Personalizing Healthcare Benefits for Every Life Stage

Steven Collens (00:12):
Welcome everyone to Personalizing Healthcare Benefits for every life stage. It's a program we are producing together with our partner VSP I am Steven Collens. I'm the CEO of MATTER. We are a healthcare technology incubator and innovation hub. Built on a belief that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. We do three things. First is we incubate startups. Since we launched eight years ago, we've worked with more than 800 companies. They range from very early stage to growth stage companies and we have a suite of services to help them at every stage of development. Our companies have raised about $5 billion now to fuel their growth. Second, we work with big organizations, health systems and life sciences companies and payers to strengthen their innovation capacity. We help them find value in emerging technologies, unlock the full potential of their internal innovators and bridge connections across the industry to help create larger scale collaborations.

(01:18):
And third, we're a nexus for people who are passionate about healthcare innovation. We like to bring people together to be inspired and learn and connect with each other. And so we produce a lot of events. Some are open to the public and some of are exclusively for our members and our partners. Today's event is about personalizing healthcare benefits for every life stage. And the US workforce has never been more diverse in terms of age as it is today. One in four workers is over the age of 55 compared to one in seven a few decades ago. There are five generations in the workforce now, and on top of the age demographics, companies are working to have a more inclusive set of benefits that support their whole employee population. And instead of taking a universal all purpose approach, stage of life benefits include programs that address the various challenges employees of different stages face, which can mean maternal health or family planning or elder care or other benefits, allowing employees to tap into a menu of options that are designed to support their unique needs at specific moments in time.

(02:34):
We're delighted to co-host today's program with our partner, the VSP Global Innovation Center, which is the innovation hub of VSP Vision. VSP is America's largest vision payer and the leader in health-focused vision care. The company provides affordable access to eyecare and eyewear for more than 85 million members through a network of more than 41,000 doctors. V S SS P recently published a report on the future of healthcare benefits and we have three leaders with us today to discuss trends and opportunities in this space. Ruth Yomtoubian is the head of the VSP Global Innovation Center, which she built and launched at VSP. She joined the company, came to the company with a significant amount of experience helping companies be more innovative. Dr. Fahimeh Sasan is the founding physician and chief innovation officer of Kindbody and an assistant professor of obstetrics and gynecology at Mount Sinai in New York.

(03:35):
Kindbody is transforming fertility care with a full range of services and a comprehensive offering for employers. And Amy Smith is the Chief Human Resources Officer of VillageMD, which may be the most important organization in the country, advancing value-based care. The company has more than 20,000 employees in 680 practice locations across 26 markets. Thank you all for joining us today. If you have questions for Ruth or Fahimeh or Amy, please drop them into the chat. I will do my best to weave them into the conversation as we go. And with that, I'd ask the panelists to join us on camera. And Ruth, we will get started with you and sort of help us set the stage in some ways as to why we're even talking about this topic. So in recent years we've been seeing more and more talk around tailoring benefits to people's life stages, whether that's college or having a baby or retiring from the workforce. And that's a shift from the historical approach to benefits. So why are we seeing this change and what are the driving factors?

Ruth Yomtoubian, VSP Global Innovation Center (04:53):
Yeah, so first of all, it's great to be here back on a MATTER event. VSP has really enjoyed being part of this community of innovators, particularly in the healthcare space, and excited to bring two innovators to stand alongside us to talk about this topic. So as you just shared, we at VSP are one of the original, you could say we're the OG vision care provider within the healthcare landscape. And so for 70 years we've been working with employers on how do you improve the vision of your employees? How do you make sure that they can see every possibility? And having that role and being in this space for almost 70 years means that we not only serve our clients or those employers, but we also are in a consultative or advisory role. So as the space has grown, we've had to make sure we understand this changing landscape.

(05:53):
And that's part of the function of the VSP Global Innovation Center is to help see the future for VSP, but also for our stakeholders, which are doctors and employers. And so as we've watched this change take place, I think we've seen this be a major undercurrent of the future of work. So whether that's employees selecting where they want to work or how they're empowered or retained within that work, this has been a major undercurrent and one of the big changes that's come out of not just the pandemic but was already taking place ahead of time. I know we'll talk to Kindbody a little bit about how the investment has grown in the space around female health. But I'll just share three takeaways based on your question about what has changed. So the first is that employers are trying to get the most value out of everything.

(06:47):
If you look at how they're trying to get value out of their supply chain, out of just their current resources and be frugal and stealth, we hear a lot about being agile within organizations. Part of being agile is also getting the most out of your employees. And so let's remember that employers subsidize part of employee healthcare. This whole healthcare experience, we often just focus on the innovation of health and virtual care and all the ways that we can improve health. But we forget that the beginning of the equation starts with employers and the way in which they subsidize and support healthcare. So they need their employees to be healthy and productive, not only to reduce their costs in the overall healthcare spend, but to maximize the value out of their workers. So a healthy individual, a healthy means, a healthy team means a healthy organization.

(07:44):
And then of course there's retention. Yes, we keep hearing about layoffs, but it's not very clear where that's going. And once you make an investment in an employee, you likely want to retain them. So I think we've seen an up and down in retention has been a reason for investing in benefits. And then I think you mentioned it, Steven, around multi-generational workforce is that we have a complex work situation with a number of generations with different needs in the workforce. Now you have within one team that used to be in one geographic place, you have a multi geographic team, a distributed team that might have individuals that live in an urban environment where you typically wait longer to have children and you might have those on your team, which are in a different environment and social situations. So you have age, you have geography, and also what type of worker you have. You might have workers who are in labs and in the field and those who are working from home. And so I think this diversity of experiences also ladders up to a bigger trend outside of healthcare, which is consumers are used to having personalized, individualized experiences. So why shouldn't they get personalized benefits based on just something very simple like their stage of life. So I know we're going to have a great conversation about what that looks like, but that's really some of the major undercurrents of this big shift.

Steven Collens (09:14):
That's great. Thank you for sharing. And just a follow up, does the shift to hybrid work, you sort of touched on it with employees in different locations and things like that. Is that something that you've seen as a particularly significant driver of this kind of change in this shift?

Ruth Yomtoubian, VSP Global Innovation Center (09:33):
Yeah, I think that coming out of the pandemic, having that bifurcated employee group where you might have an onsite health clinic, you might have onsite benefit fairs and now those are irrelevant. And so are you going to continue to invest in new benefit fairs and your onsite clinics or are you going to maybe move some of that spend into some kind of virtual care experience or quiz or engagement on someone's health? And another way we're seeing this I think is in the future of mental health care and that going from a nice to have to a true business imperative. So it sounds great to be working from home, it sounds great to be working from the office depending on who you are, but for some they're getting burnt out, whether that's the commute turning into now being in front of a computer for hours and hours. And so I think that's another way that we're seeing that investment play out. And from a VSP perspective, we we're seeing a number of startups growing in that space.

Steven Collens (10:34):
VillageMD has a unique model of delivering healthcare and is really, as I mentioned in my introduction, is really a leader in providing value-based care and helping to make value-based care a reality across the country. You're leading HR for the organization. And so there's sort of two perspectives you might have. One is a big organization, you've got a lot of people who work there and you're shaping the benefits specifically for them, but also perhaps informed by the mission of the organization and the company and what it is that you're really the change that you're affecting in the world. So as the head of hr, what is the value that you see in particular in these sort of specialty benefits offering offerings, these kind of more non-traditional approaches to personalizing benefits to life stages? And if there is a connection with this sort of approach to value-based care, we'd love if you touch on that as well.

Amy Smith, VillageMD (11:45):
That's great. Well thanks for having me, Steven. I appreciate it. I think it gets to a couple of the points that Ruth made around wanting to be competitive, wanting to drive retention just from an HR employee experience standpoint. But as it pertains to what we do at Village, I think an underlying premise of being successful in value-based care is that you're thinking about the person as a whole. And a lot of the things that we look at when we're thinking about specialty benefits, whether that's various offerings as it pertains to wellness, fertility benefits, financial or legal support, those types of additional benefits that really contribute to the overall well-being of an individual links to what we do from a value-based perspective to drive better health outcomes. So when we look at what we're going to structure for someone, we do take that approach and we think that links up to our mission very nicely in terms of driving overall better health outcomes, more accessibility, more equity, and at a lower cost to the individual.

(12:55):
And so those are a couple of the things that we contemplate. But also I think a great point that Ruth made was around how differentiated the workplace is today. So when you think about an organization like VillageMD, we have a large, the predominant population of our employees sit within clinics in a clinical setting, and so there's no option to be hybrid. But then when we have several thousand employees that support all of the work that happens in those clinics, whether it's revenue cycle or call center or some corporate functions that do work in a hybrid capacity. So when we're designing benefits, we're first leading with how do we think about the whole health and wellbeing of the individual and what things do we have that can contribute to that? What is the demographic profile of our organization and how do we structure the benefits that supports those folks, but also where are they, how are they interacting and engaging with the benefits that we're offering?

(14:01):
So a great example would be around our wellness offerings, our behavioral health supports and some of the various things that we offer there where if you are in New Jersey, which is where we have a very large hub, that's where our behavioral health organization actually is predominantly located, you have much more of an opportunity for face-to-face interactions. Whereas for everyone else in the organization, we think about how to lean a little more heavily on telehealth offerings and advertise those and get those out in front of people. Or we think about the experience of engaging with a tool like Thrive. So we have a partnership with Thrive and that's embedded in our Microsoft teams. And what we have found is the of course is going to be much higher for those folks that aren't in front of patients all day. So now we're working with Thrive to think about, well, what are some of the other things that we can do to equip leaders to support the mental health and wellbeing and avoid burnout for the folks in the clinic that is more embedded in morning huddles or meeting people where they are, I think is a really important part of designing the benefits and ensuring that you also get the most utilization out of it.

Steven Collens (15:21):
Great. Fahimeh, I want to pull you into the conversation. We've touched on it a little bit and the report that VSP put out talks about a variety of different benefit categories and kind of goes through a number of them that I would consider sort of non-traditional and they call out elder care and student loans and fertility and other kind of fem tech as a category within their report. And one thing I think interesting about this conversation, we've got the payer perspective. We have an employer, a large employer with shaping a benefits plan and then you represent one of these sort of non-traditional solutions and would love to just hear a little bit Kindbody was started about five years ago, a little bit on the history of the company and the journey journey, but also just about fertility benefits in the workplace in the United States overall, which it didn't use to be a thing. And so what's happened and how does that look and how is Kindbody approaching it?

Fahimeh Sasan, Kindbody (16:42):
Thank you. I want to begin with a little bit of a history lesson when it comes to fertility care as a whole. So historically, fertility was available as a cash only self-pay type of service, and as a result it was available to the top white 1%, meaning very rich affluent people could afford this care. It was very kind of synergistic with plastic surgery and cosmetic procedures in that if you could afford it, you went to these clinics and the clinics charged an incredible amount because they knew they had a captive audience who could afford it. And this isn't that long ago, we're talking about 10 to 15 years. And then what happened was that fertility is not just the top 1%. And actually the most recent World Health Organization data shows that one out of six adults, and I emphasize the word adults, not women, but one out of six adults are impacted by fertility issues.

(17:48):
And so I think historically we also thought of fertility as a woman problem and maybe as an older woman problem. But in reality, fertility is age agnostic and it's also gender agnostic. And as more and more women wait longer to have children, and this isn't just in New York and San Francisco, but across the country, fertility issues are going to increase. We also have an entire group of LGBTQ plus community who historically used to look to adoption for family building that now want to have biological children. And that is becoming more and more a mainstay and then an entire subgroup of people who want to have children as single parents by choice and also men and women who want to preserve their fertility for the future. So there's a lot more to it than an I V F person, which is what we historically thought of.

(18:41):
And what originally happened, which kind buddies founder and chairwoman, Gina Barde, esi, her first company was Progeny. And so Progeny was one of the first to come to the table as a fertility benefit provider. And when she first started, her original adopters were Google and Facebook. And at the time they even got criticized that they were offering egg freezing benefits and the criticism was you're forcing women to the desk. And that somehow it was cryptic to be offering these benefits. And we fast forward only a few years later and the concept of kind Buddy came out of one, these benefits are no longer a nice to have that because such a large portion of the population is being impacted by fertility either directly or indirectly or in their desire to have the perfect family that it's no longer a nice to have, but it really is becoming a mainstay.

(19:39):
So that while you said it's a non-traditional, I think very quickly it's becoming one of the standard mandatories. You have major medical, vision, dental, and some sort of fertility. Family building benefit is becoming much more common but also is no longer just tech companies, but companies like Walmart who now offer fertility benefits to all of their associates, including the cashiers and the part-time truck drivers and that it's no longer something that's being offered to the affluent, but that is something that should be offered and accessible to everyone. And I think that's where we've seen a huge shift where it went from self-pay to the carriers offered some sort of fertility benefits, which unfortunately are typically unintentionally discriminatory because of the rules. And then companies like Kindbody came about who now are distinctly looking to offer those fertility benefits. And then I think the final stage is recognizing having transactional fertility benefits is too focused and that it's important to be able to help this population through their full range of reproductive health needs from puberty and that first menstrual cycle all the way through menopause and kind of everything in between, which is where we as a benefit manager who is also in the provision of care are uniquely able to provide telemedicine or have brick and mortar clinics, have partner clinics and be able to provide that full scope of healthcare as opposed to just transactionally being a benefit manager.

Steven Collens (21:18):
So interesting. There's 12 things you said that I would love to follow up on, but maybe a couple of things that come to mind and then I'm sure we'll loop back to some of the other things. So one is you threw something out there that said that the sort of progression of these benefits moved through sort of the large medical payers and that there's some disadvantageous provisions built into the way that they structure their fertility benefits. I'm curious if you can expand a little bit on that and how it relates to the needs of the workforce or needs of people in this day and age relative to what was out there.

Fahimeh Sasan, Kindbody (22:08):
It's really interesting and now I'm going to put on my doctor's hat as an ob, G Y N who sits in front of patients historically, if you think of a traditional payer model, it's to have rules. So it's to give direction and rules so that you can maximize efficiency and not drive up costs. So the concept that for example, if someone needs an M R I, typically the rule is you had to have an x-ray, you had to see a specialist, let's say an orthopedic doctor who then had to say, yes, this person needs an M R I and maybe you have to fill out a prior auth. All these things were meant to make sure that employers or people weren't paying for expensive MRIs unless it was truly indicated, right? So that's an example. So in the same lens, the carrier say, okay, well we don't want everyone to do IVF is expensive, so let's make rules.

(23:02):
But unintentionally, and I stress the word unintentionally, the rules become discriminatory. So for example, if the rule is you must have been trying to conceive for a year before you could see a fertility doctor and be eligible for IVF, how does a same sex female or male couple try for a year? Oops. Right? Or if the rule states that you must try insemination before you're approved for IVF, but I as a doctor can tell you that Suzy Q will never succeed at insemination and now you're forcing me as a doctor, but also this patient to go through multiple cycles that are going to affect her mentally, that are going to affect her emotionally that have no chance of clinical success. That's not right either, right? And so I think we tried to put a round peg into a square hole and say fertility should match other ways we deliver care and it doesn't work. And so the carriers are starting to catch up and understand that maybe these medical criteria don't fit when it comes to fertility, but we're not completely there yet. And I think that's why you're seeing such an significant uptick of utilization of companies like ours specifically for the fertility benefits.

Ruth Yomtoubian, VSP Global Innovation Center (24:24):
Interesting. Can I build on that utilization piece? I think it's really important to understand, and Dr. Fahimeh and I, we met actually during the research phase of our report and I think she's been a great resource and Ken Body has been just an excellent example of the impact of hybrid care and how that's going to impact the rest of the industry. So like I said, we work with clients but we also work with doctors. And so we want to make sure that they're also understanding the impact of new benefits coming into the discretionary space. They often see their patients and forget the whole cycle of events. So one is that having a company like Kindbody or VillageMD or VSP lets your employees know this is a great place to work, where we've talked about the curb cut effect and how having a benefit that serves just a small population can be an indicator of we care, we care about your family, we care that you're going to have a family.

(25:24):
We care about your vision, we care about your health. And so it becomes an indicator of this is a great place to work. We use the very best partners and then these hybrid health companies or new benefit companies for stage of life, they're scaling through an employer, they're scaling and making it available to everyone in their employee set, but they're also then making it available just generally to a wider audience. And so there's a bigger impact at play for the world. So I would say to innovators, if you're thinking about scaling and your impact on the world, this is a great avenue to start thinking about and it's often under the radar. And then lastly, to provide value to the employers, companies like Kindbody and other startups in this space, mental health space, they have to be on it in terms of providing an excellent hybrid experience.

(26:23):
They're very close to the patient, they're tracking data retention like we were just talking about utilization. This is what sparked this thought and they're reporting that back, that value back to the employers. So this has an effect on those existing players because now VSP and others, our peers in the space that have been around for a while, we are constantly showing value back to our employers, but there might be new ways that these startups are doing that that we are not aware of. So that's why we have to be in constant conversation and understand the feedback loop and how that's getting back to employers about their employee's health.

Steven Collens (27:12):
You mentioned that offering a suite of benefits is often something that employees will look at favorably, look on favorably, even if there are benefits that don't affect them as individuals. Can you elaborate a little bit more on that, Ruth, and how much of that is, I don't know if some of that came out in the research on the report that you did or some of the data there, and then Amy, I would also love your take on it after your perspective on that question from your vantage point.

Ruth Yomtoubian, VSP Global Innovation Center (27:55):
Yeah, I think I could be brief on this one. It's pretty simple. It's a sign that employers care and we're seeing an over 22% investment in growth. And so for an employer to talk to a prospective employee or even existing employee about that investment and where it's going, and it's also caretaker benefits for example, it's also those younger employees or not younger, coming in with student loans. And so to be able to say to someone who doesn't have student loans, this is how much we want to lift a burden off of our employees, it lets that person who might not have the student loans know, wow, this is a company who really caress about my whole health, also my whole life, my whole sanity and stress.

Amy Smith, VillageMD (28:53):
Yeah, I agree with Ruth completely. I also think in addition to that, it is something that I think people kind of file away as, I might not be at this life stage now, but I may be in the future and I know that that's available to me for this employer and that they've thought about those various things. Especially for us, one of the things that we've looked at, our population is 80% female. And so the conversation around fertility benefits and that type of coverage comes up and especially we bring people in who are sometimes right out of school and they're not at that stage, but they know that they will be. So I think people also come in when they're coming into companies or what they're looking at that's attractive. There are certain talking points where it's like whether it is dependent care coverage or heightened fertility benefits or mental health and wellbeing offerings, I think that they look at those things as even if they're not in a place to use them today, I do think they think ahead around what they might need in the future or what they just may need that's unforeseen.

(30:07):
Yeah, I do. I think it goes to Rick's point of it does send the message that overall we holistically invest in people and I think that's meaningful to folks.

Steven Collens (30:18):
Yeah, that's a positive statement on humanity to say that I think Fahimeh, one of the things that at MATTER we keep hearing is that whether it's employers, whether it's payers, whether it's providers, sort of a movement trying to move away from this proliferation of very narrowly tailored solutions that kind of address one aspect of health or wellness or care and more of an interest in these sort of platform approaches, which as a user experience thing for whether it's the employers or the people who are doctors who are kind of managing these things or whether it's patients or whether it's individual employees. And I'm interested in actually all of your perspectives on this, but Fahimeh start with you because Kindbody is arguably a point solution for employers and from an employer perspective and from an employee perspective. And is that something you get pushback on? How do you see that in the market? Is it a barrier? And if it's not a barrier, why not?

Fahimeh Sasan, Kindbody (31:43):
Yeah, so I think the most important thing today as we sit in 2023 and recognizing that there in the employer space, and I'm sure Amy will nod her head to this, there's point solution fatigue, meaning there's a million companies that do one little thing and now all of a sudden you used to have literally just five years ago benefits, even the most robust benefits for a list. You could fit it on one page, these are our benefits, and now all of a sudden you have a website that is ongoing of your benefits and at some point more isn't better. And that fragmentation that's being caused by here's a solution that only does this one thing for you is counterproductive. Because one of the reasons why benefits exist is we can all agree that our healthcare system in the United States is a little broken, that it's hard to navigate a system.

(32:36):
But then if you have a hundred different benefits, even though they're amazing and your employer is so generous, you haven't actually solved the problem. And so you're right, Kindbody is a point solution, but what we'd like to say is we're a point solution that goes beyond a transactional taking care of fertility and that we're actually, because we're doctors, because we're directly connecting the employee with physicians who can diagnose, who can treat, who manage symptoms, whether it's routine gynecologic care, an employee who has a question about their adolescent child's new menstrual cycle and its effect all the way through fertility. And I'm trying as an L G B T Q member to raise a family and I don't understand how I'm supposed to find a surrogate through menopause and low testosterone and being able to connect members directly with physicians who can stay, this is what you need.

(33:36):
I can actually provide it for you directly, whether it's through telemedicine or through in-person care and understanding we live in a world where you need both the world where everyone walked into a brick and mortar is no longer convenient and for many cases no longer necessary. It's much more productive to go from your Zoom meeting to a 30 minute doctor's meeting through Zoom and then go back to your meeting. So from a productivity perspective, but there's got to be a marriage, you can't do everything via Zoom either. So sometimes as a doctor, I still need to touch and see you in the flesh. And so I think what we do really well, and I'm hoping more and more employers will start, especially benefits teams being more cognizant of, is to not just check a box like, oh, this company does fertility, great, but say, what do you actually do with fertility? Because I don't think a lot of times people need a middleman. They actually need someone that can take care of their employees. And that's what I think Kindbody's biggest value is, is that when an employer signs up Kindbody, your giving your employees direct access to board certified physicians who can care for them through a variety of life stages. And that's where then all of a sudden we become more than a point solution and are able to really be there for more robust offering.

Steven Collens (35:09):
And I tried to be a little provocative in saying con body's a point solution, but in the sense it's a category of fertility just in the sense that I don't think people would suggest that VSP is a point solution, although it's just about vision and there's a lot of different ways to slice it. But Amy, I'm interested in your perspective on what is more important to you. Is it sort of a suite of best in class but maybe disconnected solutions or is it having one seamless experience for your employee population? And if it's some hybrid of that, how do you help employees sort of navigate this as Vahe was talking about this sort of proliferation of options that's happened in recent years?

Amy Smith, VillageMD (36:09):
It's a great question. I think it's a balance too of both. And I come back to big on understanding the population that we have and the needs of the employee population when we're thinking about what we would bolt on, what's important to us. So you can't necessarily do a one size fits all approach. And I think if you know your employee population and what's important and where you're likely to get people leaning into certain things, whether it's a carved out fertility benefit or some kind of a wellness offering, if you have the data and you know that that's something that's going to be important, it's worth having that split out. Now that said, I think it's also important to create the awareness and make it consumable for people. So I think that navigation support becomes really important. And because we're a healthcare company, we have some capabilities to support care navigation internally, but I do think that that is an important piece of it so that everyone is kind of getting the R O I for those suite of benefits put together. Got it. If that answers what we were looking for.

Steven Collens (37:27):
Yeah, for sure. And Ruth, we haven't spent a lot of time talking about vision benefits yet, but we'd love to pull in that concept here as well. And how do vision benefits factor into this conversation? How does eyecare enable employee health and wellness? And I assume you don't think of vision benefits as a point solution, but how do you think about integrating with the overall health and wellness experience of the population that you are serving?

Ruth Yomtoubian, VSP Global Innovation Center (38:12):
Yeah, so our team thinks about this a lot and I would say more and more and more because yes, vision care is one of the original employer sponsored benefits. And so we need to continuously make the case to our employers that having strong vision across your company and these vision benefits is so important to people's livelihood. If you have any kind of deteriorating vision, it decreases your chance of being able to hold a job. And on top of that, there are other impacts that you can detect through your vision. So your vision is actually a diagnostic to what's happening inside your body, whether that's hormonal. And so we need to be in touch with those Kindbody's of the world because when men or women are having changes in their hormones, it can affect their vision. That's just something that people are not really aware of.

(39:11):
But more pervasive than that is there's early detection to diabetes. And so when you go to your vision care provider, you are getting an overall look into your health, whether it's diabetes, hypertension, even Alzheimer's now. And so it's integrated across your overall health. And so our team is actually working on more ways now that there's new solutions around clinical detection of things like diabetes and hypertension using generative AI and those retinal images. How can we connect that to the overall healthcare system? How can we connect that communication and by doing that, increase the value again to that employer who is investing in VSP Vision benefits for their employees. But another kind of piece to this that we were talking about navigation a second ago is our team about a year or so ago, looked into that decision-making process. So now that we are in a more hybrid world and we're not having benefits bears, some employees are a little bit more open to their benefits providers talking directly to their employees or helping them make sense so that those benefits are accessible and utilized.

(40:29):
And so we did find that there are different kinds of people, not just in terms of stage of life but in how they want to learn and engage about their benefits. So yes, some people do sit there with a calculator and want to understand the cost benefit decision that's about a worth of us. Others ask a friend and ask a colleague and have that kind of peer information and others want to go to a trusted resource. But I think Amy actually brought something up just around that made me think about privacy and how not all employees understand what is private and what is not. And I think that's a big hurdle for utilizing benefits. What if my employer finds out that I have hypertension or diabetes because it came through in my retinal scan or through a vision test? What if they find out that I am suffering migraines and some of the days that I'm present, I'm actually really not there. What if they find out that I'm going through fertility treatment? So I think this is one of the other hurdles that we have to address as well, is what is private and what is not. And that sometimes becomes murky when you understand that your benefits aren't came from your employer.

Amy Smith, VillageMD (41:54):
I think that's a great point I'll speak to, I actually saw this pop up in the q and a for us. Village has a couple of major investors. Cigna is one of them. So we work really closely with them and the while they administer our benefits, even though we have a domestic tier because we're a provider group and we route people through our provider system, nobody in HR sees that data or the claims data that is submitted goes through the administrator and they have tier management and functions like that. Both. We have that internally within VillageMD, but we also through the insurance company have care management functions through Cigna. So we don't actually see any of the claims data tied to names. To your point, Ruth, it's more of if we get a readout on high cost claims or trends, it's never linked to an individual. So even in hr, we don't have the ability to pinpoint or see anything like that. So to your point, it is set up in such a way that there anonymity there for sure. And in compliance with it, the laws,

Steven Collens (43:10):
Is that a choice or is it always like that?

Amy Smith, VillageMD (43:18):
Which piece?

Steven Collens (43:19):
I mean if you wanted to have that sort of visibility or theme and pull you into on the fertility side, could there be more of a dialogue there?

Fahimeh Sasan, Kindbody (43:32):
No, it's pretty universal. What Amy is describing is how all employer benefits are structured. Even when the employer is self-insured, no one in HR can see how many people got a vision exam. They can just see that there were 10 vision exams and then of those ten five people got diagnosed with high blood pressure. That's very universal. It's intentional because obviously hipaa, I mean by the federal government, there's HIPAA regulations, so you can't combine the names and date of births or anything that would actually even allow someone to, if they were smart, it's a smaller company. No, this was so and so. The one other thing if I may that I wanted to add that I think is really important, Ruth, you mentioned the education piece of vision that, and I think one of the biggest parts of the benefits just in general has to be the education that the benefit provides.

(44:27):
So not just providing the care, but helping people be educated on why this benefit is important to you. So I think historically vision is a good example. Or even a fertility. People might think, oh, you only need to go to a fertility doctor if someone gave you a prescription that you have a fertility problem or I should only go see a vision doctor once a yearly, but I don't need glasses so I don't have to go to vision doctor. But the idea is that there's so much more technology and advances that have been made that a simple eye exam isn't just about whether or not you need glasses or contacts, that an eye exam can actually help diagnose other medical conditions or be proactive and preventative about your future vision health. In our world, when we talk about educating people about fertility, it's not just that you were trying to have a baby today and are you able to have one today or not, but if you plan on having four kids and you want to wait until you're 35 to start, let's be proactive about that fourth kid. And so I think there's a lot of really beautiful education that benefits providers can bring to the table for employees that can really change the face of the health of their people.

Ruth Yomtoubian, VSP Global Innovation Center (45:43):
If I could build back on that, it's like know your numbers. Know your numbers now. And so when you go to get your vision checked, you're likely to go to the optometrist one time a year and you're actually less likely to go to a primary care physician once a year and unless something's wrong. And so it's also a great way to be proactive about your health is going to optometrists because typically they will check your blood pressure while you're there. They will ask you questions to just understand your overall health and you are talking to a doctor and a provider that's connected to the overall healthcare system. So that's one of the pieces about vision care, aside from making sure that you have the correct prescription, but you're getting a check on your overall health once a year. And so it's sort of like a first line of assurance, I don't want to say defense, but assurance for your health.

(46:35):
So know your numbers. And so actually one other thing I wanted to add about your numbers is that we're living in a world of the quantified self. People are getting their numbers from their aura rings from their Apple watches, and so they're already trained. The hardest thing to change is human behavior, but if our behavior is changing already, it's become more geared towards numbers, that's when the providers who are prepared like the kind bodies with numbers to share and walk through with a patient or an optometrist who has numbers and how that's changed over time. Our patients are more well versed and ready to get that information. I believe

Steven Collens (47:18):
There's some very specific questions that people have asked that maybe can run through quickly. Most of them Fahimeh are for you. So one of them is how much employees need to pay out of pocket if they're, and Amy, maybe you also have a perspective on this of if their employers do support fertility care and then if one in six adults need, that means most of the rest don't. And the question is asking is how do they feel about it? Because ultimately they're paying for part of that. So would love your perspective.

Fahimeh Sasan, Kindbody (48:01):
I'll begin and then I'm sure Amy will have something very valuable to add too. So first and foremost, I think the uniqueness of a benefit design that Kindbody brings to the table is we recognize that one size does not fit all and actually one size never fits all. And so what we do is we sit down with the employer to understand their population, to understand the needs of their population based on the age ranges and the genders of your population and where they are in their life stages. What's the likelihood, what's your expenditure going to look like? And with our value-based bundled national case rates, we're actually able to pretty predictably tell you what we think your expenditure will be based on known facts, data-driven facts that can tell you how many people are likely to do I V F for example, or have a fertility treatment.

(48:55):
So that piece can, from an employer perspective, be very dependable. From an employee perspective, it depends on the employer. So we have some employers who are very generous and have the capability financially to cover unlimited fertility benefits, for example, other employers don't, and that's fair. It's 2023. And so other employers will say we can pay up to a certain allotted amount. And then in that case, it's just having really crystal clear transparency that your employer has this benefit for you, but X amount of it will be a cost share or X amount of it will come out of your own pocket. And if you're able to provide the transparency from the get-go that this is an employee's out-of-pocket cost, this is what the employer will cover, it's always going to be welcome, especially for something that's so intimately impacts people's lives like family building. But I think transparency is key, but being fair that not all employers can just have a blank check of how much, and that's where also being cognizant of the cost of your benefit is this benefit, actually saving people money or not is going to be a really important piece.

(50:16):
And then the last part of your question was, so one out of six adults are impacted by fertility, but I would argue that everybody, all six people should learn about their body. And I think we live in a world where we spend the majority of our reproductive lives as men and women trying to not get pregnant and not get an STD. And so a lot of times we leave what we would consider a very important part, ability to have children now or someday up to chance. And so where kind buddy comes, maybe not all six people are going to have an IVF treatment, but I think all six people should have a consultation and learn about their fertility. Even if's as simple as doing a semen analysis to know that your sperm health is good as an example.

Steven Collens (51:09):
Got it. That's a very helpful perspective. I think some of the other questions that are very particular to Kindbody, I might ask the audience if you can just send me a note, steven@matter.health, I'll package 'em up and see if we can get a response from Dr. Sasan. I do want to ask a little bit future looking of you. So we've talked a lot about, we talked about history of fertility and how we got to where we are. We got to some sort of trends and I think state-of-the state-of-the-art. And Ruth, I would love to start with you as the author of this report or on benefits. So what's coming next? So one thing that comes to mind is we're sort of moved from healthcare, medical and then dental and then vision, and now fertility is becoming much more of a expected benefit as part of that, what comes next? Where's this heading?

Ruth Yomtoubian, VSP Global Innovation Center (52:23):
Yeah, I think that we called it a futurist report because all of these trends and shifts are indicators of what's to come. Even though it does exist today, it doesn't exist pervasively. So I'll just hit some of the ones I think are important. But first I just want to say that saying rising tide, the rising tide lifts all boats. I think that's very much the case when it comes to the benefit space where this conversation has become louder because of new entrants and startups and emerging solutions. So that has been great for the overall healthcare system and for the VSPs of the world because we were in the room trying to talk about the value of vision and the health of your employee. And now that has been amplified by that increased focus in benefits and that look again by employers who were just, okay, yeah, we'll pass this on and see if our employees sign up for vision care.

(53:21):
But now they're taking a deeper look and saying, okay, how can we add this to the mix? And maybe we should be investing more and subsidizing further these vision benefits and engaging our employees. So first I think that the fact that we were early to this space of vision care benefits puts us in that advisory position, but it also, it has us in a position of growing our own menu and seeing how we can partner across the industry. So when we're looking at these shifts, we did talk in our report and I encourage everyone to take a look at the future of benefits report. We did look at the stage of life benefits and I think we covered a lot of that with caretaker benefits, expanding student loan repayment, some of this family planning and female health being a great space to look at. But I think where a lot of the nuances coming is in one of our first trends that we shared in the report, which really had to do with the hybrid employees and the needs around that.

(54:24):
So I mentioned about mental health and the growth there. Corporate volunteering has been around and upskilling has been around for a long time, but I think it's an opportunity to take a fresh look. And people are not just growing their careers in a traditional ladder, they're looking for experiences to be prepared for multiple jobs across their life. So if you can give them that opportunity to connect with your purpose as a benefit and to connect with skills and self-development beyond just the job they have to today, that'll be very valuable. One of my favorites that I'm excited to see grow is around travel benefits and bleisure and how we can lean in further to this hybrid work. At the innovation center, we have a distributed workforce and we're finding over time ways to leverage that. We have people in New York, in Atlanta, in Michigan, in North Carolina and California and bring those perspectives together.

(55:23):
And likewise when you go somewhere else and we're really about being tip of the spear for the company, how can we not just take that travel as travel on the surface, but look at it as a way to attract employees who are curious and adventurous and have all those characteristics that we want in an employee. So I think that's going to be interesting. And then lastly, when we have this growth in the menu and we have people who have a list to choose from, where is the navigation of these benefits going? How are we overlaying their location in terms of the data around climate? Where is that finding its place into creating specific benefits for those who are living in a place that's more likely to have a tornado, which seems to be everywhere right now? Where are those hotspots in terms of polypharmacy? So I think where we're going next is from the near term where I was saying about the hybrid employees and the stage of life into now, how do we help people navigate and how do we overlay data about our employees that we already have to create even more specific benefits in terms of taking some macro events and seeing that in a micro space.

(56:46):
And I know from the VSP perspective, we know there are definitely hotspots when it comes to healthcare deserts where we can help close gaps. And there's also places where people maybe are more likely to have pollution that it can impact their vision visibility and other things. So I think it's definitely an area that we need to keep an eye on.

Steven Collens (57:09):
It's such an interesting perspective, and this has been such an interesting conversation. And if I just think about benefits, when I joined the workforce a long time ago, it was just, it wasn't a dynamic exciting thing. It was a very sort of rote, it was kind of what it was and it wasn't. And what I've heard from all of you in different perspectives is that today and heading into the future, a much more dynamic, relevant, interesting, tailored, useful set of benefits and options for employees that is and is really going to continue to become more so very helpful for people as they live their lives. And I find that very exciting and I'm very glad to have had this conversation with all of you. Thank you so much for joining us for your perspective Fahema, for sharing all that sort of insight and information about Kindbody and fertility. And Amy, your perspective as again, running HR for such a dynamic company that is really changing the way that healthcare gets delivered across the country. And Ruth, not just for your perspective in the area of vision as the leader in vision benefits, but the work that you did and that your team did, putting that report together on kind of the future of benefits and the future of life stage. This has been a very interesting conversation and thank you to all of you who have joined us today. I hope that you enjoyed the conversation.