[00:00:00] Nancy: I don't know about you, but when I'm in a restaurant and the server starts listing out the day specials, what I'm thinking the whole time is, so how much does that cost ingredients and flavors are important, but at the end of the day, you wanna make sure you're getting a decent deal too, to be honest. I don't usually end up asking about the specials.
[00:00:27] I think it's because I have too much pride or maybe shame anyway, when you're making the case for a new employee benefit to your boss or chief financial officer, chances are, they'll be less shy than I am when it comes to asking about costs, but unlike a restaurant meal, which will be gone in an hour or so for tilling benefits also have a return on investment.
[00:00:49] That's critical to factor in. Today on baby steps. I talk with Mary Lasky director of benefits at Accolade about how she thinks about fertility benefits and [00:01:00] costs. As a healthcare company themselves accolade understands the impact healthcare costs can have on a company's budget and how reducing those costs can make a significant difference.
[00:01:10] Let's hear from Mary.
[00:01:15] Mary: Hey Mary. Thanks for joining me. Hey Nancy. Thanks for having me. It's a pleasure to be here
[00:01:20] Nancy: for those who aren't familiar with accolade. Could you share a little bit about what your company?
[00:01:25] Mary: Our mission is to ensure that people are able to live their healthiest lives. We started primarily as an advocacy organization for employers to help their employees navigate the very complex landscape of healthcare.
[00:01:40] In the United States. We have grown into personalized healthcare, which includes the acquisition of plush care as a virtual care model. And second MD as an expert medical opinion expansion. So now we can offer our customers the full scope of services in order to, again, [00:02:00] ensure that they're able to live their healthiest lives.
[00:02:02] And have
[00:02:03] Nancy: you been in healthcare for a long time? Have you always been in benefits?
[00:02:07] Mary: When I started in benefits, I worked at a company that was a, it was a joint venture between two very large organizations and it was considered a quote unquote startup. And their goal was to have navigation assistance in hospitals and in clinical settings.
[00:02:28] So that's where I started in benefits as well. In healthcare. And then I took a trip down a little path of compensation for a while, and then became both benefits and compensation. But when the opportunity presented itself at Accolade, it was the mission that really drove me to be there. As a benefits provider, seeing everything that my employees encountered and the difficulty they had in navigating the United States healthcare system really inspired me to become a [00:03:00] part of Accolade.
[00:03:01] And then just the natural fit of the benefits role. It was the perfect time, perfect place. So really glad to be.
[00:03:08] Nancy: I can see why carrot
[00:03:09] was a good fit for Accolade too, because so much of what we do is about helping people navigate the complexities of fertility and family forming.
[00:03:18] Mary: Exactly
[00:03:19] Nancy: what inspired accolade to start looking into fertility benefits.
[00:03:22] Mary: We were foreseeing a general trend where most organizations now have started to go in that we wanna make sure that we're taking care of all of our employees and being able to offer diverse benefits such as carat is one of those ways that we can do. So we also have 75% of our employee population is female, and we wanna make sure that we're able to hire top talent and attract.
[00:03:48] And of course retain the people that we. Many of those females as well are within the 30 to 40 age group, understanding their complex health needs, as [00:04:00] well as understanding where they're at in their family forming journey assisted us in and actually propelled us into thinking about how we can offer a solution.
[00:04:10] That would fit the needs of that group. But also one of the things that was really great about Carrot in my opinion, was the expansiveness of the benefit, the surrogacy and the adoption options, ways that we can offer benefits to all of our employees, rather than just simply female heterosexual couples, but also looking at same sex couples.
[00:04:32] What sorts of family forming benefits are we able to offer them and help them start their own families as well..
[00:04:39] Do you know,
[00:04:39] Nancy: when
[00:04:39] you had in place before, was there any fertility coverage available through insurance
[00:04:43] or anything?
[00:04:44] Mary: We did not actually. Okay. And, and that's another thing too, looking at what is covered under our medical plan and balancing that with what could be covered by Carrot and then continuing to evaluate those two things, because they do go hand in hand.
[00:04:59] But another thing [00:05:00] Nancy that I would say was important about Carrot as a benefit. And one of the things that I really liked when we were discussing it, Talking through the options was that you had a large engagement of the male population. So the partners, people were getting their partners to engage.
[00:05:16] It. Wasn't just simply a woman's health problem. You were looking at it from a variety of different perspectives and that was important as well. There's a lot of other things, but I think the second thing I would. Is the vetting process with which you went through that was described to me and explained to me for the providers that you have quote, unquote, within your, I don't know, network's not the right word, but within your carrot platform.
[00:05:41] Nancy: I'm sure
[00:05:41] with Accolade being a, a healthcare company, you were really vigorous or your whole team was very vigorous in terms of looking at that kind of thing.
[00:05:49] Like how do we vet our eligible providers? How do we think about the medical side of fertility?
[00:05:57] Mary: One of the things that was really [00:06:00] clear is we have obviously business development team as well, that looks out and goes to a variety of partners to see really who is doing the best thing in the market and might be the wise choice from an ecosystem partner.
[00:06:14] And it isn't necessarily that I have to pick those same partners as. Our vendors. But then when I was given the evaluation that was done in carrot related to the other point solutions that were out there in the market at that time, Carrot was above and beyond the others in a variety of different ways.
[00:06:34] And one of them was the surrogacy piece, which I think is super important to be able to ensure that we're, we're again, covering that gamut of. For all of the employees that we have in our organization, regardless of who they choose is quote unquote in their family. The other thing too, that was really impactful was the single embryo transfer.
[00:06:56] Nancy: Yes.
[00:06:56] Mary: The single embryo transfer. Your direction [00:07:00] and that being your key principle in the IVF process was very important as well, because of instances where we have had a high cost due to multiple births, i.e. Twins, triplets, that kind of thing. So that was also from a ROI perspective important for us to share that with our decision makers, because for me, I'm coming at it from the lens of what is gonna empower and engage and attract our employees but we also wanna make sure that we're driving home potential cost impact with our finance team.
[00:07:34] Nancy: You mentioned when we were talking before that your company did have a lot of incidences of yeah. Multiple births. Yeah. And for anyone who is unfamiliar, kinda with the costs associated with that, could you share a little bit about that?
[00:07:47] Cause I, I think a lot of people, obviously twins are cute, like little
[00:07:51] babies, but oh, they're adorable. Yes. But why is that something
[00:07:54] really like you do kind of wanna stay away from when
[00:07:57] Mary: when you're going down that family forming [00:08:00] journey. I think it's imperative to recognize. You don't know how someone is feeling or where they're at.
[00:08:07] And I think a lot of directions that people might choose are ones out of just sheer emotion. They're so driven down the like gotta get there pathway, that they wanna make sure that they get to the child or get to having that baby or having babies. And when you're in that for so long, it's hard to see beyond that thing.
[00:08:30] One of the things obviously is not all twin births or multiple births that result in this kind of cost. But for us, it was on this scale of 1.5 million for this multiple birth, which then was both impactful from a health perspective on the birthing mother as wellas the children. So all three were impacted all three made up the 1.5 million claim that we [00:09:00] incurred.
[00:09:00] That is
[00:09:01] Nancy: a lot. So was it like care in the neonatal intensive care
[00:09:05] Mary: Yep. NICU. And I don't recall specifically what the claim was related to the birthing mother, but I know that the children were in the NICU for a considerable period of time. I believe it may have been eight to nine months and I would make the assumption that we're still.
[00:09:25] Likely paying claims related to that multiple birth instant, because oftentimes it's not just the first nine months of life there's gonna be ongoing healthcare needs in those situations.
[00:09:36] Nancy: And yeah to your
[00:09:37] point, We talk about at cared. People do go into IVF. Maybe they wanna, they know they want two kids, so they think, oh, I could save money by transferring multiple embryos, or maybe it'll improve exactly my chances of getting pregnant, but it's really safer and better for everyone in most cases to do single embryo transfer.
[00:09:54] Mary: Yeah. Yeah. And so Nancy that's part of where the, because we're a [00:10:00] healthcare organization. I don't have to explain that. Often some of my peers that maybe are not in healthcare might have to have that conversation with their decision makers around why it's best to go through a single embryo transfer.
[00:10:16] There's pluses and minuses of being a healthcare organization. One of them is that when I get to that level of detail, it is often like, oh, there, there isn't much more information that needs to be provided because the clinicians that are helping us put forth these vendors are understanding of the long term impact as well as the short term impact of the healthcare of both the birthing mother and the children.
[00:10:38] Nancy: I've
[00:10:38] heard from other people on the opposite and maybe they don't really have any familiarity with fertility health or anything like that. So that is kind of a, a nice advantage that you can just say, oh, we'll reduce this. And your leadership would just go great.
[00:10:51] sometimes. Yeah. sometimes that's. I mean, and I think for me, I lead with my heart and I [00:11:00] have to accommodate and ensure that I am also leading with the return on investment.
[00:11:06] As a leader, within my organization, leading with your heart is important, but you don't maintain a company with just heart. You have to make sure that you are doing the right thing for your employees, but also being a good economical steward as a shareholder within the company. in
[00:11:23] terms of the care navigation side of what you do and what the people you work with are familiar with.
[00:11:28] Was that something you were looking for in a fertility benefit as well?
[00:11:31] Mary: Absolutely. It's not only the care navigation, but it's the library. It's the research that goes behind everything that you put forth every month we have new. Content that we call just in time content. And we'll pick a theme that's specific to that month and we'll reach out to our point solutions vendors and ask them what contributing information they might have based on that theme.
[00:11:57] And we consistently reach out to Carrot. For [00:12:00] example, we had a quarter where we focused on mental health. One of the things that we talked about was obviously when you're going through a process of figuring out what will your family forming journey look like and what impacts that it could be very challenging from a emotional landscape.
[00:12:20] And so how can we provide employees with the resources they need in those situations as well? And so when we talked to cared about that, that was one of the things that our awesome account manager helped us with. Talking about, Hey, here's where Carrot can plug into your, just in time monthly topics that you're putting out there.
[00:12:41] So it's not just the navigation, but the navigation is probably the most important because what you're doing is you're making sure that our employees are able to get the best services by the best in their field. For the specific thing that they're needing. And that is exactly what we would expect [00:13:00] from a partner specifically when it comes to the family forming journey.
[00:13:04] One of the things that was mentioned to me just recently in an employee conversation that I had was every time I call Carrot, I'm able to get a resource answer. Almost immediately. And one of the comments that was just recently shared with me was my nurse provided some information on P C O S and possible fertility treatments that could be recommended and guided me to providers within my area.
[00:13:31] It's also that network of care and providing them with resources regardless of where they are. So again, we're equalizing the plain field from a geographical standpoint of where people can access care. So that's an example of the navigation. And again, another quote that I received was that they're consistently getting better help every time they're calling, they're getting better help every time.
[00:13:53] And. To me just means that the relationship between Carrot and Accolade is going to exponentially [00:14:00] impact my employees when I hear feedback such as that. That's great.
[00:14:04] Nancy: And where are your employees located? Are you mostly a remote company or do you have an
[00:14:07] Mary: office? We actually have four offices. And then we have a lot of remote employees as well.
[00:14:15] We're split all over. We have a very large United States geographical footprint, but we also have an office in Prague in the Czech Republic. And we have about 20 Canadian employees that are largely based in British Columbia. I keep coming up with this. This is another reason why carrot was so enticing to me because it.
[00:14:36] A global solution. It is very difficult to find benefits that can be offered globally. Mm-hmm for so many reasons. And to be able to. Reach out to my colleagues in those areas and say, this is an option. How would it fit best for your employee population within your geographical region? Culturally based on the [00:15:00] medical services in that area, and then working with care to try to figure out, okay, how do we specifically target that audience to ensure they're getting the information.
[00:15:10] Healthcare is different everywhere. Mm-hmm . And so it's just nice to be able to have a benefit that does have that global reach. Yeah,
[00:15:16] Nancy: that's something we definitely talk about a lot. How different regulations around fertility care are in different countries. Mm-hmm, some countries offer subsidies for different fertility treatments, some countries don't, maybe it's not culturally acceptable to pursue different things.
[00:15:32] So, yeah, exactly. Great to have help along the way. Absolutely. Exactly. Yeah. Any other advice for other HR leaders considering fertility
[00:15:41] Mary: benefits? I would definitely go back and pick Carrot all over. The launch was very smooth. Of course there is the beautiful aspect of this that we get to share with our employees of, Hey, we've gone through, we've done the vetting.
[00:15:56] We've come up with a perfect solution [00:16:00] for our employees regarding fertility, but then on the back end, I also get to see. The ease in which we were able to implement the ease in which we're able to continue that relationship Nancy. And that is for most of my peers, I believe where the rubber meets the road.
[00:16:18] It's beauty on both sides because you actually make. My job easier by the benefits that you offer. You're meeting all of my expectations based on why I originally went with Carrot. And that is something that I think is very important for benefit directors to hear, because it is impactful when those expectations are not reached.
[00:16:42] You've been
[00:16:42] Nancy: using Carrot since January. Right. So right. It'll be exciting to see what families are
[00:16:47] Mary: grown. In six months, we already have 7% of our eligible population registered. The benchmark that I was told was 9.7, but that's for looking at a full year mm-hmm . [00:17:00] So I still have six more months to blow the benchmark out of the water.
[00:17:04] And I can't.
[00:17:05] Nancy: And to a point we made earlier, a lot of people do think of mostly women using fertility benefits. And I know you have a large percentage of women at your company, but it's really
[00:17:14] Mary: for everybody. Absolutely. And I know of several same sex couples that have gone through the carrot offering to start their family forming journey and have specifically mentioned to me how appreciative they are of this benefit in more ways than one, primarily based on the areas in which they live as.
[00:17:34] So, like you mentioned that access to care. So ensuring that our employees do have safe access to care is also a number one priority.
[00:17:48] Nancy: Mary mentioned that Accolade was hoping to reduce their chances of employees having high risk pregnancies with multiples. We touched on the process of single embryo transfer, but I wanted to [00:18:00] hear a bit more about what that process is and why it's typically recommended to help. I spoke with Dr. Sharon Moayeri, founder and medical director of OC Fertility in Newport beach, California.
[00:18:18] I'd love to start by just hearing a little bit about how you first got into medicine. Yeah,
[00:18:22] Dr. Moayeri: so I, um, I actually come from a family of doctors that thought I would never do medicine until I started getting more exposure to patient care indirectly through my major as a cognitive science psychology major.
[00:18:35] And I realized I just loved the interaction with patients, which is funny, cuz I was always so phobic with needles and blood, but obviously got over that part of it. My first exposure was doing research in the neurologic industry and. Thought I was gonna go down that path until I had direct patient care.
[00:18:52] I was doing some research in clinical trials, realized that I thrived in that environment. So that's what got me into medicine. And [00:19:00] then eventually it evolved into caring for women, which was my favorite population to work with.
[00:19:05] Nancy: For listeners who might not be familiar with the fertility world, could you, I know it can be challenging, but in kind of like as simple language, as you can explain how II versus I IVF
[00:19:16] Dr. Moayeri: both work.
[00:19:17] Of course. Yeah. Absolutely. IUI stands for intrauterine insemination. It's also referred to commonly as artificial insemination. IVF, which is acronym for in vitro fertilization, um, is the other kind of what I like to refer to as the higher tech treatment. So with the former, the IUI or artificial insemination, the eggs remain in the woman's body and we're placing the sperm into her body through a small tube, a catheter through the cervix. So there's no incisions on her body, but we're monitoring her to identify when she's ovulating. Sometimes we're enhancing her ovulation with fertility medications. We're often placing [00:20:00] the sample the partner or a sperm donor provides within that catheter into the uterine space. Then we just wait to see if the egg and the sperm were able to fertilize and implant. And that takes about two weeks after the procedure.. The procedure for insemination, which is placing the specimen inside the uterus is very similar to a pap smear for what the woman experiences, basically a speculum exam, and then takes about five minutes to place the specimen. She's awake during that procedure.
[00:20:29] In terms of IVF, the differences we're removing the eggs from the women's ovaries under a light anesthesia, so she won't remember that procedure. In order to remove the eggs from the ovary we use a skinny needle. Pass through the back of the vagina with an ultrasound to guide us into the ovaries. Oftentimes the woman is receiving fertility enhancing medications so that we're able to ovulate and mature more than one egg for that menstrual cycle so that we're [00:21:00] increasing her yield for that treatment. Our aim is usually to get at least a half a dozen to a dozen eggs with each of those procedures so that she doesn't have to undergo that procedure repeatedly. And then once we have extracted the eggs, we combine 'em with the sperm in the laboratory, and that's how we're able to ensure a higher incidence of fertilization between the egg and sperm.
[00:21:24] Nancy: Yeah, I think that was a really clear explanation of those two procedures. I really appreciate it. And for people who are maybe a little less familiar with all the different fertility specializations and that kind of thing, could you just share a little bit about how you work with patients?
[00:21:39] Dr. Moayeri: I specialize, particularly in reproductive endocrinology, which is a fancy word for anything related to hormones and ovaries and uterus, also the male reproductive tract, but primarily we take care of the women and we are also involved in fertility treatment primarily.
[00:21:58] So patients who have [00:22:00] difficulty getting pregnant patients who have underlying hereditary concerns and wanna utilize fertility treatments to improve the chance of having a healthy baby. We also take care of those patients, whether or not they have difficulty conceiving.
[00:22:14] Nancy: So one reason I wanted to have you on our show was something that I think is a common belief about fertility treatments is that people really associate them with multiples, twins and triplets.
[00:22:25] So I was hoping you could share a little bit about where that belief comes from and maybe like why it's not really true these days.
[00:22:33] Dr. Moayeri: Yeah. So when I first started practicing and reproductive medicine, back in early two thousands, we definitely saw a higher risk for multiple gestation pregnancy associated with our patients.
[00:22:44] And it had to do with the way we took care of our patients. I'd say over the past 20 years, we've really changed the way we practice. And some of it stems from advances in our field. One thing in particular, we learned is that letting the embryos develop longer in [00:23:00] laboratory allows us to select out the stronger embryos.
[00:23:04] So survivability of the embryos allows us to take some of the guesswork out of which embryos are the best to replace into the uterus. The other advantage we've learned is doing some genetic testing on the embryos helps us also identify which embryos are the healthiest and most likely to result in a pregnancy.
[00:23:23] So we don't have to take as many risks or guesses, which embryos to replace back in the uterus because we're using science to guide us. And so I think nowadays it's commonplace to limit the number of embryos we replaced to no more than. Whether or not people are doing genetic testing on the embryo because our pregnancy rates have improved so significantly and putting extra embryos generally doesn't result in better pregnancy rates, but it significantly increases the risk for twins.
[00:23:53] And there is a small chance, even with fertility treatments that a single embryo can split. So that's another reason to [00:24:00] limit your embryo transfers to single embryo in the instance that it does split, you don't wanna end up with triplets or quadruplets because you replace too many embryos into the uterus.
[00:24:09] The other treatments such as artificial insemination still do have a risk of twins. That's harder to control. Triplets if you're very aggressive with the medications used on the female partner, even in that instance, a lot of patients are limiting the number of times they do those treatments and moving probably quicker in my experience than they used to to the more advanced treatments such as in vitro. We have a lot more control over multiple gestation pregnancies.
[00:24:37] Nancy: Why do you think that is that patients are moving from intrauterine insemination II as we usually say a Carrot to IVF?
[00:24:45] Dr. Moayeri: Yeah, I think there's a couple good reasons why people are spending less time doing artificial insemination or intre and insemination and moving on to advanced treatments like in vitro fertilization.
[00:24:55] One, I think that the success rates have increased within [00:25:00] vitro over the past. 10 20 years. And so there's a larger gap between what I like to call the low tech versus the high tech treatments that wasn't the case years ago. Second is we do see more insurance coverage for these advanced treatments.
[00:25:14] Third people are waiting till they're older to start families. And so if you're starting to have your family later in life, the most recent statistic I heard is approximately 40% of first time mothers are older than 35. And if you imagine that they may want more than one child, when they're starting at that age, they probably wanna start considering planning for their next pregnancy.
[00:25:37] And obviously when we're pregnant, carrying a baby, we're unable to either do fertility treatments. Preserve our fertility. And of course we have to wait till we give birth and recover to come back and try again. And so banking, eggs, or embryos becomes a real important option for those couples or women who are starting later in life.
[00:25:58] Are there
[00:25:58] Nancy: where you would [00:26:00] recommend that a patient start with IUI instead of moving more quickly to IBF?
[00:26:05] Dr. Moayeri: I always feel like my job when guiding my patients on whether to start with IUI or move straight to in vitro is guided on what their wants are and how big of a family they want, how old they are when they're starting, what their goals are, ethically where they stand on different aspects of reproductive medicine. And so particularly for younger women, I think it's very reasonable to start with the IUI or low tech treatments before moving on to in vitro. But I even have some older women who may not be comfortable with moving straight into, in vitro, even if medically or clinically, we think it might be their best opportunity for success.
[00:26:41] So I always feel my job is just giving them the best medical advice I can while supporting them to make the decision that works for their family. If they're interested in one child only, it might be very reasonable to try a couple of the lower tech treatments before committing to the in vitro fertilization.
[00:26:58] So we
[00:26:58] Nancy: talked about the [00:27:00] misconception that these days IVF and other fertility treatments often lead to multiples. Are there other misconceptions that you tend to hear either from patients or from other people, you know, in your life about fertility treatments?
[00:27:13] Dr. Moayeri: One thing I'm always pleasantly surprised to learn from my patients is I always ask them when they're going through their fertility enhancing medications, you know, was it as hard as you thought harder, easier.
[00:27:24] And I think that a lot of information on the internet can make it seem a lot scarier than it ends up being for patients. I feel like if they have the right support and the right education and their expectations and they're prepared, they do really amazingly well. The length of time going through treatment is often misconstrued.
[00:27:44] They think it might take much more time than it does to undergo some of these techniques. And they probably worry about the side effects of the medications, which certainly for some women can be difficult, but oftentimes women tolerate the medications quite well. [00:28:00]
[00:28:00] Nancy: Thanks again for joining me, Dr. Moayeri.
[00:28:01] Dr. Moayeri: Really appreciate it. Thanks
[00:28:03] for having me, Nancy. It was wonderful to
[00:28:04] talk with you.
[00:28:16] Nancy: If you'd
[00:28:16] like to learn more about how fertility benefits can help reduce healthcare costs, check out the resources listed in our. And to learn more about carrot fertility, visit carrot, fertility.com.
[00:28:37] Baby Steps is produced and edited by Eric Montgomery and Christopher Olin. To get notified when new episodes are released, subscribe to baby steps on Apple, Spotify, or wherever you get your podcasts. Thanks for listening.