OB-GYNs can likewise perform transfers and retrievals with appropriate training and initial supervision.

Effective utilization of both APPs and OB-GYNs optimizes clinic workflows, improves patient experience, and enables REIs to focus their valuable time on the more complex aspects of fertility treatment. 

How, in your opinion, can IVF become more affordable and accessible?

Fully leveraging APPs and OB-GYNs to complement REIs and enable them to effectively initiate more IVF cycles would make IVF treatment more affordable. This is exactly what Dr. Paco Arredondo at Pozitivf and Dr. Mark Amols at New Direction are doing. Combining this staffing model with other sources of improved efficiencies and economics, such as the digital AI platform from LEVY Health to automate and augment diagnostics, as well as implementing Lean, can significantly reduce the unit treatment cost for IVF. Increasing accessibility can also be achieved using the same levers, by enabling APPs and OB-GYNs at remote satellite and partner women’s health clinics to manage intake, diagnostics, low-complexity fertility treatment, and monitoring, effectively expanding the range of the fertility clinic. Unfortunately, fully leveraging APPs and OBGYNs to the top of their license and their capabilities with training and supervision are somewhat controversial.

With under 20% of fertility treatment needs being addressed in North America, is the fertility profession collectively supporting access to medical care and fully leveraging other health professionals to get patients the help they need?

If the fertility profession agrees, as I believe it does, that the ability to reproduce and raise a family is a universal human right, then we have a huge gap to close to make that a reality. Incremental changes, such as increasing REI fellowship positions and reducing the fellowship duration to two years, will not close that huge gap any time soon. Therefore, radically different approaches are needed that still ensure effective outcomes, while increasing access and reducing time and cost to baby. These radically different approaches include a staffing model that fully leverages APPs and OB-GYNs, both within and as remote extensions of the fertility clinic, implementing Lean thinking to improve efficiency and patient experience, and using digital/ AI platforms, such as LEVY Health, to automate, augment and advance clinician capability to reduce time and cost to baby.