Investor Insights: Building Transformative Companies in Healthcare with Lee Shapiro, Managing Partner at 7WireVentures

[00:00:00] Think Oral Welcome to Think Oral, where we connect the unconnected between oral and physical health. I'm your host, Dr. Jonathan Levy. And I'm your host, Maria Filippova. Let's get at it. Hi everyone, and welcome to another episode of Think Oral Health Podcast.

[00:00:28] I'm joined as usual by my co-host, Dr. Jonathan Levy. We are continuing the conversation with a series of investors, operators turned investors. And we're talking to them about opportunities in healthcare, in oral systemic health and opportunities in integrated care. How amazing is that? It really is amazing.

[00:00:51] And having lived in the world of raising money with the different ventures that I've jumped into when you're an operator, that is also your investor. They have such insights into the difficulties and the headwinds that young companies have.

[00:01:06] And it's just day and night difference between people who have just in the private equity or in the venture field and never really have operated businesses before. And I know Lee has an amazing background. What about that?

[00:01:18] I mean, Lee Shapiro, a veteran investor who's taken multiple companies public and who's connected dots in healthcare between mental health, behavioral health, overall physical health, a pioneer in having the radical thought that if you're treating a patient's diabetes,

[00:01:36] you might also want to treat their stress levels and their behavioral health. So what a great jumping off point to ask him about integrating the silo of the medical and the dental teams coming together and seeing what he thinks about where the opportunities are. Yes, completely.

[00:01:54] It's really at the heartbeat of what we think about because integration of dentistry and medicine is exactly why we started this podcast and having someone like Lee Shapiro, I'm really excited to ask him some of these questions that are yearning and burning for us.

[00:02:12] And today we are very pleased to welcome Lee Shapiro as our conversation partner for this episode. Lee is a managing partner at 7Y Ventures. 7Y is an investment firm that Lee co-founded over a decade ago. He also served the chief financial officer of Leetvongo.

[00:02:30] Lee is one of our favorite investors because he's an investor operator having built, scaled and taken public multiple organizations, not only Leetvongo, but he also served as the president of Allscripts. And he is responsible for the execution of over $4 billion of mergers, acquisitions and financing.

[00:02:50] So we're incredibly grateful to have Lee here, not only in his capacity as an accomplished investor, but also as somebody who is deeply involved in caring and good causes. He has served in the past six years as a member of the National Board of Directors of the

[00:03:06] American Heart Association. So we'll ask him about that. And the fact that really very few people know about Lee is that he is also an avid runner. He runs marathons. He probably not always was such an avid runner, but we will ask him about that as well.

[00:03:25] With that, Lee, we're so happy to have you. Welcome. Thank you so much, Maria and Jonathan. It's great to be with you today. Fantastic. Thank you. So, Lee, let's start with an easy question. Did you always know that you're going to end up investing?

[00:03:40] How did you end up being an investor from running and operating healthcare companies? And where did that investment thesis, how did it come along the way? So maybe I'll start with a story that ties running and investing together. Well, there you go.

[00:03:55] So I'm not sure if either of you have heard of Hash House Carriers, but it's a group of runners. They actually sponsor some marathons and things around the country, but the name comes from the British Foreign Service.

[00:04:10] And when people were stationed in far-flung places in the British Empire, a hundred plus years ago, they might be in Mumbai or they might be in Singapore, but the new recruits would always have to learn the city.

[00:04:26] And the veterans who had been there would say, best way to learn the city is to go out for a run. We'll mark a trail for you. And you have to carefully follow the markings because we're going to meet you at the end of the trail.

[00:04:41] And so the new recruits would learn that they were also part of the entertainment. Some of those markings would be false markings and it would send them down dead-end streets. It would send them through districts that you wouldn't want to ever go into, might have

[00:04:55] them running through the middle of the department store. But if they followed the true markings, they would always end up where there was beer. Might be at a pub, might be out in the middle of a field, but there was always beer when they finished.

[00:05:08] And the Hash House Carriers call themselves a drinking club with a running problem. And so when you think about 7Wire and what Glenn Telman and I have been doing, we're operators with an investing problem. We've loved to build businesses.

[00:05:23] We'd love to help create companies that are addressing some of the thorny problems and issues that exist in healthcare. And investing is something that we've been doing as a vehicle to allow us to not only operate businesses ourselves.

[00:05:39] Sometimes we take operating roles, but we really try to help founders achieve their dreams. And that means helping them recruit teams, helping them grow their businesses. We're engaged in business development.

[00:05:52] We're the ones who are there as their partners, not the people who just show up once a quarter and to get a report and then have a dinner and disappear. So investing is something we've been doing together for over 30 years.

[00:06:05] We started building special purpose vehicles while we were operating other businesses and finding like-minded people who wanted to invest with us. And after a while, we had so many of these special purpose vehicles going that our investors

[00:06:19] were saying to us, you're killing us with all these different vehicles, start a funder. And so we fell into the fund business based on all the interesting investments that we were seeing and things we were trying to do. So that's how we got to building 7Wire. Wow.

[00:06:34] And 7Wire is, as we said, over a decade in the industry building billion dollar companies, if you will. I saw recently a statistic that about half of the VC funds worldwide are a single fund VC.

[00:06:51] Only 17% of funds actually make it to, VC firms actually make it to fund four. So there's something to be said about longevity in that business, in the VC business and being able to have a unique differentiated approach and investment thesis to consistently pick

[00:07:12] winning teams, build winning teams, scale and grow companies, and then raise different funds. So Lee, tell us a little bit about 7Wire and how it's been successfully sustainable and why you think you've had such a longevity in a pretty volatile industry.

[00:07:33] Well, we're fortunate and, you know, in a lot of what we've done, we owe to luck or maybe putting ourselves in a position to be lucky. But when Glenn and I were involved with companies like Enterprise Systems or Allscripts, we

[00:07:49] were focused on addressing challenges that existed inside the four walls of hospitals and doctor's offices. And over the years that we were doing that, we came to understand that our healthcare system was built for a different time and age and set of needs.

[00:08:07] Really great at addressing acute episodes of care, but not great for addressing the things that are frankly the leading cause of death like cardiovascular disease, cancers, where you are getting an episode that lasts for a long period of time and you need to find ways to manage that.

[00:08:25] We developed a thesis around helping to build better informed and connected health consumers and allowing us the ability to better manage our health with guidance and with support between doctor's offices. Even the most compliant patients who have a condition like diabetes might see their

[00:08:45] doctor a couple of times a year, but they're managing that condition on their own or with their families the rest of the time. So our formula, which has been refined over the years, really involves three key elements.

[00:08:58] First is you need to create an experience for a consumer that addresses a point of pain for them. How are you addressing needs in a way that are going to motivate someone to change because it's markedly better than what the prior experience was?

[00:09:17] Now the great news for us investing in healthcare is that such a terrible experience, there's lots of room for improvement. So that threshold is oftentimes easy to accomplish. And we do a lot of work in what we call consumer hassle mapping to understand what's the status

[00:09:34] quo and how can it be changed? What does that consumer journey look like? One of our partners, David Schoenthal, has written a book called The Human Element that's focusing on exactly what those needs are. Clayton Christiansen had done some work around jobs to be done theory.

[00:09:51] We rely on that to understand what is it a consumer needs from health experience and how can that be accomplished? The second element is how do you demonstrate in a provable way improved outcomes? Not something someone just likes better, but are you really moving the needle and improving

[00:10:09] outcomes in an objective way? When you do that, what you're able to do is demonstrate to that consumer that their health is improving. But now the third part, the third leg of the stool, so to speak, and the most important part is finding someone to pay for it.

[00:10:26] And so that means who's ever at risk for the cost of care. Could be the government, could be a health plan, could be an at-risk provider group, could be a self-insured employer, the consumer herself or himself.

[00:10:39] You want to make sure that you're getting them value by being able to demonstrate that with those improved outcomes, the price is going to have a return on investment. So it's better, faster, cheaper than the alternative and that you're improving outcomes in a way that the alternatives can't.

[00:10:56] So a lot of bars that companies have to get over in terms of getting that point of being successful, but we think that's an important part of the formula coupled with founders who have lived the experience themselves and are committed to making that change and are

[00:11:11] willing to persist through all the challenges that you know are going to happen in that environment. I love that. Jonathan could testify that there's probably a lot of consumer hassle mapping that needs to be done in oral health as well, right? And on the dental side. For sure.

[00:11:28] We share that for sure with dentistry and medicine. But let me throw a question at you because your background is so special from a standpoint of running companies and then investing in companies and truly understanding the pain points of the healthcare system.

[00:11:44] As we look at the healthcare system, and so many people talk about it as a sickness model and not really as a wellness model. How do we get upstream in diagnostics and to prevent these diseases, these systemic

[00:11:56] inflammatory diseases like cardiovascular disease, as we all know, number one killer in America? How do you think about the companies that are innovating for us to get to that upstream, more of a wellness approach and preventing people from getting sick and getting ahead of that?

[00:12:15] So it's really hard to prove a negative. If you say invest in this and something won't happen down the road, it's hard to demonstrate that there's value that's being created there.

[00:12:26] So you need to find those who are willing to agree that if you are able to make a certain investment upfront in a diagnostic or in a service, that you can be preventative in that regard.

[00:12:42] One of the great companies in our portfolio, Parsley Health, is focused on root cause resolution. What they do is help identify through a diagnostic approach upfront, going through a process of evaluating the healthcare burden, what we call the Parsley Burden Index, of someone's

[00:13:03] health on their current condition and then trying to triage someone so that they're not over utilizing healthcare services and waiting years before they get diagnosed. Another example of that is a company called NoCD, N-O-C-D, that started in the obsessive

[00:13:20] compulsive disorder condition but now have moved it to other severe mental illness space. They're helping people understand the nature of their circumstances so they can get the right type of help sooner as opposed to waiting seven years before they're appropriately diagnosed.

[00:13:39] So when you can show the comparative between someone who's able to get health sooner and not consume as many healthcare resources versus those who are still struggling with that journey,

[00:13:51] you can get those who are at risk for the cost of care to step up and pay for that. These companies are demonstrating that in a meaningful way to those payers and self-insured employers as examples who are interested in making sure that their policyholders or their

[00:14:06] team members are getting the right level of care. I will also say that this is more of a challenge that all of us face, is that our healthcare system doesn't have the right incentives aligned for prevention. We certainly could be doing so much more.

[00:14:22] I know Jonathan, Neil and Maria are passionate about oral health as being one of the places that you actually can make great investments and help determine, diagnose, onset of disease well in advance of when you might otherwise be able to do so if only we have the right

[00:14:43] incentives put in place to allow that to happen. And we have to be spending more time as a healthcare system in doing that than we do today and I think move to a different place there. How much of it, I wonder about that early intervention, upstream intervention that

[00:15:00] Jonathan is describing and the misaligned incentives that you are describing, Lee. And I wonder how much of it is a care coordination problem, awareness raising and removing a stigma problem, right? And that's why we're seeing a lot of companies like one of your portfolio companies, Transcarin,

[00:15:20] is looking at this as a care coordination problem and taking it not as a challenge, as an opportunity, as a market opportunity. Or other, again, maybe there's a parallel here, Lee, between years ago, mental health

[00:15:34] and behavioral health was a whole separate thing, topic that had no place in a discussion about cost of care or medical outcomes, right? Similarly with social drivers of health up until recently, this wasn't part of the discussion.

[00:15:50] So as you've seen us as a community embrace this more holistic view of what drives clinical outcomes, could you see some parallels between integrating mental health into the overall health conversation and maybe what we could learn about integrating oral health into the overall health conversation?

[00:16:11] I think it's a great point. There's been a recognition probably because of the pandemic, where so many people were faced with mental health challenges that it became a very significant issue that had to be addressed in an area where there's a shortage of providers.

[00:16:30] That the accessibility that was provided through use of technology, video, phone-based operations that you could use in terms of accessing mental health resources that can be combined with utilization of other healthcare services. You had mentioned, Lavanga, earlier, and one of the things we found was that you could

[00:16:53] help someone maintain a healthy blood sugar level. But if you ask them how they felt, they might still say lousy. And we came to understand that there was a reason why Joe was coming home from driving

[00:17:06] his truck during the day and having a six pack and eating a bag of Doritos. And there was a level of stress or anxiety or depression that wasn't being addressed. And we could work on trying to change Joe's diet or getting Joe to exercise.

[00:17:21] But if we weren't addressing Joe's mental health, it was a challenge. So we acquired a company called MyStrength, a great asset that we had merged into the work that we were doing at Lavanga to start to address in an integrated way, both the medical

[00:17:37] condition that was being treated, hypertension, diabetes or otherwise, and the mental health aspects of it. And that translates into so many other conditions as well. If you're dealing with a cancer, you've got to focus on the mental as well as the physical.

[00:17:53] If you're dealing with a condition like in the CNS space, whether it's MS or whether it's Alzheimer's or Parkinson's, there's a significant mental health burden that comes with a diagnosis like that you have to be addressing as well.

[00:18:08] That has been proven that if you are able to help people support some mental resilience and some strength, you can actually improve their path to recovery. I think that there needs to be a recognition in a similar way around oral health.

[00:18:23] That if you're able to think about physical health, it should stop at your neck and pick up again at your nose. There's a reason why we have another area that should be considered an exam, and yet

[00:18:39] that is a specialty, if you will, that isn't necessarily thought of the same way that we might think about EMT and referrals. People need to get their annual eye exam, and yes, they need to get their oral health exam,

[00:18:53] but how do you integrate that in a way that all the information is shared so that things that are being seen during an oral health exam might actually lead to a better understanding of what's happening with the rest of the organ systems.

[00:19:07] I think that there's an important place there from an education standpoint that has to occur. You probably know that in medical school, doctors are provided with roughly five hours of training on nutrition.

[00:19:20] I can honestly say I don't know how much training they're getting on oral health, but it probably has to start there. And then we have to move upstream in terms of being able to make sure that once they

[00:19:31] get into practice, that they're able to fully appreciate the impact of oral health on overall health, physical and mental. Yeah, that's exactly right. I liken the lack of understanding between the disciplines of medicine and dentistry, similar

[00:19:47] to Western medicine thinking compared to the functional medicine people who are really connecting the dots of this ecosystem called the human body. And yeah, the mouth might not know that it's connected to the rest of the body, but we do that. We know that it does.

[00:20:05] And the more research and science and really technology that comes out, the dental office today, first line of defense, people come to the dental office more than they come to their physician. There's such opportunity in this new technology where, for example, diagnostics, where we're

[00:20:21] looking at the microbiome of the mouth. We know the mouth now seeds the gut. We never thought it could before. We find P. gingivalis, the bacteria, the pathogen. There's seven big pathogens that cause inflammation in the mouth in all these distant organs. The first one was 20 years ago.

[00:20:37] Moisey Devereux's group out of Columbia founded in the carotid artery of cardiovascular diseases in the intermediate and on of all the different organs, pancreatic cancer and the interstitial cells of leaky gut. There is this incredible connectivity.

[00:20:51] So if someone has inflammation in the mouth and we see it in the dental office and we can test very quickly, C-reactive protein out of the saliva, well, it goes up to the cloud.

[00:21:02] A note goes to the physician and all of a sudden maybe we're actually communicating between dentistry and medicine. Maria and I talk about this all the time. And it's really fascinating from an opportunity standpoint of how we can improve the system

[00:21:13] and create more efficiency and get to these diseases earlier through a focus of how do we improve the diagnostics in the dental office, but communicate better between the medicine and to dentistry and dentistry to medicine. It's the same thing with sleep.

[00:21:30] Now standard of care is going to be in dentistry, a CAT scan for the jaw. We call it the CBCT, cone beam computerized tomography. So standard in our office where we have 26 people, multi-specialty practice, but we look at the airway.

[00:21:47] We look at all the structures of the jaw and we can get ahead of so many things, but we're very airway. It's very sleep aware, very focused on airway so that people can get into deep sleep.

[00:21:58] So quickly deep sleep is regenerative sleep and that's what prevents our cancers and our oxidative stresses in our cells and all the diseases that we could name that unfortunately kill people. We can get way upstream just by diagnosing early.

[00:22:12] So just as an example to exactly what you're saying, but it's very, I think it's the question to you as a leader. Can I just ask a question to you actually while you're describing this because it's

[00:22:23] clear that the clinical connection is there and I love how you just, I know we had an hour you would- I get a little passionate about it. Maria, jump in. You would still be listing the connections.

[00:22:32] You would be like, oh my God, let me tell you about 15 more. The clinical connections are there, right? And so if I could ask both you and Lee, if you could have your wishlist, anything you

[00:22:46] could change, what would you change in the workflow or the payment system today to enable those clinical connections? Because it sounds to me that the science, the physiology, biology, we know what these connections are from a clinical side.

[00:23:02] I'll tell you from my perspective, I would love as simple as it is in the practice management system for any physician practice, Epic, CERN or whatever. When they see Maria diagnosed as diabetic, I want to pop up to come up and say, please

[00:23:18] click here to schedule Maria's next dental visit. That's all I want because I know that if I treat Maria's oral health while she's a diabetic, her A1C levels are more likely to be controlled if we also control her period. Right?

[00:23:34] And it doesn't have to be anything more complicated than that, right? Sometimes all it takes is inserting the right intervention in the right workflow. And I know those folks on the listeners who know what IT integration looks like in large

[00:23:49] hospital systems, they're like, Maria, it's not that easy. But if we could change one thing in the workflow or in the payment systems, what would be on top of your list? Right now we rely on the patient or the member in our world to carry that burden.

[00:24:06] My wife had a knee replacement and she has the burden of letting her dentist know that before they clean her teeth, she needs to have an antibiotic because of concern about contamination that might get into the metal in her joint. Why is that communication happening there?

[00:24:26] Why isn't it that we now have communication between medical licensed professionals that allows for this exchange of information that right now is siloed and dental is thought of way over here in terms of something separate insurance system, separate coding for dentists than from a medical standpoint.

[00:24:47] We need to find a way to help bring that together. And I love the opportunity. We see it maybe in managed Medicaid where you're able to bring together a medical and a dental benefit.

[00:24:59] I think we should think about that for commercial insurance in a similar way to align all of that. And maybe that has to come from some of our largest buyers of health care services, which are the self-insured employers, to say, we want all this brought together.

[00:25:17] It's our dollar, we're self-insured. You need to make sure that these things are connected. But we have to align on that and help drive that from the buyer side because otherwise I think the status quo just remains too strong. I totally agree with both of you.

[00:25:33] I would only add to what you both have said is what Lee's bringing out is aligning incentives and whether it happens in the self-insured companies or the insurance companies, this prevention direction of being preventative.

[00:25:47] And if you did it in the oral health, it's very easy for a hygienist to take baseline blood pressure, A1C, a pulse ox on the finger. And then now there's some of these sensors that are getting developed and involved with

[00:25:58] the company that we're putting it into aligners where we can detect certain metabolites of inflammation. But it is aligning incentives and educating the consumer, which is happening, of the connection of the mouth and the body and where the professionals are working closer together.

[00:26:16] And Maria, I couldn't agree with you more about just a basic, let Epic and Dentrix ascend and a couple of these great companies, software companies, just start talking to each other. A simple little... When I go into the dentist, they ask me about what medications I'm on. Yes.

[00:26:34] Yes. They're not getting any data. Nothing. And I'd be happy to share information from my patient portal with my dental provider. And likewise, I'd love to see a similar kind of patient facing application that would allow me to share what is being learned in the dental office.

[00:26:53] So maybe we can make some of those connections happen as well, just through education of the importance of knowing that because there are observations when that dentist does an oral cancer screen. If something were to happen, they'd say, hey, we found this.

[00:27:10] Now you have to go communicate that to your doctor. But if there was that link there, no different than another specialist, I think there'd be better communication. Yeah. And you went with Parsley Health. I didn't realize that you were behind that.

[00:27:23] You have a patient portal where the patient owns a lot of their information. It is very smart because I don't know, the healthcare system, when you go to NYU in New York and you want to talk to the people at Cornell, you got to go get a disc.

[00:27:36] Did you imagine it's 2024 and I got to carry it over to my friends at hospital special surgery because I hurt my shoulder because it was at NYU. And so they're not figuring out the healthcare system.

[00:27:48] I think smart companies like Parsley and Forward Medical are looking at these patient portals, which I think is brilliant because at least they could bridge the gap. And then make a patient portal that then talks to the dental software company and the dental

[00:28:02] software companies work closely with healthcare systems like what you've built there with Parsley. But we got to keep banging on the door. We got to keep banging and yelling from the mountaintop. We got to connect the dots. And that's what this is all about. It's a great conversation.

[00:28:16] That's why we started this podcast, right Maria? That's right. We're educating patients to be empowered consumers of health. And I love that we're going in that direction because it seems to me that there is a business opportunity here for all the entrepreneurs, hungry entrepreneurs who are listening right

[00:28:30] now. I think the light bulb is going off saying, aha, integration interoperability layer between the dental side, the cottage industry of dental practice management systems and the medical side. And that's probably somewhere in the works already.

[00:28:43] I know both of you, John and Anny, are optimists at your core, despite of what we're seeing on a daily basis and the hustle of the experience. So where do you see the glimmers of hope and the positive signs in terms of integrating different disciplines in health?

[00:29:02] And where do you see unmet needs that could become great billion dollar companies in the future? You had mentioned earlier the attention that's being paid to the social determinants of health and our recognition that someone's circumstances, their employment status, their housing status,

[00:29:20] their access to healthy food is important in terms of understanding what their needs might be. We might even get to the point where health and human services speaks to housing and urban development, speaks to kind of FDA around food and food quality and the agriculture

[00:29:40] department around food subsidies. And to get our government talking about the things that they can bring together that might impact health. I'm encouraged by the fact that starting 2027, Medicare is going to be looking more closely at environmental factors like social determinants of health in risk scoring individuals of

[00:30:01] understanding what their circumstances are and how they have an overall impact on health. It would be wonderful to start thinking about ways that they can integrate oral health, mental health, physical health as well, because all those are really part of understanding what's happening with someone.

[00:30:20] And truly, if you don't have the access to oral health, you're endangering your health. And we need to understand if people are health insecure in terms of not only access to be able to get physical exam, but also from an oral health standpoint, because if you're

[00:30:38] not taking care of your teeth, you're going to end up with a significant level of downstream health care problems that are going to cause many other diseases that are very expensive to treat.

[00:30:49] And you end up in the emergency room with oral pain, which is the most expensive, least effective way of treating oral pain. So that's right. Sorry, didn't want to interrupt you there, but that final, the exceptionally important point there. Yeah.

[00:31:04] Well, Maria, that's a classic point about the emergency room. The United States spending $2 billion on emergency room visits and you don't have a dentist or anybody there and they give people pain pills and antibiotics and send them on their way and it's just a tremendous waste of money.

[00:31:20] And it's just a underscores this lack of integration between the medical and dental world. Jonathan, I actually though believe that there's things that we learn maybe just because it's expeditious and we're trying to keep our military healthy, but that's not true in the military health system.

[00:31:38] That they actually do have availability of dentists when you go into emergency facilities at our veterans hospitals and otherwise. So we have a lot to learn from a functioning, integrating healthcare system that already exists that should be translated into general practice. That's right.

[00:31:58] And you made the point earlier about Medicaid and there's a lot to be learned there. There are dental service organizations, DSOs in dentistry where the industry is moving in that way. But we've talked to a number of companies that are all Medicaid driven, that have a profitable

[00:32:13] model for Medicaid and going into the inequality areas of lack of oral health and medical and are successful at it. And it just underscores that you could have an enterprise that works on that and Medicare could go in that same direction.

[00:32:31] And Lord knows that when we can get the insurance companies, Maria, I'm in your world now, but the insurance companies to pay for preventative and diagnostic and a lot of these new technologies that are preventing these later diseases, we're moving the needle.

[00:32:46] And it's the same thing in medicine. And everybody's, I think, like all of us on this call, a ring in the bell about this. And Jonathan, one question for you, because I'm drawn to a situation that existed some

[00:33:00] years ago when we were working on having doctors prescribe medication, deliver medications to patients at the point of care. And there was a lot of pushback from the pharmacy board around letting doctors do this.

[00:33:14] And yet in all but two states in the union, doctors had the ability to deliver, I think, short term supply of medications up to three days and the like to their patients. Do you think that licensing also is creating barriers that there's concern by whatever

[00:33:32] the licensing body is on the dental side, that having too much floating between what's done in a dental office versus what's done in a doctor's office? I think our collective concern is we need to promote the way in which you think about oral

[00:33:47] health as part of overall health. But yet, have we siloed this inadvertently by saying this is done here, that's done there and neither shall between be? That's exactly right. It just underscores the separation that exists today.

[00:34:06] And it underscores the need for change into the future because you have exactly what you described. You have the dental, this is what a dentist can prescribe, whether it's a pain med or a Tylenol 3.

[00:34:18] But God forbid if you have a dental office that's more integrated, which happens to be like mine because we cover all the different specialties and we have a very strong connection of medical in our dental hygiene visit, let the dentists kind of work more integrated in

[00:34:34] the medical model. I'm personally, I'm putting my mouth, my money where my mouth is and I'm starting what I'm going to look at as the dental practice of the future as a new practice that I'm working with a number of the companies.

[00:34:48] I'm dragging, of course, Maria in because I drag her into everything I do because she's way smarter than I am. And look at how do we integrate because dentistry needs integration, all the different disciplines,

[00:34:58] all the specialties, because they're all like this guy's here, this guy's here, you got a periodontal problem, I'm going to refer to it. In my world, everybody's under one roof. We work collaboratively. It's like grand rounds.

[00:35:08] We put everything up on the screen and we have our zoom calls every Friday going over our cases. So that needs integration and dentistry and medicine needs integration. And that's what I'm going to be looking to do to partner with a group medical on the

[00:35:22] medical side on primary care to work together to say this is the dental practice and the integration of medical dental into the future and really look at what you're doing so we can put some of our money where your mouth is. There you go. This is it.

[00:35:36] This is how the magic happens. We can at least compare notes from the old days when we were running and hiding in the corners. Two runners here who figured out how to run at the right time at the right place. In the right direction. In the right direction.

[00:35:52] That's right. I love that you both went in that integrated model because just an episode or two ago, we had an advisor, financial advisor who is responsible for over $4 billion investments being in investing institutional investments in those invisible DSO practices.

[00:36:12] And what he was describing that the multiple at which you are able to sell a practice differs based on the state that you are in and based on the licensing regulations of the state that you're in. So you're in Chicago, Illinois.

[00:36:29] The multiples there are lower than the multiples in Indianapolis. Why? Because hygiene licensing hygienist could the scope of practice for hygienist is broader in Indianapolis than in Illinois. And I'm very forward thinking dentist in Indianapolis could turn the hygiene room into what Jonathan

[00:36:51] has turned it, which is the tip of the spear for integrated care delivery. While the hygienist in Illinois could just do a very regimented smaller subset of. She means Indiana, not Indianapolis, but we knew who you, what you meant. Speak Maria, Jonathan speak Maria by now.

[00:37:09] You make a great point there Maria. But this was great. It was so interesting to hear your perspective on this and someone who's really looking to drive change. And yes, but putting the money where the mouth is saying, well, let's make some change.

[00:37:28] Look for those who are in a similar position as we are, we hope to do good. If we can do well by doing good, that's great. As Maria has noted, many early stage companies don't make it more, don't make it then do survive and become successful.

[00:37:45] But just because the odds aren't necessarily in our favor with regard to the number of companies, these are things that are worth trying that there's value in, in trying to force change and they may be early and leading the way for someone in the future who might

[00:38:01] be successful. So we're hopeful that we know what the right answer is. We just have to keep pushing and try and get the rest of the system to agree. But I think over time it's been proven that if you continue to pursue something that makes

[00:38:17] as much sense as you're describing with regard to focusing on someone's overall, full health, including oral health, it will happen. And I hope it happens soon. I'm with you. Maria, are we with Lee on this one? Thank you. Yes. Thank you. I couldn't have said it better.

[00:38:35] This is what a great aspirational invitation for everybody else to join us. And with that, thank you. Thank you, Lee, for the time. Thank you so much for giving me the opportunity to join you today. Thanks for listening to the Think Oral podcast.

[00:38:52] For the show notes and resources from today's podcast, visit us at www.outcomesrocket.health slash thinkoral or start a conversation with us on social media. Until then, keep smiling and connecting care.