Holistic Fertility Management and Payer Collaboration

Opinion
Video

An expert spotlights how open data communication between payers and fertility clinics can drive collaboration expanding coverage for proven, successful treatments that crucially improve assisted reproductive outcomes when timely access barriers are eliminated through aligned medical policies.

This is a video synopsis/summary of a Population Health Perspectives® involving Sean Tipton.In the video, Tipton, of the American Society for Reproductive Medicine (ASRM), discusses the role of payers in American healthcare, specifically in providing quality control and ensuring providers deliver good care. He notes that in vitro fertilization clinics have good outcomes data available through required federal reporting and ASRM’s affiliate, the Society for Assisted Reproductive Technology. However, he cautions that clinic success rates must be carefully interpreted as they do not account for patient difficulty. Tipton advises that payers work with clinics to reward effective practices and limit unsuccessful treatments. He advocates for reproductive medicine to receive the same coverage as other medical care, arguing that comprehensive fertility benefits do not substantially raise costs for employers and payers. Additionally, lack of coverage can lead to inappropriate care and consequences that increase spending. Tipton calls for an “enlightened partnership” between payers and providers focused on efficient, quality care to help more patients. He acknowledges the inherent tensions between payers and providers due to differing goals and incentives, but stresses the importance of prioritizing optimal, cost-effective care. Open communication and mutual understanding are key. Providers must better comprehend performance outcomes and be willing to discuss cost-efficiency, whereaspayers cannot ignore costs. Ultimately, honest dialogue will benefit patients.

Video synopsis is AIgenerated and reviewed by Managed Healthcare Executive® editorial staff. 

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