By Brian Klepper
97% of employers offering infertility coverage say that it adds little to medical plan costs and that many employees prize it.
--There are multiple considerations when choosing a fertility clinic, such as pricing, success rate and what the percentages are for singletons vs. multiple births.
--Another important consideration is whether a vendor’s performance claims have been vetted by an independent third party, like the Validation Institute. If not, why not?
Does your company’s health plan offer fertility benefits? What’s the case for making these services available, and what issues should you consider in choosing a vendor?
A recent World Health Organization (WHO) report found that one in six people worldwide experiences infertility during their lifetimes and one in eight experiences it at any one time. Infertility is “a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular, unprotected sexual intercourse.” The report clarifies that infertility is a common condition worldwide. Any employees and their partners, both women and men, including singles and those in the LGBTQ+ communities, can need help in forming a family. For employers, workers with infertility issues are likely to have physical and emotional burdens -- e.g., anxiety, depression and financial stress -- that corrode employee engagement and productivity.
Infertility care can be expensive. A single in vitro fertilization (IVF) cycle -- ovarian stimulation, egg retrieval and embryo transfer -- can range from $15,000 to $30,000. Many patients require multiple IVF cycles before getting pregnant or taking a different path.
While 12 states have mandated coverage of fertility services, its cost has led many employer benefits managers and consultants to consider it a “premium” benefit, meaning that they’re most popular with employers in high-margin industries. The result has been limited coverage, with only one in four people getting the treatment they need.
Even so, 97% of employers offering infertility coverage say that adding it did not significantly increase medical plan costs. They appreciate that these services are prized by many employees and can often be a deciding factor in the competition for top talent. 90% of employees with infertility concerns say they would change jobs for fertility benefits. 61% claim that receiving benefits increased their loyalty. 58% think it is discriminatory not to provide fertility benefits.
A number of fertility companies have come into the market in recent years, and it can be difficult to compare them. Here are some key issues to consider:
- What are the recruitment criteria for the fertility companies’ physicians and clinics networks? Do they rely on objective data related to health outcomes and cost?
- What are their rates of singletons vs. multiple births? Singletons are likely to have a higher gestational age than multiple gestation births, so they typically have lower morbidity and mortality rates, as well, with better health outcomes and lower costs. It’s critical to know what each vendor’s numbers are and what they’ll guarantee.
- What is their pricing and what is it based on?
- Is the employer-paid portion fixed or flexible/discretionary? Does the fertility vendor offer employers a range of subsidy options?
- Is the vendor backed by private equity or venture capital investments? If so, it’s almost certainly paying a 20% to 30% annual interest rate on those investments that must be built into the vendor’s pricing structure. Organizations that have bootstrapped their operations, with lower-cost capital typically have a competitive pricing advantage.
Another important consideration is whether a vendor’s performance claims -- fertility or other -- have been vetted by an independent third party, like the Validation Institute (VI), and if not, why not. (Disclosure: I serve unpaid on the VI’s Advisory Board.)
The VI stands behind its validation process, offering customers of validated solution providers up to a $25,000 guarantee for claims-based validations and up to $50,000 for program validations. They offer four validation levels, with 4 representing the highest.
1) Contractual Integrity, meaning that a vendor “is willing to put part of their fees 'at risk,' as a performance guarantee.”
2) Metrics, meaning that “credible sources and valid assumptions create a reasonable estimate of the program’s impact.”
3) Outcomes, meaning that “the product/solution has measurably improved an outcome of importance.”
4) Savings, meaning that “the vendor can reduce healthcare spending per case/participant or for the plan/purchaser overall.”
As I wrote this article, I pulled up the VI home page, clicked on Validation Reports and searched using the keyword “fertility.” Up popped the names of 11 fertility companies, including Carrot Fertility and ARC Fertility, which had sought validation. Nine others were marked “Not Validated.” The VI’s listing does not include all U.S. fertility vendors.
Carrot achieved a Level 2 validation (Metrics) for their savings calculator. The report reads, “For each component in [Carrot’s] logic model, Validation Institute verified each assumption, data source and calculation. The model gives an evidence-based estimate of the program’s impact.”
ARC Fertility achieved Level 3 (Outcomes) and 4 (Savings) validations on two different performance claims. The Level 3 claim was “ARC Fertility clinics’ patients have a lower rate of multiple births (twins, triplets and higher) than all other U.S. clinics' average. Multiple births impact the health and the medical costs for mothers and babies.” The Level 4 claim was, ”By reducing the frequency of twins and higher multiple births, ARC Fertility reduces employers’ cost for offering fertility benefits.”
In ARC Fertility’s validation report, VI accessed a data repository maintained by The Society for Assisted Reproductive Technology (SART), which 86% of U.S. fertility clinics participate in. Members contribute specified data on each fertility patient's treatment and outcomes. VI used this resource to compare ARC’s health outcomes and savings with the average performance of other fertility firms. Other member firms can perform a similar analysis.
Which is to say that objective information is available to judge the relative performance of fertility services firms, making it straightforward to identify a vendor that is likely to deliver the highest value care.
(I have no financial relationship with any of the companies named in this article).
This piece was originally published by Insurance Thought Leadership.
To learn more about fertility benefit solutions, search, The Granite List today.