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I recently had a discussion with Marianna Zaslavsky, Founder and CEO of Norka Health on the ...
I recently had a discussion with Marianna Zaslavsky, Founder and CEO of Norka Health on the importance of employers offering fertility benefits in the US. With New York’s new IVF law, advancements in FemTech, increased workplace support for nursing mothers and organization’s like Bloomberg increasing their paternity leave, comprehensive health benefits is a topic at the forefront of Employee Value Proposition Strategies. Including fertility treatment in benefit packages provides innovative organizations with the opportunity to both differentiate themselves in the market place, but more so, drive for gender equality. Marianna shares more on how such initiatives create a positive impact on an organization’s brand and enable them to retain their best staff. What is the current state of affairs for fertility benefits? While drastically and quickly improving, it is still mixed. According to a 2017 survey conducted by consulting firm Mercer, only 26% of employers with 500+ employees and 44% of employers with 20,000+ employees covered IVF. However, that number is expected to jump to 66% for employers with 20,000+ employees by the end of 2019. Also, starting in January of 2020 in New York state, 2.4 million fully-insured employees will have coverage for three rounds of IVF after the New York IVF bill passed earlier this year. While few employers offer surrogacy and adoption assistance or coverage for the preservation of sperm and eggs prior to cancer treatment, things are changing.
Starbucks just announced a $30,000 surrogacy benefit, in addition to their existing fertility benefit that was also increased. The New York IVF bill adds fertility preservation for those undergoing cancer treatment. Massachusetts, New Jersey and California are actively discussing similar bills. Despite this increase in awareness, legislation and growing employer coverage, many employers still offer zero coverage, offer coverage to heterosexual married couples only, offer coverage for diagnostics only or, most strangely, offer coverage to those who prove they have been trying to conceive (but have been unsuccessful) for five years or more. Those employers that do offer coverage today are likely offering what are “fertility 1.0” benefits. Their benefits programs, while well-intentioned, may be hurting their bottom lines (and ultimately their employees). More on this below.
The solution is to offer a managed and individualized program, tailoring the fertility journey to the patient’s unique situation. This is “fertility 2.0.” Why do some employers choose to offer fertility benefits in the first place? There are several important reasons why employers offer benefits, including gains in recruiting and retention. According to Mercer, 68% of millennials take fertility benefits into account when choosing an employer and 29% of employees leave for better fertility benefits (their cost of replacement can be 23 – 213% of their salary). But it’s not just about recruitment and retention. Many self-insured employers choose to offer a managed fertility benefit to reduce medical costs related to twins, triplets and preterm births that can result from poorly executed IVF cycles. For example, more than 20% of twins and 80% of triplets are born prematurely and require NICU (neonatal intensive care unit) time. Preterm births can cost between $40,000 - $1,000,000 to the employer, making the ROI of a managed benefit obvious.
What do fertility benefits 2.0 look like? As mentioned, certain fertility plan designs can actually be hurting the employer’s bottom line (and the employee). For instance, Clomid, a common medication prescribed as a required first step prior to authorization for IVF (regardless of the patient’s medical situation)., is fairly cheap. Clomid causes a women’s body to ovulate more than one egg, which in many cases, leads to multiples and pre-term births. The total cost of a successful IVF pregnancy with a singleton embryo would have been cheaper. Another example is Rx waste. Many employer plan designs separate fertility drugs from the treatment plan. Medications typically represent 50% of the cost of a single round of IVF (the average cost of which is $12,000). This leads to tremendous waste as patients frequently overfill medications and are left with expensive and expiring hormones in their freezers. Moreover, these hormones are self-administered via at-home injections and often must be timed precisely. Without patient support tools and programs to ensure adherence, an entire IVF cycle may be cancelled, wasting thousands of dollars.
Lastly, very few benefit programs focus on assisting patients holistically with the single goal of shortening the time and cost of successful pregnancy. Providing IVF coverage is well-intentioned and necessary, but shouldn’t the goal really be to help employees build families in the easiest way, one that makes most sense for that patient? Personalization in healthcare has arrived onto the national scene and it must be applied to fertility benefits as well. The real bottom line: Providing coverage isn’t just a “yes” or “no,” “should we” or “shouldn’t we” consideration. If you care about staying competitive on your benefits for recruitment and retention, if you care about reducing medical expenses, and if you care about the patient experience, it’s more than that. It’s about providing a benefit that aligns the employer with the patient around one shared goal: successful, stress-free and cost-effective pregnancies. Here are six ways to align a benefit around this shared goal: Offer a capped but personalized course of treatment, not a lifetime maximum dollar value (such as $10,000, which is a common offering). Ensure your rates are negotiated with your providers and focus on working with providers that produce higher than average singleton live-birth rates. Build incentive partnerships with clinics that pay more for success and better outcomes. Include patient experience and concierge services to help your employees along the way, including access to education, diagnostics and, most importantly, clinical experts. It is important to ensure active and personalized case management from a clinical standpoint, not passive management via call center staff. Cap and manage your pharmacy benefit, including self-injection assistance. Make sure your coverage program is inclusive to single parents, LGBTQ+, and those undergoing cancer treatment and others that may be struggling to conceive. Make sure your plan design prerequisites make sense for the individual and are not blanket prerequisites (that may in fact increase overall claims costs). What does your company provide? Leading into open enrollment season (when employees in the US can make changes to their various benefit plans, such as health insurance) this is a great new offering for companies to be including.
If you would like more information and assistance on adding to or changing fertility benefits, reach out to Norka Health at Hello@norkahealth.com. If you have an innovative benefit offering, I would love to hear from you, get in touch with myself at firstname.lastname@example.org