Fast Track to Fertility

Accelerating and enhancing care for fertility patients

Opportunity

Nationally, one in eight couples has trouble getting pregnant. Infertility can lead to substantial distress due to the emotional, physical, financial, and logistical burden it places on patients.

Most patients have been trying to get pregnant for at least a year, if not several years, before seeking fertility care. By the time they make an appointment, the emotional stakes can be high, and patients are very eager to get started. 

After an initial visit with a doctor, couples have to complete a fertility workup so that a personalized treatment plan can be developed. Both partners must complete the workup, which can include blood work, ultrasound, X-ray tests, semen analysis, and genetic testing. Many of the tests and procedures in the female partner are menstrual cycle-dependent, which can lead to significant delays in completion if testing windows are missed.

When this work began, the wait time for new patient appointments at Penn Fertility Care was about four to six weeks. And the time it took couples to complete their fertility workup spanned between two to three months. For patients, each month that goes by represents a missed opportunity to get pregnant.

Intervention

Fast Track to Fertility (FTF) reimagines the fertility intake process to enable patients to start personalized treatment sooner.

The program engages patients fast. When patients call for an appointment, they are first connected with a nurse practitioner (NP) for a telehealth visit. During these visits, NPs obtain information about the couple’s medical history, provide education, answer questions, and explain the infertility workup process.

After this visit, patients receive prompts and reminders via text message to complete the various tests required for workup. This automated engagement supports patients in navigating the complicated, time-sensitive, and cycle-dependent process in the shortest possible time. They are now ready for the physician visit.

With FTF, patients come to their first physician visit with completed workups - setting the stage for more productive and personalized visits and enabling treatment plans to be put in place sooner.

Impact

FTF improves patient access, experience, and care delivery while streamlining provider and care team workflows. 

In the original pilot, FTF reduced the wait time for an initial appointment by about 88 percent - from an average of 36 days to only four days. It also decreased the time it took couples to complete their workup by more than 50 percent - from approximately 61 days to 25 days, with most patients completing workup within one menstrual cycle.

Patients reported high satisfaction, better clarity, and time saved. Pilot participants made no calls to the office to inquire about next steps or ask questions, compared to 25 percent of new patients who were not enrolled in the program. There were also fewer calls made to pilot participants from the clinic, indicating a reduction in phone tag between patients and their care team.

No-show and same-day cancellation rates for new patient appointments dropped from 30 percent to 8 percent with FTF. And with NPs conducting initial intake, physicians were freed up to care for other patients with complex problems or those requiring surgery.  

FTF is an innovative model for world-class health care delivery with a compelling business case that can be easily expanded to new settings. The team is currently working to establish the program as the standard of care across all Penn Fertility Care sites.

COVID-19

The FTF team was able to scale telehealth visits rapidly during the COVID-19 pandemic as patients readily accepted socially distanced visits.

Phase 2: It does work
Collaborators

Anuja Dokras, MD, PhD
Suneeta Senapati, MD, MSCE

Innovation leads

Emily Seltzer, MPH
Christina Mancheno, MPH
Mike Serpa, MS
Roy Rosin, MBA
Raina Merchant, MD, MSHP, FAHA

Funding

Innovation Accelerator Program

External partners

Memora Health

Innovation Methods

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user.

Do the things they are required to do to gain a firsthand experience of the challenges they face. Completing a day in the life exercise will enable you to uncover actionable insights and build empathy for the people you're hoping to help.

A day in the life

We immersed ourselves in the patient process by making calls to schedule new fertility appointments at Penn Medicine and non-affiliated clinics. This helped us learn all of the ins and outs of the intake process from the patient perspective and identify areas that could be optimized.

Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
 
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
 
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
 
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end

We used a fake back end to test the impact of texting patients to guide them through their fertility workup. Members of our team mimicked the communication of an automated bot during initial pilots.

Running a fake back end helped us validate that texting information and reminders could reduce the time it took for patients to complete their workup before building an automated program.

Videos

Stories of Innovation