Click to edit Master title style. The Power of IVF for ASCs. Dan Beuerlein Vivere Health. Chief Development Officer EVP, Operations

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1 The Power of IVF for ASCs Dan Beuerlein Vivere Health Chief Development Officer EVP, Operations

2 About Vivere Health Vivere Healthis a fertility management and equity partner that transforms successful practices into thriving businesses. Founded in 2010 Revenue growth from $174 Million to $350 Million in three years 15 Fertility partnerships (Labs, Practices, ASCs) across the United States Honored as the #1 Fastest Growing Private Company in Middle Tennessee

3 About In Vitro Fertilization (IVF) IVF is a growing industry. Assisted Reproductive Therapy has doubled over the last decade (CDC). Approximately 1 in 5 couples struggle with infertility Approximately 1.5% of babies born in the U.S. each year are conceived using assisted reproductive technology (CDC); 66,000 in global market revenue for IVF was $9.3 billion IVF industry expected to reach $21.6 billion by 2020 (Allied Market Research)

4 IVF in the ASC As an almost exclusively outpatient service, IVF is well suited for the ASC setting. Patients Usually young and healthy (25 40 years) Generally with few risk factors Procedures Minimally invasive Short in duration (15 45 minutes) Performed under general (hysteroscopy, myomectomy, egg retrieval) and local anesthesia (embryo transfer) Commonly require diagnostics (HSG) Can sometimes be scheduled for off-peak surgical times (weekends)

5 Integrating IVF Adding IVF as a complimentary service line can increase ASC utilization and profitability. Increases utilization of surgical and diagnostic equipment Leverages surgical support team Stimulates ancillary services such as imaging and lab work Builds clinical, operational and back-office synergies Enhances relationships among physicians and other referral sources

6 Integrating IVF The Economics Typically Cash Pay Package (excluding medications) = $14,000 Average ASC Revenues: Egg Retrieval = $1,600 Embryo Transfer = $1,600 HSG = $600 Anesthesia = $500 Average Supply Cost = $175

7 Integrating IVF How well will patients, physicians and procedures integrate with your existing facility? Things to consider: Patients Expect a higher level of privacy Expect a higher level of customer service Prefer a refined, personalized patient experience Physicians Reproductive endocrinologists require advanced, specialized training. Subspecialty after OB/GYN IVF is a very small world, competitive space with only new Fellows each year Recruitment often requires long-term commitment (sign-on bonus, relocation, contracts, equity options, etc.)

8 Integrating IVF How well will patients, physicians and procedures integrate with your existing facility? Facility Reception and waiting areas must be highly patient focused Must be able to accommodate a fertility laboratory o Typically range between 750 and 1,500 square feet o Should be adjacent to the OR and connect by pass-through window or door for easy transfer of eggs and embryos o Require sophisticated air handling and purification systems ($50k - $100K) IVF integrates most easily into ASCs already equipped for comparable specialties such as gynecology, urology or general surgery Complimentary specialties may include plastics and/or ENT.

9 Sample Lab Layout

10 Potential Challenges Scheduling and Staffing IVF centers often operate on the weekends due to unpredictable timing of egg retrievals Patient experience training is very critical to success Business Fertility lab may operate as a completely separate business from the ASC and may require a dedicated waiting area and support systems IVF is still a largely self-pay specialty; research how your current payer contracts treat IVF Physical Plant and Capital Needs Be sure the potential IVF program will cover the long-term costs of implementation (design, construction, syndication, staffing, etc.)

11 Additional Considerations 1. Don t be something you re not IVF fits best in ASCs that offer a limited range of services to a similar patient population. 2. Integrate with other specialties Find ways to co-market IVF with other specialties that provide services to a similar demographic like gynecology, urology and plastic surgery. 3. Bring multiple physicians together Smaller IVF practices may or may not have their own laboratory or surgery center, so search for ways to bring multiple fertility physicians together into one joint venture. 4. Work with the right partner A fertility program presents a completely new list of regulations and challenges. Partner with an expert that can execute the strategy.

12 Questions?

13 DanVivere Health Chief Development Officer, EVP

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