David vs Goliath: The Fertility Founder Taking on Fees and Patient Lock-In | with Charlie Boyer, BOAC #67

0:00There's a booming fertility industry in the United States and really starting to be around the world. It's eye-opening to understand the business behind the healthcare providers. But what is happening, particularly in the United States, is that in certain areas of the U.S. healthcare system, there's a great amount of consolidation. And in the U.S., in the fertility industry, for the most part, patients don't have insurance coverage. I think it's punitive to a patient who, in my industry, is simply trying to have a baby. And that's where my moral flag starts to go up a little bit, that this is a little bit odd.

0:34The reality of it is you have a very eager customer who in the United States is usually paying for that out of pocket. And they will pay just about anything that they can afford to have a baby. And we had an example recently where a potential client wanted to move to us and she was going to be charged$650. No, I think it was worse than that. I think it was over$1 ,000 just as a fee to put the tissues that she had at a clinic into a shipper to ship to us. When patients are at their most vulnerable, you need to be the least commercial. It's because of the patient pain that I was like, wait a minute, people are literally getting ripped off here and I got to solve this problem that we switched.

1:25Before we get started, this episode of The Business of a Clinic is sponsored by Virillo. Virillo is the trusted marketplace for clinic owners looking to sell and groups and clinic buyers looking to acquire high-performing clinics. There are very few specialized marketplaces in the UK that focus on this transition for clinic operators. Virillo is one of them. Learn more at virillo.co.uk. Now on to the episode. Hey everyone, this is Jared, co-founder at Coherent Healthcare, back with another episode of The Business of a Clinic. I'm really excited about this one today because we haven't had a conversation yet with someone who's involved in the leadership of a fertility practice before.

2:03So this is a first for us on the show. We've done respiratory, pulmonology, neurology, dermatology, dentistry. We've not yet hit fertility. So one thing I'm excited about is the fact that there is an opportunity to learn a bit more about a new clinical specialty. But the other thing that I'm really excited about is I think that Charlie, who's our guest today is going to have an interesting and perhaps controversial perspective as it relates to growing and leading a high-performing patient-centric healthcare practice, especially as considered against other folks who have come on the show. So Charlie, thank you so much for being here.

2:36Maybe just to start off, we've had a chance to chat already in the past, but if you could give us the introduction, help people understand how you're coming to this conversation, what's your journey into healthcare look like, and how might it be a little bit different from others? Yeah, I've been told by many that I am unique in the fertility industry, at least here in the United States, because my background is not at all a medical background. My background is actually in computer science. So I started off in big systems engineering in the early part of my career, helping organizations, specifically in telecommunications, actually working on their computer systems.

3:14And from there, just got a bit of a reputation. So I got pulled over into financial services to, again, help in technology and financial services, and worked my way up to just then effectively be a serial chief operating officer, running operations well beyond technology, basically all the middle and back office functions of things, and became a bit of an expert in just general business operations. And in financial services, that exposed me to a very different world than was in telecom. And ultimately, I got pulled over into cord blood banking. The founder of a cord blood bank was interested in someone who could basically help him take over.

3:54He had been running it himself. He was looking for someone to run the business. And again, I had no background in cryopreservation, no background in cord blood, but a very broad business background with a track record of success growing businesses. And so I went and worked in cord blood for several years as CEO of Accord Blood Bank in the US. And it really exposed me to how to run cryostorage, how to understand warehousing. But there were a lot of synergies with the work I've been doing in all my other stops in my career. Because at the end of the day, and we'll talk a lot more about this, I think, the problem is storing specimens and preserving them, but also maintaining an accurate data record and ledger, what we call chain of custody in the industry for those specimens.

4:42Those are the two major risk categories, and we'll talk more about that. But in trying to grow the cord blood business, we see in the United States, it's a pretty well-saturated market. I was looking at adjacencies, and specifically adjacencies in cryostorage, and that's where I started to become very interested in fertility cryostorage. And met a woman who had been working in the industry for several decades, decided we'd co-found a business. So I left AmeriCorps, co-founded that business. It's called Generations Cry Vault in the United States, though we do serve customers worldwide. And we're in the fertility cross-storage business, and it's really opened my eyes in a way.

5:19I got an introduction, baby steps in the world of cord blood, dealing with OBs, delivering babies in the world of doctors in that space, but really had more eye-opening when I got into fertility because there's a booming fertility industry in the United States and really starting to be around the world. And how that practice has evolved in the last 10 to 15 years is really interesting. And we're now part of that in the fertility cryostorage bit, just one slice of the equation, but nonetheless a very critical slice. So we get good exposure to how all the practices work. So that's my 30 plus year career arc in a short summary.

6:00It's really helpful and it's interesting to hear. I think you described as serial COO or COO of many hats and many industries, which I think is very relevant because so much of what we focus on here in the show is the operational side of healthcare. So I think you're in healthcare, you've done the operations thing. I think there's a lot to dig into. I know from conversations before this one that part of your positioning and or outlook in the world of healthcare is very much connected to the David and Goliath story. The David story being the single practice, the solo practitioner, the community-based care provider who is doing this on their own merit from zero, the founder of the practice, as it were, the entrepreneur clinician, and how sometimes David goes head to head with Goliath.

6:49Goliath here can be the consolidator, the financially backed group, the acquirers, so on and so forth. I know, and we've had a chance to talk about this a little bit that there's some tension in the market, perhaps particularly in fertility, probably elsewhere as well. Maybe the place to start is, what is your view of the David and Goliath story as it relates to smaller, bigger infertility? How has that shown up for you in the experience that you've had in the industry? Yeah, and I have to say, as someone who's participated in the US healthcare system just as a patient for my entire life. It's eye-opening to understand the business behind the healthcare providers.

7:33And so much of it feels like it's being run by business as opposed to led by doctors. So if you're an entrepreneur doctor and you've set up your own practice clinic, you've probably gotten into medicine to have a patient focus. and there is money to be made in medicine, but I would hope and think that the bias for most doctors when they go to medical school isn't, I'm going to go make millions and millions of dollars and return that money to investors, or I'm going to help push the field of medicine and I'm going to treat my patients and help them overcome whatever obstacles they're overcoming.

8:09And in And in the, you know, deservedly so, earning a very good or a living doing that. And there are tons of doctors who do that. There are tons of doctors that have gone and started their own practices and are running that way. And they joined together with other doctors like-minded. But what is happening, particularly in the United States, I'm not sure how it impacts other areas of your listenership, is that in certain areas of the U.S. healthcare system, there's a great amount of consolidation. And again, as a guy who's very focused on business operations and basically hung his hat on efficiency in multiple different industries over his career, I am super interested and excited about that type of work.

8:50But it starts to hit a wall a little bit for me when it comes at this tension of patient care. And it's almost impossible for me to foresee a scenario where when the focus shifts from I'm here to take care of my patient to I'm here to return an outsized investment return to a bunch of investors. because let's be real, if you have private equity funding purchases, they need to beat the S &P at least by some notable amount or they're not going to have investors. So that's pretty high return for the average person listening to this podcast. I mean, we're talking 25, 30, 35 % returns. That's pretty good.

9:30That's what those investors need to do. And in order to do that, you need to find efficiencies. You need to consolidate. You need to find the synergies that exist in these practices so that the play is consolidation. So the independent clinician is bought out, the independent doctors bought out, their practice is bought out. It's merged with other independent doctors. In many cases, the doctors themselves are reduced because they're the most expensive staff in the equation. And all of that is in the name of quote unquote efficiency, but really driving the profits that drive the returns back to investors.

10:03And I always feel like every time I go into this discussion, I sound like I'm anti-business or anti-profit and I 100 % am not. And I got into fertility storage not expecting to be a little bit of an activist, but I've become a little bit of an activist because it's pretty wild for me as the independent, smaller side of the equation in this industry to see the doors that get shut to competitive businesses like mine, but also to patients who now feel captive in a system that they're overpaying for. And in the US, in the fertility industry, for the most part, patients don't have insurance coverage, a typical, and you've rattled off a lot of the other disciplines that you've talked to on this show before, say dermatology.

10:48You go to a dermatologist, it's likely going to be covered by your medical insurance that most people have huge controversies in the United States around the whole insurance setup. But most people, when they go to a dermatologists are going to get some level of insurance coverage. So they've already paid into that. That's not the case for fertility. And so in most instances in fertility, the patient is paying out of pocket. So when they're in a captive scenario where crises are unbounded, that's out of pocket in a way that I think is punitive to a patient who in my industry is simply trying to have a baby.

11:21And that's where my moral flag starts to go up a little bit, but this is a little bit odd. It's a very interesting dynamic. I appreciate what you're saying. So it's an interesting thing you're touching on, which is this idea that almost like the choice, choice is being taken away from the patient and the absence of choice results in cost, results in a predefined set of options that otherwise might be less favorable to the patient. I'm going to be controversial. I don't have a horse in this race, just for the avoidance of doubt. I am not a private equity allocator. I'm no longer running a clinic.

11:57So I'm not, I've got no horse in the race, but we were speaking recently as early as this week with the gentleman who runs a financed, potentially back dental, I think, dental surgery group. And he was saying that one of the big things that they've done at a group level, I appreciate this dentistry, non-fertility, but one of the big things that they've done at a group level is they have found a way to deliver same day, something, same day surgery or something, Rather than two visits, it's now one visit. Now, obviously, that's massively operationally efficient and favorable by comparison to two days.

12:33There's a lot that works on the P &L, but there's also a lot that works for the patient. The patient is delighted by the fact that they get to come in once and they don't have to do two days and take two afternoons off work. And so that's an example, I think, of something where sometimes you get that alignment. And so it'd be interesting to understand from you, where is there alignment versus non-alignment in this conversation? I agree with you completely. And again, most of my career has been in this efficiency gain and contributing back to the customer at the end of the day. And I think your example is a perfect example of that because when there's consolidation, when there's deeper pockets that can be brought to a clinic, you could upgrade equipment, you can upgrade the customer service.

13:19You can upgrade the environment. You can upgrade so much about the patient experience that there's so much good that can come of it. In my particular niche in fertility, what I see is more outright profiteering because in the consolidation effort, let's take a step back of what makes fertility a little bit special versus maybe other doctor experiences. Infertility, you generally have a point where you're trying to do something that a lot of people happen naturally. I mean, we're taught throughout our entire life how not to get pregnant when you're going to school. And so when you start to have trouble actually getting pregnant, that feels a little bit shocking.

14:00And it usually is occurring at a point where there is a sense of urgency that, hey, we would really like to have a baby, whether that's an individual or a couple or whatever the situation may be. And so you get to be a bit desperate and you are willing to do whatever it takes to have a baby. That starts to be the frame of mind. And I'm not going to sit on this discussion and accuse anyone of taking advantage of that situation. But the reality of is you have a very eager customer who in the United States is usually paying for that out of pocket, and they will pay just about anything that they can afford to have a baby.

14:37And in our space, specifically in storage, I know exactly what it takes to store. I know the underlying cost structure. And so when I see competitors out there charging, say,$1 ,300,$1 ,400 a year to store tissues that at the scale that they're at probably would cost them$25 a year,$40 a year, it's a gigantic gap. and maybe you could argue to me that that money is funding other operations and it offsets, but the reality of it is there are options out there like my company that charge significantly less and we can talk about my pricing promise and how I've gotten so upset about this. I'm basically capping our margin to try to drive down the price in this industry.

15:25But the problem is the contracts are written in a way that prevent people from choosing where their tissues are stored. Or they charge exorbitant transfer fees if you want to leave. And those contracts are signed at a point where, again, the client, the patient is simply desperate to have a child. So they're just signing. And it becomes reams and reams and reams of paperwork. Who reads that stuff? We always click agree when we get terms and conditions on the screen, you know, those kinds of things. And deep down in that paperwork, they're trapped. So suddenly they're paying$1 ,300 a year, whatever the number is,$800 a year.

16:00It varies considerably. And it's really hard for them to change. And so when they see a company like ours that's limiting our margins, charging a very reasonable amount, they almost can't move or it costs them so much to move their captive. And that just creates this pricing elasticity for the companies to charge a lot. And that's the part that irks me more than anything else, Jared. It becomes like an uncompetitive playing field in that way. And the more there's consolidation, the more power that captive audience is put under. or pressure. It's interesting. So I guess what I'm hearing is this David Wirth-Goliath story, infertility in particular, is challenging because of exactly what you're describing, this consolidation and ultimately this proposition onward to the patient that isn't necessarily in their best interest, as opposed to other examples.

16:53I use the dental example. I'm sure there are other ones as well where, you know what, hey, if clinic A plus clinic B equals better experience for patient, then actually great, happy days. If it also happens to create commercial efficiency for the group, then that's fine as well. But it needs the place that it needs to show up first is, yeah, interesting. Okay. So that's helpful to add a bit of color. So I guess you use the word champion or advocate. You've become someone who is now really passionate about addressing this head on. Obviously, it's coming out a bit now in the conversation. I think there are many conversations that I've been part of, both on the show and elsewhere, where a practitioner, a David in the David and Goliath, a David has a very clear belief around something that should change.

17:42And that is a big uphill battle. I'm thinking in particular about a practice leader that we work with actually in the UK in the musculoskeletal space. And he has a whole bunch of opinions around how patients are sort of enticed into problems they may not have had and how that is, there's something in that that doesn't necessarily feel right. And I think most practitioners would agree that there needs to be a clinical basis for supporting the patient. So I think I see the David versus Goliath story show up elsewhere. It's not always in the practitioner versus group. Sometimes it's on a clinical belief.

18:28Sometimes it's on a patient experience belief. Sometimes it's on a different platform. But thinking holistically, I guess, as the David in the David and Goliath, how do you battle against that? Like, what is the customer or the patient facing motion? How do you communicate that passion, that point of difference to the patient? I'm sure there are many ways to do it to the industry. But from the patient perspective, how do you give them that sense of trust and confidence to say, hey, we're doing it differently. And by the way, be aware, big, scary dog on that side of the fence. What does that look like for you?

19:01Right. So the message that has resonated the best for us on the business side of it is just simply what we call our pricing promise, which we've agreed to cap our margin. We'll never make more than 15 percent margin. And we show our cost structure to our clients. So once you become a client, you have access to your customer portal, you'll see where your tissues are stored, but you can also see like, hey, this is what it's costing us right now to provide your service and this is what we're charging you. And you can feel good that you're never going to pay more than 15 % and that's going to be it.

19:34And that doesn't mean prices won't go up, by the way. Our cost structure may go up. But because of the nature of our industry and the way we've structured our business, there are a lot of fixed costs. So as our business grows, I fully expect our price to come down, which is something very different in just general businesses today in any industry, let alone this one, let alone the U.S. healthcare industry. And so part of what we're trying to do is advertise that it is possible to make healthcare in the United States more affordable without regulation. I'm a pro-business guy. I'm trying to drive this through just business activity.

20:11And what ends up happening is that message resonates with patients and potential clients of ours. But the first question is always like, what do you sacrifice? Like for the guy who's charging you 800 bucks or a thousand bucks, isn't my tissue going to be safer there than it's going to be with you? Like, what are you giving up to cut corners? And the honest answer is we probably do more than everyone else. And it's really just the cost structure that you're getting ripped off by on the other side. But in order to prove that to the clients, we go over and beyond the level of security we put into the tissues, the practices we have, the systems we implement.

20:51And we're the only ones in the United States with ISO 9001 certification, that is independent auditors who are coming in and verifying our processes, our practices, and frankly, our customer feedback mechanism too, to constantly be in an ongoing improvement mode for patients and clients, but otherwise to assure that what we say we're doing, we are actually doing. I think we're the only ones who publish a disaster recovery and business continuity plan for our clients and potential clients to look at too. So we can talk about the security that's involved in cryostorage at many levels, but the message gets out there through our pricing promise.

21:30That's what attracts the attention. But we win our clients because we prove to them that there's no loss in quality and security of their tissues when they come and spend less money with us, which is usually you spend less, you think you're getting less quality. And it's like, no, that's not the case. We're just not ripping you off. Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic. Coherent helps fast-growing healthcare providers engage, support, retain, and nurture their patients from intake to discharge. As you get bigger, your patient body grows enormously, and it becomes much more than just another hire, just another front office team member.

22:07It's no longer a people problem. You need technology that can scale with you. Coherent helps you do that by keeping every patient on track. In short, we're the agentic CRM and patient support platform for outpatient hands-on healthcare. To learn more, visit us at CoherentHQ.com. Now back to the episode.

22:51mind. And they'll say, how much does it cost for me to do service X with you, be it insured or elective care? What is the cost model? Which is a totally reasonable question. You'd understand why it is ultimately an out-of-pocket expense in some way or another. And what we often find is that patients will say back, oh, I'm actually going to go there. I found it for a lower cost. And usually our response is, of course, you do what's right for you. By the way, just make sure you know what you're getting. It's just a natural reaction. That thing costs 500. That thing costs 400. Well, someone must be doing something.

23:22Either it's a margin, unnecessary margin, in quotes, unnecessary, unnecessary margin, expansion, margin optimization, or it's very efficient, or maybe you're just getting lower quality. And I think we, particularly in healthcare, I think you're right. I think people are trained as patients, as consumers, to have a very close link between price and value. I think that is a market expectation, unlike shopping on Amazon, where you can buy 14 different flat screen TVs, and actually there's a lower cost one, which might be as good, I totally get why you need to sort of kill them with transparency and sort of say, look under the hood, look under the engine.

23:57Here's all the, you can see it all. Like we've got nothing to hide here. It's, you know, we're totally, totally naked running through the streets. You can see everything that you want to see. There's nothing that, you know, that there's nothing that doesn't, that we're not going to share with you. I'm curious from a patient perspective, having previously run provider operations with a lot of tech to deliver the treatment, as I'm sure is the case here as well. How knowledgeable do you think the patient is when they're making this decision? In your case, I guess we can extrapolate more generally to healthcare, but you say, you know, you've got the 25 pages in terms and conditions.

24:33There's a whole lot of informed consent here, but it's even more complicated because it's, you know, storage, et cetera. Do you think like, what is the patient perspective? What's the patient intelligence? How do they know enough to be making the right decision? Yeah, I'm tempted to make the joke that clearly our clients are the super smart ones. But when you say about patient intelligence, the patients are super knowledgeable about their fertility treatments. I mean, honestly, more knowledgeable than I am, but I'm not doing the treatments. What they're ignorant of is the storage space because it's 5 % of what goes on in their life when they come to fertility storage.

25:13It's even 5 % of the cost. We'd make it less than 5%. So they're not paying attention to storage. They don't really understand what it takes. But the patients are very smart about all the steps they need to take, particularly if they're going through IVF and the various testing of embryos and everything else. They're very, very focused on that. But when it comes to storage, they just kind of go along with what they're told. And they don't understand that they have a choice with who can store. And they don't fully understand, I don't believe, what it takes to do storage. Because if they did, they wouldn't stand for some of the pricing they're getting charged, realistically.

25:46And we had an example recently where a potential client wanted to move to us and she was going to be charged$650. No, I think it was worse than that. I think it was over$1 ,000 just as a fee to put the tissues that she had at a clinic into a shipper to ship to us. And that's just not a realistic rate. I totally appreciate that there's labor involved and a lot of care that's involved by the clinician or the embryologist to move tissues from a tank to a shipper because we do it all the time ourselves. So I know what that takes, but it doesn't take a thousand dollars worth of time is really the point.

26:26And so trying to educate this potential client, like, okay, here are the literal steps to your point about total transparency. Here's literally what should happen. There are, and here people often cut corners in taking things from a tank and putting them into a shipper because there is a very strict procedure you should follow to make sure that temperature stays very cold. And you can then, I've now educated you, you can make your own judgment call as to whether that seems like a reasonable charge for that amount of time and effort at that skill level. And she did end up going back and negotiating a lower rate with a clinic.

27:03So to your point, I think very knowledgeable when it comes to the treatments and the tests and the procedures to actually get pregnant, not that educated on the storage spark because no one talks about it. It's the last thing on your mind when you're trying to have a baby, honestly. It's interesting. I'm, again, sort of hearing you and imagining learning more about the industry and then also trying to extrapolate to other clinical specialties. I think this idea of what do people know a lot about versus what do they not know a lot about, I think this is a very interesting conversation in healthcare because obviously everyone's got, you know, online doctors now and the AI doctor will see you and all this sort of stuff.

27:41So suddenly information, the price of information has now hit the floor. Yep. Yep. And the ability to put that information in context is very, very challenging. So you can, you know, I'm sure you could go online to your point. I'm sure you could go online and try and understand if the$1 ,000 quote for moving specimen from here to there or transporting here to there, I'm sure you could get a whole lot of information online that tells you how correctly priced$1 ,000 is, because that intelligence is drawing on other people's intelligence who have put all this intelligence into the world. And that would really lack the context that actually here's the cost of doing it and here's what it should cost you, so on and so forth.

28:24So it's interesting, even though information, price of information, price of accessing information has effectively collapsed, the quality, the context surrounding that information and the extent that people can make good decisions about that information is, I think, another question. Do you see that showing up at all in industry in terms of your relationship either with your own customers? Are they able to engage with you in a, I guess, in a more technical way or with the right language in a way that they wouldn't have before? Or has that change not really hit your side? Because as you're saying, actually, storage is a second thought to the fertility treatment itself.

28:59Oh, no, it absolutely has hit. And I've had a recent example where a gentleman was, I run a few businesses. One is an at-home sperm collection kit business for gentlemen to preserve their fertility at home. And that actually stemmed from working with a nonprofit that's serving active duty and veterans because there's great, there's an infertility crisis that's even greater than the general population in the military community, both men and women. And so we basically made kits to help support troops that are being deployed to preserve their fertility. A gentleman came to us for that fertility treatment, but he demanded that they be stored at Generations Cryobalt.

29:46And that's because ChatGPT told him that's what he wanted to do. So I will tell you that the information is out there and he was adamant. And it was really interesting because he didn't understand that my one company, Palladian, was actually a sister company to Generations Cryobalt. He's like, I'm coming to you to get this kit, but you have to then send it to Generations Cryvault. And I'm like, okay, that's how it works anyway. But that said, yeah, I see it out there electronically. But the issue is all these engines, and Google was manipulating us for decades prior to AI now manipulating us. The problem is that these things are only trained and they only see the data that's out there.

30:22So if someone was to go say, like, what's a normal price for fertility storage, They're going to see the$400,$800,$1 ,000 that is just out there published in material. And so to your point about education, they may not get the true, here are the steps and here's what it should cost. They just get the, here are the steps and here's what it does cost. And I turned to this potential client that I referenced and I just said, now it's, you think about it. Like, what do you think? Like, I'm telling you, it's a 15 minute process. this, how much do you think that woman or man doing the job, that embryologist or clinician is getting paid?

30:59And what's a reasonable markup for that? Like maybe 200 bucks would be a good fee or 250 bucks would be a good fee, but a thousand bucks or whatever her number was, I think it was even more than a thousand dollars, starts to seem outrageous to me. And again, she did push back on the clinic and they did adjust because at the end of the day, you own your tissues. They're your tissues. No one can truly hold you captive like that. It's, you know, and so you do have to be educated to know to push back and fight a bit. Yeah. We work with a practice here that in the UK that has the gentleman who runs it, he has a wonderful saying, which is that when patients are at their most vulnerable, you need to be the least commercial.

31:44Like there's like a percent. Yes. It was like, I love that. It's like a two by two, right? It's like, how vulnerable are you and how commercial should you be? And as you get less vulnerable, maybe it's okay to be more commercially minded. And as you get more vulnerable, you need to be less commercially minded. These things don't work in the same direction. They should work in opposite directions, which is not to say you should ever be exploitative. But the reality is that you are running a business. And sometimes there are opportunities to put the business first, provided that it does not expose this patient vulnerability.

32:15And I think what you're describing is people in their fertility journey are just, there's a vulnerability top to tail. It's all the way through the experience, unlike it might be in a different healthcare specialty. Yeah, I'm not going to ever sit on one of these calls and accuse anyone of anything because doctors prescribe things in all kinds of different areas that may or may not be necessary. They're good doctors. They're bad doctors. It's good practices, bad practices. I think in net, people are trying to help and find. So I'll just state that. However, in this particular niche, I see what it actually costs.

32:52And I can appreciate that, again, maybe we're running light in one area, so we need to charge more in this area that makes up. So I'm not thinking about it in terms of running an entire practice. But I'm also pretty sure that's not what's going on in some of these broader situations because we work with doctors who are retiring or have sold out to PE and now are getting pushed out. There's a lot of cost consolidation going on, which suggests that the storage part of it shouldn't necessarily need to be where they're making up if they're making up savings elsewhere too. But yeah, I love that because your expression of the two-dimensional grid, because infertility in particular, and I suppose anytime you're going for any sort of medical care, you're vulnerable, You're exposed because you need help.

33:37And you are going to people who know a lot more about the subject, have gone for years of training or experts in fields. You're going to trust them. It's very natural to trust your doctor. It's very important that you do what your doctor says most of the time too, right? But particularly people who are trying to have babies and have struggled to do it on their own are very vulnerable. And especially again in the United States where most of the time they're paying for that out of pocket, they start to pay a lot to have the opportunity to have a child. And yeah, it just feels a little bit off to me.

34:11And it felt enough off to me that I decided I'd put my own money where my mouth is with our pricing promise. And maybe we'll get into this as an aspect of David and Goliath too, Jared, because there are independent insurance-like products in the United States where employers can subscribe to these products and then therefore offer a level of fertility coverage to their employees that is different than standard kind of healthcare plans, health insurance plans. And we as Generation Cryovolt have been shut out of every single one of those. No one has taken us on as one of their storage options yet.

34:48And it strikes me, and maybe you can educate me on this call, it strikes me as an odd choice for their business model because if they're getting paid X dollars from their employer to offer this coverage and we're charging a lower number than other storage providers, doesn't that actually help their business? So I've like struggled to understand why no one wants to invite us into their plan eagerly. And so there's some other mechanism, cost sharing mechanism or something going on that I'm not privy to. And it just strikes me. So I'm just not sure what's happening. Maybe, you know, I have I am I am unfortunately not in a position to have anything good to say about that.

35:32I my reaction is that doesn't make sense. But I also. Yeah. I. I got nothing. And the only the only reason I the only reason I bring it up and I'm not not trying to whine or anything is is just there's so much chatter in the United States. And there has been for decades about the cost of health care in the United States. And the deeper I get into my own work, the more I realize there are these weird back channel inefficiencies that I don't think necessarily, again, I'm not sitting here asking for any special government regulation or something, but there is some business angle that needs to break that down in a competitive way and be disruptive.

36:14And that's the mode I'm attempting to take on. So I think we should be part of all supplemental insurance plans because we're the highest quality, high quality storage provider at the lowest cost. To me, that seems like a no-brainer for someone who's in the insurance business to want to be partnered with. The fact that we're not yet has me wondering, okay, what other angle do I need to go figure out to break down ultimately to help everyone? Because if we're charging less, they can still make their profits. They might even be able to charge less. It's still hit their returns. And at the end of the day, who benefits the employer, which means they now have more money to push back to their employees.

36:56Like the whole network just gets cheaper. And if there are no doubt layers and layers of these kinds of situations embedded into the system, which is one of the reasons it's so hard to break in, but it's also so hard to stop it. I think it's, um, I'm conscious of time. I want to be respectful of yours, but it's an interesting one. You use the word layers. And I think the cost base of healthcare is exactly that. It's layers upon layers upon layers. The bill of materials to get care from point of origination in front of a patient is extraordinary. I mean, we will say on the business of a clinic, I have lost track of the number of times I've said that healthcare does not have a healthcare problem.

37:43It has a logistics problem. The fundamental problem in healthcare is it's logistics, it's supply chain, it's operational. We have had billions of dollars invested in drugs and devices, in improving point-of-care solutions. And it's gotten better, obviously, but you still have costs rising. You still have long wait times. You still have complex... That is fun. As you're saying, that's layers of operational mess and things that people have just done historically that haven't been questioned and sort of unpicked. So the idea of sort of going at it from the inside, I think is very, very cool. I know that that message resonates because I've had conversations with others on the show as well, where they have said, you know what, I want to grow my business.

38:28And here are the things I'm not going to compromise on as it comes to patient care. And sometimes that's cost, but oftentimes it's also these 10 things. And it's interesting when you intersect that conversation with, as an example, the AI-ification of everything. A lot of practices that we've spoken to, practice leaders will say, you know what, I'm not going to compromise on letting empathy be the first line encounter as it relates to patient access. That's going to be a human layer. Now, what happens underneath that hood? TBD, that's an efficiency story. But actually, the no-fly zone for me is human first.

39:02So I think what you're saying is really interesting. It's like one of the no-fly zones for you is actually the price guarantee price promise and saying we're going to go on this journey together of transparency, of honesty, and hopefully of making this affordable or as affordable as it can be in the context of what a patient needs. um charlie i'm as i'm conscious of time maybe a closing question for you going back where we started david and goliath you're on this journey now you're you're battling you're battling things uphill somewhere or directly it's like running through the forest while animals try to attack you you're on this journey you're trying to battle things right if you look back to the beginning of the journey you've been on what is the one thing that you would have done differently?

39:51What's the one aha moment that when you look back at it, you say, you know what, we got that one wrong. We should have, we should have done it this way. What is, what have you learned on this experience of being the David that actually, if you had done it differently, you might've had a, you might've been a slightly stronger footing now as you think about the next chapter. Yeah, it's interesting because I would have flipped my mentality. I, again, grew up, especially having spent time in financial services, very business growth, business profit focused. And I think I lost opportunities early on running Generations CryoVault because of that focus.

40:30And so it's because of the patient pain that I was like, wait a minute, people are literally getting ripped off here and I got to solve this problem that we switched. But I went in with like kind of a typical, I'm going to run this business as my typical business mode. And that's why I say I didn't get into this really to be an activist or a disruptor, but I'd become one because I'm like, wait, to be patient first and to truly do the good that I switched out of say cord blood banking to do to help people who want to have babies. we need to change this model. So I would switch with faster is really the lesson learned.

41:07I was too much trying to ride the umbrella of others and how the others are running the industry. And it took me a while to figure out, okay, no, we need to be different. And I don't like the way that is being run. I shouldn't be trying to do it that way. Thank you, Charlie, for sharing that. And I imagine others will hear that and say, oh, yeah, day one, I thought this. And actually, if I had made that switch X months earlier, X years earlier, it would be in a different place. Charlie, really appreciate your joining. Thank you for taking us into the world of storage, of fertility and being so honest about the challenges in the ecosystem.

41:45Really appreciate it. And for those interested in learning more, please do reach out to Charlie. You can find him online and I'm sure he'd be happy to have that conversation. Look forward to seeing everyone again next time. Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way. We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time.

42:10Thanks so much.