About Cutting Costs and Great Patient Experience: Pozitivf’s Strategies for Cost-Effective, Quality Treatment

Dr. Paco Arredondo is a ‘MedikalPreneur’ challenging the notion that doctors can’t be successful entrepreneurs. As the medical director and founder of Pozitivf, he’s revolutionizing fertility care. Discover his insights on cost-effective treatments and his unique approach to blending medical expertise with business acumen in this exclusive interview.

Silva

Paco, you are well known for your efforts to increase accessibility to fertility care. At your clinic, Pozitivf, you offer a fresh IVF cycle for $11,500, including medication. How did you manage to reduce costs?

Paco

In essence, we achieved this by eliminating variability, eliminating non-value-adding elements, and maintaining a laser focus on essential aspects.

Silvia

Can you explain what you mean by ‘eliminating variability’?

Paco

I had access to data covering 17 years of a typical IVF clinic. Surprisingly, there are over 183 permutations of possible patient paths for IUI and IVF. Such variability makes fertility treatments less efficient and effective. Variability undermines quality. For instance, if you wanted to buy a bike but didn’t know which one was right for you, you’d receive better service in a bike store than in a general merchandise retailer.

Some fertility centers have ten to twelve protocols to stimulate patients, without clear evidence of which is best. The major players in achieving pregnancy with any protocol are still the egg and the sperm, and there are no randomized controlled trials accounting for the variability of eggs and sperm. At Pozitivf, we stick to a couple of protocols to reduce waste, variability, and thereby costs, and we are still able to provide high-quality care.

Silvia

You seem to have developed a clear system for determining when an REI is needed and what tasks can be delegated. How did you educate and train your team to assume responsibilities usually reserved for REIs in other centers while maintaining high standards?

Paco

I’d like to point out that our team has remained stable for a long time. What’s changed over time is our mindset. 18 years ago, the concept of customer experience was absent in fertility clinics. In fact, I remember when I gave the first talk in Denver at ASRM everybody thought that it was crazy because they were of the opinion that patients didn’t care about customer experience, just about the outcome. That they just cared about having a baby. That is not true.

At our clinic, the customer experience has been ingrained in our DNA. Now what we needed to focus on was to reduce the cost without compromising the quality, including the quality of the customer service. We identified critical points in IVF where an REI adds higher value than other healthcare professionals and steps that can be delegated to nurse practitioners or medical assistants without quality loss. For example, all test orders can be managed by NPs. NPs and OB-GYNs can be trained to conduct saline ultrasounds, antral follicle counts, and embryo transfers. While some REIs may prefer to perform these procedures for a personal connection with patients, this might not be as relevant to patients when they have to pay $25,000 for a cycle. However, tasks like complex cases or cystic fibrosis counseling mandated by the FDA are always handled by REIs at our clinic.

Silvia

How has your approach reduced time to treatment?

Paco

We conduct upfront blood tests, HSG, and semen analysis for all patients, providing a treatment plan for 100% of our patients on their first visit. That’s where our approach is very much aligned with LEVY Health. It’s important that we don’t waste time here, ensuring momentum for patients eager to conceive. Women aged 39 or 40 years old really don’t have any time to lose. I know that our approach does not suit everyone.  We prioritize transparency, with all information, including prices, available on our website. If $7,000 is too expensive, unfortunately, at this time it’s best not to visit our clinic to avoid wasting your time as well as ours.

Silvia

In many medical areas, clinics specializing in certain diseases or procedures achieve the best results. If this specialization approach were applied to fertility care in the USA, how would fertility clinics operate differently, and what would be the role of OB-GYNs?

Paco

Specialized IVF clinics could significantly improve outcomes. For example, hospitals focusing solely on hernia repairs or certain orthopedic procedures achieve high success rates with lower costs. Similarly, in fertility care, there could be clinics specializing in diagnostics, egg cryopreservation, or gestational carrier pregnancies. This specialization is already emerging and would likely enhance efficiency and outcomes.

Silvia

How does technology reduce time to treatment?

Paco

Technology will enhance the affordability of fertility treatments. Soon, patients in rural areas will access telehealth services, including online lab requisitions, medication delivery, a portable vaginal ultrasound probe connected to a smartphone app, and distant cycle monitoring. I appreciate how LEVY Health meets those needs by helping clinics in offering fertility work-ups that patients can conveniently initiate from home.  Not only does this shorten the path to treatment but it also engages patients because they can use their wait time to undergo testing.

Millennials and Generation Z, who are more tech-savvy, will demand partnerships with physicians on an eye-to-eye level, involvement  in all decisions. Fertility care will increasingly focus on customer experience.

Silvia

Thank you, Paco,  it’s always great to talk to you.