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Providing Affordable Infertility Treatment in a Value-Based System

Fertility treatments — or assisted reproductive technology — have become almost commonplace. Despite couples struggling with infertility, women entering motherhood later in life and more single people and same-sex couples deciding to have children, “affordable fertility treatment” still sounds like an oxymoron.

This growing popularity is one reason health insurers are making it a point to cover fertility treatments, including in vitro fertilization (IVF). Another cause is the tight labor market: employers are expanding benefits to attract the best workers. Often, fertility coverage is an attractive benefit.

It’s also a tricky one. Fertility treatments are costly — especially IVF. Costs vary by geography, but it’s generally above $20,000 per cycle, and the average IVF patient undergoes more than two cycles. That means total IVF treatment comes to at least $51,000 in normal cases without including the cost of fertility drugs, additional testing or delivery.

The financial burden is tremendous, but that’s just part of it. Outcomes are uncertain and the process can pose an array of physical and psychological risks to patients and their partners. In fact, the psychological burden is the most common reason insured patients discontinue IVF treatment.

Ideally, fertility treatment providers would address all these issues holistically. Where that doesn’t happen, value-based care models are improving access to health care that’s comprehensive and affordable.

Fertility Treatment Requires a Diverse, Collaborative Team

Fertility treatments can involve so many areas, including embryology, reproductive endocrinology, obstetrics and gynecology, behavioral health, and genetics. It’s multidisciplinary, and a simple fee-for-service model can’t capture that level of complexity. It isn’t designed to support continuity of care across the various kinds of treatment, and it certainly doesn’t support affordable fertility treatment.

Value-based approaches, which incorporate care coordination and care teams, are meant to ensure continuity and support. Research presented at the 2019 Pacific Coast Reproductive Society conference concluded that when infertility treatment involves emotional support from trained professionals — including a patient advocate to guide patients through the “infertility journey” — more women achieve pregnancies in a shorter time frame. Less time spent in treatment translates to higher satisfaction for patients and lower costs for patients and employers.

With IVF, Value Over Volume Really Matters

The goal of providing value over volume is particularly meaningful for those undergoing IVF.

Just look at Google’s experience with fertility coverage. Employees using fertility services reported poor outcomes and overall negative experiences. They complained in particular about the high rate of multiple births, which are more costly and more dangerous to the mother and the children.

So, Google moved away from fee-for-service providers and entered an outcomes-based contract with a new fertility-service provider. Multiple births dropped from 15% to 3% in two years, improving outcomes and lowering costs at the same time.

The problems Google employees encountered aren’t uncommon. The risk of multiple births also tends to be higher for those without fertility coverage, since families in this situation often have only enough money for one cycle and choose to implant multiple embryos.

Doing it right, however, actually costs less in the long run. Although covering fertility treatments may increase costs for employers, it’s more affordable overall. “It turns out that paying for infertility care and controlling the number of embryos that are transferred would actually save money for the overall cost of medical care in the United States,” says Dr. Richard Paulson, former president of the American Society for Reproductive Medicine.

Introducing Fertility Treatment for the Future

Startups are jumping to get ahead of this shift and offer bundled fertility programs directly to employers or in collaboration with health plans. They focus on outcomes and, ideally, allow patients and their doctors to determine the best course of treatment together. Expect to see even more.

Reproductive assistance is beginning to garner the attention it deserves. Shining a spotlight on the obstacles that have impacted those struggling with fertility for decades, often since many of these treatments became available, improves outcomes, enhances the patient experience and makes fertility treatment less of a financial strain. Fertility treatments are already sophisticated — now the onus is on the delivery system catch up to the science.