CARES© Financial Program

Program FINANCIAL PROGRAM FOR FERTILITY

CLINICS

The

PRESENTED BY: TAMMIE S. POE

WWW.SMARTMDPRACTICES.COM

Financial Programs for Fertility

In today’s fertility market, most clinics are familiar with companies like ARC and IntegraMed, both offering their own versions of an IVF and/or Donor Egg Shared Risk/Refund program.

Unfortunately, minimal patient interest, overly strict medical criteria, and high prices, prevent these programs from generating the level of revenue promised or anticipated.

As a result, many clinics are finding little to no benefit, and instead, realizing that between steep monthly partnership fees and reduced package sales, the cost to offer these programs is exceeding the revenue they generate.

Why Most Shared Risk & Refund Programs Fail….

THERE ARE THREE MAIN REASONS THESE PROGRAMS FAIL TO ACHIEVE THEIR ANTICIPATED SUCCESS:

1. A limited number of patients seeking IVF or Donor Egg

2. The economy, and

3. The structure of the programs.

Limited Number of Patients….

ONLY ~10-12% OF THE POPULATION REQUIRES FERTILITY TREATMENT:

- And Of Patients That Seek Treatment, Less Than 5% Seek IVF Or Donor Egg.

THIS LEAVES THE MAJORITY OF INFERTILITY PATIENTS:

-Pursuing Or Using Less Expensive, And Less Aggressive Therapy Options.

The Economy….

THE CURRENT ECONOMIC SITUATION MAKES IT DIFFICULT FOR MOST PATIENTS TO AFFORD HIGH PRICED TREATMENT PACKAGES.

• Especially, when most packages carry fees in excess of 2.5 to 3 times that of a single IVF cycle, and prices exclude… the cost of fertility drugs.

The hard fact is this, of patients expressing interest in a refund package, many are simply unable to secure the necessary funds, or unable to afford the interest rates, service charges, or monthly payment terms in order to proceed…..

The Structure of the Programs…. THESE PROGRAMS POSE MULTIPLE ISSUES FOR PATIENTS AND CLINICS:

ISSUES FOR PATIENTS

1. These programs are actually controlled by the “Company”, not the clinic. That said, the “Company” has the odds “stacked” in their favor:

A. Patients over a certain age (usually 35yo), or with less than optimal FSH levels, are denied participation – and not permitted to purchase a Refund Plan.

B. Patients must “buy” multiple cycles up front, which increases their initial out of pocket costs

C. Refunds for unused/unneeded services and cycles are not offered, when the patient achieves a pregnancy…..

1) Thus a patient who gets pregnant with their 1st cycle, gets no money back, and ends up paying for 3 (or more) cycles unnecessarily. By the way, the “Company” keeps this extra money, not the clinic….

The Structure of the Programs….

CLINIC ISSUES:

1. The per cycle payout to the clinic,

2. Lag time between performing services and receiving payment from the “Company” (i.e. ARC or IntegraMed®)

3. Penalty fees for unsuccessful cycles

4. Monthly partnership fees the clinic pays the “Company” to offer these programs to their patients.


CLINIC ISSUES:

1. Per Cycle Payout:

A. The company packages the clinic’s IVF, FET, and Donor cycle services based on the clinic’s regular charges, BUT THEN…applies a harsh discount of ~25-35%, in order to reach the overall “package fee” that is then offered to patients.

2. Delayed Clinic Payments:

A. The company collects and controls all monies associated with package sales, and only pays the clinic for each cycle AFTER it occurs. Typically 5-8 weeks post the completion of the cycle.


CLINIC ISSUES:

3. Penalty fees for unsuccessful cycles:

A. When a cycle is unsuccessful (i.e. patient doesn’t achieve a pregnancy), the “Company” typically reduces the clinic’s payment for services, some by 10-20%.

*Don’t forget your fees were already reduced by 25% or more at the onset of packaging your services….

4. Monthly partnership fees the clinic pays to offer the programs.

A. The company charges the clinic a monthly partnership fee, typically ranging from $3,000 to $5,000 per month (or more), and is due regardless of the number of packages sold or cycles performed, even if that is “0”.

C.A.R.E.S.© ~ A Different Type of Financial Program….

The C.A.R.E.S.© Program is a different type of financial program; based on a platform meant to benefit BOTH:

• The fertility patient/couple AND

• The participating fertility clinic.


PATIENT BENEFITS:

1. Reduces the cost of testing & treatment for “cash” patients.

2. More program options – program applies to all “cash” patients, not just those needing IVF or Donor Egg IVF.

3. Patients pay for treatment they need now, not what they “may” need (or not), later.


Reduces The Cost For “Cash” Patients:

A. Services are packaged and discounted, and fees are less than the standard fee-for-service if purchased individually.

B. More affordable treatment means more patients are able to proceed with treatment.


More Package Options – program fits the needs of 85-90% of patients vs. the ~5% with standard IVF and Donor Egg, to include:

A. Basic infertility testing D. IUI’s

B. Clomid/Femara treatment E. Natural Cycle IVF

C. Ovulation induction therapy F. As well as Regular IVF & Donor Egg


Patients Only Pay For Treatment They Need Now…

Single cycle packages allow successful patients to:

1) Pay less for treatment than otherwise required. Patient keeps money that would have been forfeited if they’d purchased a Shared Risk plan.

2) Reduces overall amount needed to borrow, and affords quicker and easier processing of loan.

3) Reduces monthly payments, overall repayment terms, and associated fees.


PRACTICE/CLINIC BENEFITS:

1. Incites business growth, and allows the clinic to assume a greater market share of the fertility business in their region.

2. Increases and generates additional streams of revenue.

3. Reduces clinic’s A/R and costs for billing and follow-up


INCITES GROWTH AND GENERATES ADDITIONAL REVENUE FOR THE PRACTICE.

This results from three main contributors:

A. An increase in self-referred patients – those seeking more/different treatment options; and ones that are more affordable.

B. Higher retention of existing patients- program affords them discounts on services not offered by other clinics.

C. Increase in procedures and cycles – initial testing to assess patients’ treatment options is expedited, and couples can begin treatment sooner. Then, if unsuccessful, they engage in additional cycles.


INCREASE IN SELF-REFERRED PATIENTS:

More Available Treatment Options/Packages:

a. Basic Infertility Testing

b. Clomid/Femara Cycle (with IUI) (and CC + Testing)

c. Ovulation Induction Cycle (with IUI) (and OI + Testing)

d. Natural, Modified, and Regular IVF – single cycle

e. Multi-Cycle IVF – 2-Fresh (or) 1-Fresh + 1-Frozen

f. Donor Egg IVF – single cycle


HIGHER RETENTION OF EXISTING PATIENTS:

All ART Packages require an enrollment fee for participation and eligibility to receive applicable discount(s):

a. Once enrolled – the average patient discount ranges from ~15-20%.

b. The more services purchased, the more discounts a patient can earn.

c. There are NO refunds – if the patient withdraws from the program or leaves the practice, there is no refund of the enrollment fee, and no further discounts. Thus, patients earn their greatest return on their enrollment investment, by staying in the program and with the practice.


INCREASE IN NUMBER OF PROCEDURES WITH EXPEDITED TESTING & TREATMENT:

1) All C.A.R.E.S.© Packages have a time limit in which patients must complete the included services – ensures patients proceed expeditiously.

2) The fee for service pricing is higher, and many patients plan poorly or not at all, to set aside the money needed for each test when the time arrives.

EXAMPLE: The basic infertility testing “technically” can be accomplished in ~30 days, but the average “cash” patient actually takes 3 or more months to complete. The answer - The C.A.R.E.S.© BASIC TESTING PACKAGE


REDUCES CLINIC A/R AND BILLING COSTS/FEES:

A. Patients pay the practice direct for enrollment fees and packages, and in advance of services being performed.

B. This decreases the need to balance bill for services, and subsequently reducing time and work for billing department staff or billing service companies.

C. There are no refunds to worry about or “fund”, and all packages have a “maximum discount limit” – protects the clinic financially.

PATIENT BENEFITS

• Package includes all necessary initial testing procedures in one package

• Advance payment (in full), affords them a generous discount off the standard fee for service pricing

• With package pre-paid, there are no financial obstacles to prevent completion within one menstrual cycle/month, and they are able to proceed with their next step (or cycle), more quickly.

CLINIC BENEFITS

• Payment received in advance of services offers an immediate influx of cash, with no balance billing required.

• Patients complete testing 2-3 months sooner, and move on to treatment more quickly.

• Double to triple the number of services (and revenue) can be achieved in same time period:

• Patient “A” regular “cash” – testing only completed over 4 months.

• Patient “B” C.A.R.E.S.© – testing, a Clomid or OI cycle, and 1-IVF cycle can be completed in these same 4 months.

C.A.R.E.S.© Basic Testing Package-Example:

THE SAME OR SIMILAR BENEFITS RESULT WITH ANY OF THE

C.A.R.E.S.© TREATMENT PACKAGES:

• Clomid/Femara Cycle Packages

• OI Cycles Packages

• Etc.

The C.A.R.E.S.© Program:

CLINICS SELECT THE PACKAGES THAT WILL BEST FIT THE

NEEDS OF THEIR PRACTICE:

• Tricare/Military IVF

• Multi-Cycle Packages:

• 1 Fresh Cycle + 1 FET (Cryo Cycle)

• 2 Fresh IVF Cycles

The C.A.R.E.S.© Program ~ ART Packages:

• Natural Cycle IVF

• Regular IVF

• Donor Egg IVF

• Combo~Donor Egg + Regular IVF

ART PACKAGES REQUIRE ENROLLMENT….

The C.A.R.E.S.© Program ~ ART Packages:

• Enrollment fees generate additional up front revenue and cash flow for the practice.

• Enrollment fees are non-refundable – even if patient dis-enrolls or leaves the practice.

• This additional revenue actually “offsets” the overall discount absorbed by the clinic.

THE CARES© PROGRAM WAS PILOTED AT AN IVF CLINIC IN VIRGINIA.

IT HAS SHOWN SUCH IMPRESSIVE RESULTS, THAT IT IS THE ONLY

PROGRAM THE CLINIC OFFERS!

The C.A.R.E.S.© Program ~ Pilot Clinic:

• Over a 3 year period, the number of CARES© Enrollments and Fresh IVF cycles more than tripled since its introduction….

• By its 3rd year, CARES© represented more than 65% of all the clinic’s Fresh IVF cycle cases….

SEE ACTUAL DATA PRESENTED IN NEXT 2 SLIDES

Pilot Clinic & The C.A.R.E.S.© Program ~

98

54

12

164

36

95 116

247

0

26 9

35

65 53 51

169

Year #1 Year #2 Year #3 TOTALS

Cash IVF Sales CARES© IVF Sales

CARES© "Tricare" IVF Sales Insurance Cov'd IVF Cycles

The C.A.R.E.S.© Program ~ Pilot Clinic

• The first year, CARES© made up 27% of clinic patients in Fresh-Regular IVF cycles.

• In its second year, CARES© encompassed 52% of all Fresh IVF cycles (Regular CARES© + those in the newly implemented Military program)

• By its third full year, CARES© assumed 68% of all Fresh-Regular IVF cycles for the clinic.

Cash % CARES©

% CARES©-Military%

Insurance %

Year #1 73% 27% NA 33%

Year #2 23% 41% 11% 22%

Year #3 6% 62% 5% 27%

*Data only reflects Fresh IVF cycles – Donor Egg and FET cycle data was not included.

What’s The Secret Behind The CARES© Program’s Success?

Patients Clinics

More Options

Affordable Treatment

Rewards for

Repeat Cycles

Targets 95% or more of

market

Benefits Both-

Patients & Clinics

↑ Growth of Business

↑ Revenue

↓ A/R

Innovative Platform

What Does A Clinic Pay for The CARES© Program?

Well, it’s actually pretty simple, the clinic is

responsible for:

1. A one time implementation fee –

(and)

2. A reasonably priced, monthly fee - paid during each

month of participation.

That’s It…

So, treatment your patients can afford…

You collect and control your own money…

No refunds to worry about or “fund”…

No penalties for unsuccessful cycles…

No waiting for payments on your services…

If you’re ready to put the CARES© Program to work for your practice, contact Tammie S. Poe, today: [email protected]

mailto:[email protected]

Healthcare

CARES© Financial Program