The Granite List Live

Can Employers Afford to Provide Fertility Benefits? Can They Afford Not to? Part 1

September 15, 2021


Dr. David Adamson, CEO of ARC Fertility addresses challenges around offering fertility benefits and defines actionable steps for brokers and employers to get started. ARC Fertility benefits empower businesses of all sizes to foster an inclusive workplace culture, positively impact DEI, attract and retain top talent while reducing health care costs.

Here is the full transcript to this episode:

Announcer (00:07):

Welcome to another episode of The Granite List Live. Navigating a sea of benefits solution is daunting at best and new vendors emerge every week. Hosts, Leigh Dill and Sally Pace bring brokers and employers a solid resource when it comes to uncovering what's new, what's needed, and what is happening now to allow for the best plan design possible. By staying on top of trends, brokers and employers can in turn stay on top of spending while improving employee engagement and outcomes. Dr. David Adamson, CEO of ARC Fertility is here addressing challenges around offering fertility benefits and defining actionable steps for your clients and employers to get started. ARC Fertility benefits empower businesses of all types to foster an inclusive workplace culture, positively impact DEI, attract and retain top talent while reducing healthcare costs. Join the Granite List host Sally Pace and Leigh Dill to hear the discussion.

Announcer (01:10):

Reproductive health is a personal life journey that is different for everyone, but infertility is often kept in the shadows infertility causes stress, life, and work dysfunction and affects productivity. ARC Fertility empowers forward-thinking companies to help their employees overcome infertility. The ARC FertilityNow App delivers easy to use extensive evidence-based information when you need it for your reproductive health. The ARC FertilityNow App is easy to use for any stage of your reproductive journey. The app provides access to infertility and fertility care resources based on answers to questions providing personalized answers and support so people can make informed choices and avoid unnecessary medical treatments, prediction tools, tell employees about their individualized chances of a live birth, cost of treatment and emotional health status. The app is integrated with a specialized concierge support team that can support people in their reproductive journeys and connect them with a center of excellence when needed. Visit today and download the FertilityNow App from Google Play Store or Apple App Store.

Sally Pace (02:18):

Thank you so much. First of all, Dr. Adamson for joining us today, really excited, we love what you guys are doing at ARC Fertility. We think you are hands down best in the business when it comes to both outcomes and also the way you care for patients and care for people. So, let's start at the beginning of all of this. Why does infertility and fertility care even matter?

Dr. David Adamson (02:45):

Well, that's a great question Sally and many people ask that question. They say, "Well, why does it matter, isn't that something that's elective that people can choose?" And the answer is that it's not. In fact, over the reproductive life, one in eight people will suffer from infertility. So, between age 20 and 45 one in eight people, that makes infertility more common than breast cancer or diabetes and yet most people don't know that. In addition to that, infertility is not just a minor problem for someone who gets it, it can be a major life burden. In fact, The World Health Organization states that infertility is the number five burden of disease in the world and in the US in people in reproductive age and over an entire lifetime infertility is the number 12 or 13 burdens of disease. So, this is a problem that's really, really common that affects a lot of people and also carries very serious consequences for that people.

Dr. David Adamson (03:41):

In addition, one of the big issues in the United States is despite all the money we spend on our healthcare, only one person in four who has infertility in the United States gets the care they need and the primary reason for this is that they don't have coverage for infertility benefits at their work. So, it's a very big problem, it's a very common problem and yet most people can't get the help they need to manage it. So, this is why infertility is such a big issue and fertility care because every person has the right to found a family and we really believe that and that's why we're trying to help people get access to care.

Leigh Dill (04:19):

So, Dr. Adamson, you brought up the issue of employer coverage. So, tell us why infertility does matter to employers.

Dr. David Adamson (04:29):

Infertility matters to employers Leigh because this problem has such an impact on an individual's life. It causes a lot of stress and anxiety and difficulties in their relationships with their partner and with this much of a difficulty in their personal life a lot of these problems flow over into the employee's work life. And there are good studies that show that having a significant problem like this affects presenteeism and productivity of the individual at work and so this can result in reduced profits for the company and difficulties with personnel. So, managing this problem by the employer with the employer's help would really help them in the workplace. In addition to that, when there's not a fertility benefit, there are also many studies that show that what happens is somebody trying to get pregnant goes to see their doctor and say they can't get pregnant and the doctor says, well, you don't have any fertility benefits, but they can do some other treatment and code them under different diagnoses like irregular periods or fibroids or endometriosis or pelvic pain.

Dr. David Adamson (05:42):

And so what happens is that the employee gets fertility treatments, but they're not coded properly and so the employer is paying for it, but doesn't know it. And in addition to that, the treatment is usually focused around what they can get covered even if it's not necessarily the best or the right treatment for that employee. And so, the employer doesn't know that they're spending money and they're also wasting a lot of money and often services get over-utilized because of this. So, there's a huge amount of potential waste with this. And in addition to that, when fertility benefits not managed, then there's going to be an increased number of multiple pregnancies which can result obviously in increased maternity costs and NICU costs. So, there are multiple ways in which the employer ends up losing productivity and profitability on the one hand and ends up spending more money on health benefits on the other.

Dr. David Adamson (06:35):

In addition to that, these benefits matter to employers because today, many, many employees expect to see really good benefits package and so, when employers are looking to attract talent and to retain talent, having a fertility benefit can really help them in bringing in better quality people for their company to meet their needs. In addition, fertility benefits address issues of diversity, equity and inclusion. Many people want to have a family can't family and this includes those in the LGBTQ+ community and sometimes single people and so, diversity equity and inclusion goals can be assisted by having a fertility benefit. So, for all of these reasons, it's a great idea for employers to think about having a fertility benefit. It can be very important to them.

Sally Pace (07:29):

But let's talk a little bit more about the health outcomes and lower benefit costs. And is there a way to offer health benefits that meet all the goals that you just talked about while actually resulting in better outcomes and lower benefit-cost or is this a nice to have, a need to have does it actually impact the bottom line?

Dr. David Adamson (07:48):

That's a great question Sally, and the fact is that there are still a lot of myths around fertility benefits. First of all, a lot of people think they aren't that necessary, but from what we've just been discussing here, it can be seen that fertility benefits can be a really essential part of a benefits package for an employer. And there's a myth that infertility benefits are so expensive that they can't be afforded, but that's not true for a number of reasons. First, as we just discussed, by putting in a fertility benefit, the employer can manage the benefit better and they can also save money through less waste than overutilization and if they put in a program that's really focused on evidence-based medicine they get good outcomes, they will definitely reduce the maternity and NICU costs associated with a multiple pregnancy, that will happen if they don't provide some type of benefit in individual just go out and take unnecessary risks possibly in their healthcare in order to get pregnant as quickly as possible.

Dr. David Adamson (08:51):

And so it's possible with a good benefit to cut down the cost provided in a very affordable way because there's good healthcare and indeed there are programs out there like ours, which make it affordable for the employer because there's no per employee per month cost. The employer only pays when an employee actually has medical care and the employer can choose how much their subsidy is. And in this way there's a minimum subsidy of $5,000 but in this way, the employer can really manage their costs and only pay when an employee actually receives a benefit from the actual overall coverage. In addition to that, because there's a lot of emotional support, there will be better presenteeism and better productivity from the employees. So, it is affordable now and it is possible to get good quality healthcare by providing a fertility benefit and the employer will really take advantage of this and have a lot more upside than downside by providing a benefit.

Leigh Dill (09:53):

So to me, and this is a little bit off-script, but I want to dig into the financial piece of this. So, it sounds like the employer only pays when the benefit is utilized. So, it sounds like any employer can pull in your service as an offering and they can cap it as far as how much they want to spend. Is that how it works?

Dr. David Adamson (10:13):

Yes Leigh, that's how it works. Now, we do have a very small annual access fee which the company pays just once a year and those access fees are only about $1,250 for a small company under 500 employees or covered lives and it goes up to several thousand dollars for bigger companies for a year. But, what that access fee does is it enables everybody in the company, all employees to access our very, very robust digital platform website of course and then we have a very robust digital app called FertilityNow, which has specific sections for women and for men and provides questions for the employees to answer and when those employees answer the questions, they get very specific information about their reproductive health, about fertility awareness, about going infertility care and so, for a very small fee annually, all employees can improve their reproductive health and their general health to help avoid even having to go for medical care.

Dr. David Adamson (11:20):

And then when they do go for medical care, as you pointed out, the employer only pays when that employee actually undergoes some treatment. The employer only pays for the amount of treatment that the employee has and they only pay up to what their subsidy amount is. And we have a program that's extremely flexible in that the employer can choose how much subsidy they're going to pay. We have a minimum subsidy of $5,000 for an employee who uses that much a service, the average subsidies about 15 to $20,000 and some companies put in $50,000 or more. It's important to note for the employer Leigh that for 1000 covered lives, if we had a thousand covered lives about 1% of employees would actually have medical care and the employer is only paying for the medical care for that 1% or about 10 people with a thousand covered lives.

Dr. David Adamson (12:19):

So in this way, the employer can really manage their costs, they know there's going to be a small annual fee, this is going to help everybody in the company, it's going to help avoid waste and overutilization, it's going to cut down multiple rates. So there's going to be a huge return on investment for simply having the program in place and then when care occurs, the employee gets the services they need with evidence-based cost-effective care and the employer only pays up to the subsidy level that they've chosen. So, it's a very cost-effective program for essentially all employers to look at.

Leigh Dill (12:56):

Well, what I think is interesting about that and really is a win-win for the employer and the employee is they're getting the right care when they need it, rather than all this exploratory, I have pelvic pain going to multiple doctors that might be specialist and the employer is picking up that on the self-insurance plan that this really directs them to the right point of care at the right time.

Dr. David Adamson (13:19):

That's absolutely true Leigh, just about the most important thing in any medical care is to see someone who can make an accurate diagnosis and work with the employee to get a good treatment plan that's going to provide evidence-based cost-effective medicine. And there's a huge amount of savings to be had by having knowledgeable excellent physicians work with the employee to do the right thing and this is what our program is designed for, all evidence-based medicine, bundled packages of services that include everything that's needed but, does not have unnecessary or unproven or unvalidated services we do not include those in our packages and so, by doing this you can save a lot of money right upfront and then as you pointed out, the employer can control their costs by determining what level of subsidy they'd like to provide for the employee.

Leigh Dill (14:14):

One thing that is so intriguing to me is that fertility care and fertility issues, especially among my generation is a big conversation piece and is it because more people are just talking about it and more information is out there or is there just more happening to people because of the environment? Why is fertility benefits of such interest right now?

Dr. David Adamson (14:43):

Well, that's a great question and it is absolutely true that there's a lot more interest in infertility and fertility care benefits now and there's actually a number of reasons. If you look at the prevalence of infertility just at any given age in our society, it really has not changed much, which is interesting it's not changed much. But there's a lot more discussion and conversation about it and more people going through care for a number of reasons. One of the first reasons is that gratefully women now are getting more education, they're in the workforce more and as a result of that, they've tended to delay childbearing. And the reality of it is as women get older, their chances of getting pregnant at any given point in time start to go down and it's also true that as all of us get older men or women, the chance of us having some type of disease or condition and in particular a reproductive disease or conditions such as endometriosis or fibroids or irregular periods that might reduce fertility also increases.

Dr. David Adamson (15:44):

So, as women are by and large delayed the age at which they get pregnant, they're older or less likely to get pregnant and they're more likely to have some other problem that can reduce fertility. So, this of course means that more people will be looking for fertility care. Secondly, our society has changed a lot about the things we'll discuss. 30, 40 years ago people didn't discuss even breast cancer, certainly a lot of discussion around HIV, people didn't want to talk about that. But, over the last 10, 20 years, we've been much more open as a society discussing these issues, for example, emotional health is much more commonly discussed now and fertility, of course, causes a lot of emotional issues with people. So, fertility care is much more discussed and as a result of that, everybody's more aware of it and when people are more aware of it, they're more likely to come to a doctor and say, "Gee, I'd like to do something."

Dr. David Adamson (16:40):

A third thing is the technology with the assisted reproductive technologies has improved so much. The ovarian stimulation protocols, we have the embryo freezing or cryopreservation technologies that we have, the pre-implantation genetic testing that we have and multiple other advances in IVF have made it much more successful. So, people are now more likely to say, "Well, I'm going to do that because my chances of getting pregnant are really a whole lot better." And finally, the reason that we're seeing more and more people are talking about it is that a lot of us believe that every person has a right to found a family. And historically, of course, a traditional family was a man and a woman who were married and trying to have kids. But today, there are many people because of changes in our society that can be single women or single men or gay couples or lesbian couples who say we would like to have children.

Dr. David Adamson (17:39):

And for people in the LGBTQ+ community many, many, most of them are going to need some type of assisted reproductive technology in order to found a family other than say, if they decide to adopt a child of course. And so, there's a whole new population of people who are now accessing infertility care, who 10 or 20 years ago were not really able to access fertility care. So, there's a number of reasons why we're much more aware of it and just recently, of course, the issues that have come up about diversity, equity, and inclusion that are really transforming conversation in our country, recognize that many people are going to need help with fertility care who are not in a traditional community and so to meet diversity, equity, inclusion needs, fertility care is being talked about.

Dr. David Adamson (18:32):

And then, with the change in demographics and populations, there's a whole population of younger people now in the reproductive age in the workforce who expect to have benefits that are really going to help them with their lifestyle personalized benefits, not the usual traditional benefits. So, there are many, many reasons why infertility and fertility care is now so much more recognized, so much more talked about, and is really just even in the last six to 12 months, really, really picking up recognition, acceptance, and implementation across the country.

Announcer (19:08):

Be sure to listen to the second half of this episode where Dr. Adamson answers Sally's questions about fertility care from the benefits provider’s point of view. Thank you for listening to this episode of The Granite List Live. Access our entire library by visiting your favorite podcast venue or subscribing our site,

Podbean App

Play this podcast on Podbean App