Prioritizing Preventative Dental Care for Better Patient Outcomes with Bryan Carey and Dr. Jane Whang

[00:00:00] Welcome to Think Oral, where we connect and connected between oral and physical health.

[00:00:11] I'm your host Dr Jonathan Levy, and I'm your host Maria Filippova.

[00:00:15] Let's get at it!

[00:00:22] Welcome everyone to another episode of the Think Oral Health Podcast.

[00:00:27] We are recording today from beautiful Winther in New York, and I'm very excited about

[00:00:33] the conversation topic because as you all know Jonathan and I are very committed to

[00:00:40] bringing and highlighting leaders in this podcast that are doing things differently

[00:00:45] and that are succeeding in bridging silos between different care teams.

[00:00:51] So today we have a really interesting discussion and a great surprise because not only do

[00:00:58] we have one exceptional leader, but we have two exceptional leaders doing amazing work

[00:01:04] that we want to talk to you about.

[00:01:06] The topic is doing well by doing good.

[00:01:10] The topic is serving the others served, and we are here to tell you all about the amazing

[00:01:15] work that and how that's happening.

[00:01:17] Like that, I would pass it on to my partner in crime and co-host of the podcast Dr Jonathan

[00:01:23] Levy who would introduce our two, not one, but two conversation partners for today.

[00:01:31] Thank you Maria, and yes, super excited to have Jane Wang and Brian Carey from Benevis.

[00:01:36] I must tell you, we're really looking forward, we've been looking forward to this conversation.

[00:01:43] We're going to dig in on how you can have a business model that can help the underserved

[00:01:49] and have a sustainable cash flow to support that effort.

[00:01:54] And we're going to dig in on that because that is truly special.

[00:01:58] Let me start with Jane, just a little bit quick, bio Jane.

[00:02:01] As a dentist she went to Columbia, she is passionate about dentistry, she worked at a multi-specialty

[00:02:07] practice in Denver, Connecticut.

[00:02:10] And she relocated to Maryland to join Benevis.

[00:02:13] I got up with Jane a couple of months ago and I'm so excited for her to tell us her personal

[00:02:18] story and what excites her about Benevis.

[00:02:22] Brian's the chief executive officer of Benevis, and that is a leading DSO for practices focused

[00:02:29] on life changing dental care and orthodontics.

[00:02:33] But what's really special about that is they're focused on creating equality where there's

[00:02:39] the underserved population.

[00:02:41] And if a 20-year history of providing a high quality care to approximately 5 million

[00:02:48] children and adults in 120 underserved communities, then I will tell you personally having a foundation

[00:02:55] and looking to help the underserved, I'm so excited for us to dig in on this.

[00:03:00] So welcome Jane, welcome Brian to the Think Oral Health Podcast with Maria Philip Pumpen

[00:03:06] myself.

[00:03:07] Thank you so much, really happy to be here, happy to represent Benevis and excited about

[00:03:13] this topic because I spend every day thinking of how can we be successful as a business but

[00:03:18] make sure that we're fulfilling a mission.

[00:03:21] Exactly.

[00:03:22] And Jane.

[00:03:23] Thank you Dr. Livy and Maria for having me on.

[00:03:26] I so enjoy speaking with you a couple of months ago, so it's great that we can reconnect.

[00:03:30] And I know that we had a lot of interweaving interests, which is to really provide access

[00:03:36] to care for the underserved community and something that we personally feel passionate about

[00:03:41] so it's great that I could do it professionally.

[00:03:43] Oh, amazing.

[00:03:44] Amazing.

[00:03:45] I'm so excited to have both Brian and Jane having you on the podcast.

[00:03:49] Let me start it off, Maria if I can with a big burning yearning question that I have

[00:03:54] to Brian, the CEO who is overseeing the profitability and the accountability of the

[00:04:00] organization from the top.

[00:04:02] Brian, how do you do it?

[00:04:04] How do you focus on the underserved community but also have a profitable enterprise so that

[00:04:11] you can maintain the sustainability of the organization going forward?

[00:04:15] Dr. Livy, I really appreciate that question because first and foremost, we have to provide

[00:04:21] the same care.

[00:04:22] We just can't do something different, but I want to talk about what we do differently because

[00:04:28] in order to be successful is what I call a purpose built business, we're only getting paid

[00:04:33] 70 cents on the dollar by Medicaid relative to other payers and how do you do that?

[00:04:38] We really do it with three things.

[00:04:40] One is that we have access and availability.

[00:04:44] Our offices are within the communities of the underserved population and so they are able

[00:04:49] to get to us and we're also open evenings and Saturdays at times that work for them.

[00:04:55] First is that you just have to be able to be where the patients are.

[00:05:00] The second is we have a care delivery model that is different.

[00:05:05] We have assisted hygiene where the hygienist has a lot of assistance from the dental

[00:05:10] assistance to make sure that they are able to see as many children as possible but

[00:05:16] again provide the same care.

[00:05:18] And then finally, we have systems.

[00:05:20] We have a proprietary system that helps us in terms of schedule management, confirmation

[00:05:25] rates or population has a hard time getting to a dental appointment and being able to show

[00:05:32] up on time because they just don't have all the ability that others and other communities

[00:05:38] do.

[00:05:39] It's really through those three things that essentially we're able to have our offices

[00:05:45] highly productive but again, providing the same care that they would in any other community

[00:05:50] in the United States.

[00:05:52] Amazing.

[00:05:53] We're going to dig in on that a little bit.

[00:05:55] That is amazing.

[00:05:56] I love the idea of an assistant hygiene to create efficiencies from a timing perspective

[00:06:02] and at a high level of delivery of care.

[00:06:04] How did you come up with that assisted hygiene model?

[00:06:08] Was that something that you folks have figured out through iteration and your own personal

[00:06:14] growth in the organization or was that something that was learned elsewhere?

[00:06:18] All of us Dr. Wang to maybe touch on it as well but as background, we started 20 years

[00:06:24] ago as a purpose built business and said we want to have an office design and a care team

[00:06:32] that can allow for this level of care to happen in a manner that also allows us to be effective

[00:06:38] in efficient.

[00:06:39] So the model has largely been in place since the business was started 20 years ago and Dr.

[00:06:45] Wang, maybe you could talk a little bit about how we're able to really assist the hygienist

[00:06:51] as well as the dental assistants and migrating to our care delivery model.

[00:06:54] Sure.

[00:06:55] I think it's important to remember that hygienist are dental providers and when they are supported

[00:07:00] they can be most efficient.

[00:07:02] And I think that with our model of seeing high volume of patients, when they have that support

[00:07:08] they can work more efficiently to provide the care that they were trained to provide which

[00:07:13] is hygiene pro fee or hygiene instructions and to have the dental assistants support them

[00:07:19] through taking the videographs and walking the patients in and out so that they have that

[00:07:24] because you don't need a clinician to do that.

[00:07:26] And to have the assistance to provide that support, I think helps us to be efficient and

[00:07:33] really provide that high quality care for our patients where we are able to see

[00:07:38] I have a high volume in our patient offices.

[00:07:41] And maybe Dr. Luene and Maria, for your listeners, they probably have not been to one of our

[00:07:46] offices.

[00:07:47] So let me explain what our office looks like because it's probably different than most

[00:07:51] of your listeners at the office.

[00:07:53] So we're probably in a strip mall.

[00:07:56] We have a big waiting room that looks almost like a motor vehicle department and then we

[00:08:01] have what we call hygiene bay which will have 8 to 10 chairs.

[00:08:05] In some ways it sounds like it's a mass operation but it's actually fun.

[00:08:10] When you're in there and there are 6-8 kids there with their sunglasses on getting

[00:08:14] ready to have a cleaning, it's a fun environment but it's an environment that is conducive

[00:08:19] to this assisted hygiene model.

[00:08:23] And so that might help as people are trying to say what is it that they're doing?

[00:08:26] I love the UN there because that gives us a visual and it also gives us a connection

[00:08:30] that care delivery doesn't always happen in a clinic, in a dental office or in a physician's

[00:08:37] office.

[00:08:38] It happens in the community because we need to meet patients where they are in their lunch

[00:08:43] break as they're going from work and coming back from work.

[00:08:46] And that's really critical so thanks for reminding us of this.

[00:08:50] I do want to dig into a little bit of that model, the very special model that you've created

[00:08:56] but before that I want to call out for our listeners the importance of the service that

[00:09:01] you provide because it is true that if we, especially for low income populations or

[00:09:08] other serve populations who don't have access to routine dental care, the alternative

[00:09:13] is going to the emergency room.

[00:09:15] And we're still seeing over 1.8 million more visits annually in the emergency room due

[00:09:22] to non-traumatic dental care.

[00:09:25] That's $3 billion of cost to the system.

[00:09:30] And so as we think about the importance of getting care in the community to patients

[00:09:36] really needed but don't have the access or the availability, it's really important.

[00:09:40] So this is not necessarily a oral health or dental care issue.

[00:09:44] This is overall health system issue that cuts right at the crux of the cost of the care

[00:09:50] that we're delivering today because for those listeners and we have two physicians or

[00:09:55] all of physicians on the phone, going to the ED is the most expensive, least efficient

[00:10:01] way to deliver care for oral health issues.

[00:10:06] And Dr. would be able to do what?

[00:10:08] Dr. Jonathan Levine and Dr. Wang, what would the ED doctor be able to do for a patient

[00:10:13] with oral pain?

[00:10:14] Hope he always or maybe antibiotics.

[00:10:16] And then they'll refer them to a dentist and they'll wind up in the strip mall center

[00:10:20] that you guys are running.

[00:10:21] If they're lucky.

[00:10:22] If they're lucky, that's right.

[00:10:25] And so it's important to think about the broader context in which you are running those

[00:10:29] clinics and how important that is.

[00:10:31] It's really important then because income has a very significant impact on access and

[00:10:37] care and children of lower income families or twice as likely to have tooth decay.

[00:10:43] So there are also then going to be twice as likely to have the school absence were

[00:10:48] end up in the emergency room.

[00:10:50] And that's what we are seeking to do is to close that gap, to be able to be available,

[00:10:56] accessible so that income is not a determination of whether or not you receive care.

[00:11:03] What is the role?

[00:11:04] You've created something really special here and you've scaled it and you've been doing

[00:11:09] three years.

[00:11:10] So maybe talk to us a little bit about the role of technology and innovation in that model

[00:11:16] that special model we've created.

[00:11:19] And people when they talk about technology, they say, oh, well, there's AI or innovation

[00:11:23] is associated with technology.

[00:11:24] But there's other ways in which you're innovating that are probably equally important and critical

[00:11:28] to that success of the model.

[00:11:30] So talk to us about that a little bit.

[00:11:33] I'll talk a little bit about the sort of business administration aspect of it.

[00:11:37] And I'd love for Dr. Wang to talk about the use of technology and the care delivery,

[00:11:43] but we actually do have a proprietary practice management system.

[00:11:47] And what sounds very basic, but it takes less time to do a cleaning and a real health exam

[00:11:52] for a child than it does for a 50-year-old.

[00:11:55] And so we have things, everything from our schedule blocks to our confirmation process

[00:12:02] to the use of technology around predictive confirmations, which again is really important

[00:12:08] for this cohort and this demographic where it is a challenge to balance your life and

[00:12:13] get your child to the dentist.

[00:12:16] And most of the innovation that we have on the business side is around schedule management

[00:12:20] to do everything we can to have appointments be at the right time and the right availability

[00:12:27] and then to really support our patients by confirming, make sure they get reminders

[00:12:32] seven days out, three days out, the next day out.

[00:12:35] And we are using AI around when the best time to do those confirmations as well as virtual

[00:12:42] assistance in terms of if someone doesn't need to make a change and try to reschedule.

[00:12:47] But I'd love for Dr. Wang to talk about also how we use our medical records since we are using

[00:12:53] one practice management system throughout the end of this.

[00:12:56] Yeah, I was going to say that as a clinician it's so I feel blessed to have a dental service

[00:13:01] organization that supports us on the operational side.

[00:13:04] So that as a clinician we can focus on patient care because that's what we went to school for

[00:13:08] and that's what we enjoy doing.

[00:13:11] And part of it is they are so good about supporting us through making sure that we're updated

[00:13:16] in terms of our general records.

[00:13:18] It's all digital, our radiograph system everything is digital so that we can access it in different

[00:13:24] ways following hip-hop rules.

[00:13:26] And I think that's really important so that we are able to provide the full quality care

[00:13:33] for our patients and create a dental home for our patients so that we can communicate

[00:13:37] with physicians, pediatricians and to keep that communication open so that we are not

[00:13:44] as you said Maria, we're not just focusing on oral health but we're really focusing

[00:13:49] on the overall health of our patients.

[00:13:52] And I love that we started out seeing children and that's why we have an open-day model where

[00:13:57] we know that children can learn from one another to say hey it's not as scary as I thought

[00:14:02] it would be because that child who is three years old is doing it and is enjoying seeing

[00:14:06] the dentist.

[00:14:07] And now we are able to provide care for the full family.

[00:14:11] We first started out with children, parents, now we are able to provide full family service

[00:14:17] for our patients and the communities which is great.

[00:14:20] And how do you, Jane?

[00:14:22] How do you balance the physical layout of an open bay for the children because children

[00:14:29] in North-Ordew that's an open-day model and it's great but how do the adults respond

[00:14:33] to that?

[00:14:34] What have you found because it's against the norm and it's very innovative in its own

[00:14:39] right could you tell us a little bit about that?

[00:14:42] Yeah, it's actually interesting because we have different schools of adults, right?

[00:14:46] Some adults they want to be treated like children because they have a lot of anxieties and

[00:14:52] they are nervous about seeing us so they love that they get to see, be seen with children

[00:14:57] but then there are also adults who want that privacy.

[00:14:59] So we have created different models within a hygiene bay where we call it transitional

[00:15:06] where it can be converted to be a little bit more private with barriers on the side

[00:15:10] of the cares which made us very equipped to see patients during COVID as well but even

[00:15:16] we also have different separate operator zones that were created for hygiene patients so

[00:15:21] that we can cater it to what the parent patient needs, the adult patient needs to feel comfortable

[00:15:27] and to continue to come back to follow up with their care.

[00:15:31] So adults they're all different, they're all different.

[00:15:34] Of course, Brian I'm going to love this back to you.

[00:15:37] I'm trying to do the math here.

[00:15:38] You're getting paid 30% lower, 70 cents on a dollar.

[00:15:44] You deliver care at an amazing level.

[00:15:47] You take care of the undersur and you have a sustainable model.

[00:15:53] And we're answering that question and we're looking at a certain level of efficiency and

[00:15:57] improved and more efficient layout proprietary probably SOPs but give me, wrap your arms

[00:16:05] around this a little bit because with you running at 24% margins in the DSO 28% in the

[00:16:12] dental practice, you're doing pretty good.

[00:16:15] So how back to my question, how do you do it?

[00:16:19] I would say it's really two things.

[00:16:21] One our doctors work very hard.

[00:16:24] They really do.

[00:16:25] Dr. Wang is a great kind of leader by example and they are from the moment they get into

[00:16:32] the office and are at the huddle.

[00:16:34] So when that last patient is walking out the door, they are working hard and we appreciate

[00:16:40] and everything relies on that.

[00:16:42] I happen to think a lot of them do it because they relate to the mission.

[00:16:46] A lot of more providers have been from these communities, live in these communities

[00:16:51] and in addition to just practicing their profession, they really do connect with the community.

[00:16:56] The second thing is it's an extender model.

[00:16:58] The assisted hygiene model, we are using the dental assistance to do as much as possible

[00:17:05] around x-ray medical record entry, positioning patients or other things.

[00:17:10] And I'd say it's really those two things that are key to our being able to deliver the

[00:17:16] same quality care but in an environment where the reimbursement is different and that

[00:17:20] requires us to be very focused on delivering that care in an effective manner.

[00:17:26] I mean, really tremendous.

[00:17:28] Like can I go back a little bit to innovation?

[00:17:32] I know that's very good.

[00:17:33] My favorite topic.

[00:17:34] No, we don't talk about innovation at all.

[00:17:37] But how did something really go about?

[00:17:40] It's really just even all of us who are on this call together and we talk about how we

[00:17:46] want to integrate health care and oral care because it is total care but even our own

[00:17:53] organizations have a hard time with change.

[00:17:55] I'll give you two examples.

[00:17:57] We had a payer come to us and say as of March 1 of 2023, we're going to require diagnosis

[00:18:04] codes on all of the claims.

[00:18:07] And everybody was up in arms of oh my gosh this is extra work and we're going to end

[00:18:11] up with claims being denied and we're going to have to figure out how to put this in

[00:18:14] our system, how to get it across.

[00:18:17] And I said wait a second.

[00:18:19] Have we all been saying how important it is for oral health care to be integrated with

[00:18:25] total care?

[00:18:26] And if somebody is looking for a diagnosis code so they can then try to correlate some

[00:18:31] other complexities or chronic disease or risk, we should be all over it.

[00:18:35] So I said, even if we're going to have to hire additional people in the interim to do

[00:18:39] this, we want to be leading this because it is so core to our mission but it's hard,

[00:18:45] right?

[00:18:46] Because you're talking about change and you're talking about we have to do something a little

[00:18:49] differently.

[00:18:50] And a similar thing where one of our payers asked us to just add additional medical notes

[00:18:56] in a certain nomenclature so that their systems could pick it up and then correlate it with

[00:19:02] the medical records.

[00:19:03] And we just don't have time, it's going to be an additional three minutes of medical record.

[00:19:09] And again I said but we've said how important this is and it's not going to happen unless

[00:19:14] we change it.

[00:19:15] It's not technology, it's just work but it's not going to happen unless we all think about

[00:19:21] what's the value downstream of doing a little bit extra work around this.

[00:19:26] And how do you I think that's a really important point because a lot of companies who are looking

[00:19:32] to develop those new solutions don't think ahead of what the solution would look like when

[00:19:37] it's deployed and when it's deployed in scale, right?

[00:19:41] We get so excited and say, this works.

[00:19:45] But we really have to think a couple of steps ahead to say what does this works mean in

[00:19:50] the hands of hygienists, hands of an administrator or a dentist who is probably overwhelmed with

[00:19:57] all the patients they need to see in a single day and managing all the complexity.

[00:20:02] And so it's interesting for our listeners to hear from you who are doing living a day

[00:20:07] and a day out.

[00:20:08] Some people say scarcity is the mother of innovation because you're figuring it out and innovation

[00:20:13] is just the creative way of problem solving.

[00:20:16] That's all it is to think about the workflow, the application in the field and tell us maybe

[00:20:23] a little bit what do you think the role of other ecosystem players?

[00:20:28] You touched a little bit about payment models.

[00:20:31] Are we in a place where its payment models or the care delivery system is conducive for

[00:20:38] trying different things or doing things in a more innovative way?

[00:20:43] What is your take on that?

[00:20:44] Let me say I'm brand new to dental.

[00:20:46] I'm like most of the folks on this call, I've been at Benevis for two years, I was on

[00:20:50] the board for a year before that.

[00:20:53] But part of what I think at least informs my perspective is having worked in other areas

[00:20:59] of healthcare.

[00:21:00] So I ran an emergency room business which is really sort of when the system fails.

[00:21:06] There are some people that should be in the emergency room but two-thirds of them should

[00:21:10] not.

[00:21:11] Two-thirds of them should have had some sort of any counter that would have prevented them

[00:21:15] from being in the emergency room and so having been there and seen that by Omoe's

[00:21:20] thinking about where are the things that could have been done earlier.

[00:21:24] And then this is before that was actually in cancer care where so much is around the coordination

[00:21:30] of care.

[00:21:31] And to me, the learnings all come back to the sharing of information and when there is

[00:21:38] the sort of sharing of medical records or it is QR codes so that a person brings their

[00:21:44] demographics and their history to the office with them in an effective way.

[00:21:49] I just know that those are things that are going to maybe not help us next year but over

[00:21:54] the next three to five years in terms of really improving outcomes and avoiding the chronic

[00:22:00] disease.

[00:22:01] As I like to say the fee schedule is in dentistry or upside-down.

[00:22:05] They try to pay as little as possible for an oral exam or health but then they'll pay

[00:22:10] so much for a really complex recovery and we actually do a study in Louisiana looking at

[00:22:17] our care delivery because we do a lot around prevention and sealants and others and we actually

[00:22:23] have a lower cost per patient of almost $80 per patient but that's working hard to work

[00:22:30] within the system.

[00:22:31] What the system really should be doing is paying more for preventative care because

[00:22:35] what we're talking about is going to help.

[00:22:37] It just takes a while.

[00:22:38] It's happened somewhat in Med Surge because their Affordable Care Act have been paying

[00:22:44] more for primary care and geriatric primary care.

[00:22:48] We need the same thing to happen in dentistry.

[00:22:50] Boy, I love what you just said.

[00:22:52] It's ups the fee schedules are upside down and we need to focus on diagnostics.

[00:22:56] That boy has a specialist and the leading teams that is so right.

[00:23:01] Jay, let me pivot over to you a little bit and let me change gears a touch.

[00:23:06] The concept company is culture.

[00:23:09] Company is culture.

[00:23:11] I know you live in breed this.

[00:23:14] How would you describe the culture that you have at that of us and what is the big driver

[00:23:20] there that really creates that?

[00:23:24] Here is mission.

[00:23:25] I think that's the reason that I have been in the organization for more than 13 years.

[00:23:31] I tell people that I can practice dentistry in so many different ways as you're aware, Dr.

[00:23:37] Levine.

[00:23:38] What keeps me here is the mission which is to provide access to care for the underserved

[00:23:42] and I think because of the mission it attracts like-minded leaders which is why there are

[00:23:48] a lot of people that I work with that have been here a long time and that even when they

[00:23:52] do join Ryan Hoespin here for a year or two.

[00:23:56] It seems like they've been here longer because they are here with the right mission and I think

[00:24:01] that when you keep that in mind things naturally go well because that's how I speak with my

[00:24:07] dentist.

[00:24:08] If you do everything make every decision in terms of what is the best interest and what

[00:24:13] is the best thing for this patient that I have in the chair, you cannot help but do the

[00:24:17] right thing for the patients but also be successful because you're going to make an effort

[00:24:21] not to waste, have them wait too long because their time is just as valuable as my time.

[00:24:27] You're going to make sure that you do the most you can in that limited time because you

[00:24:31] know that they have a hard time coming to the appointment.

[00:24:34] The fact that they came to the appointment is such an obstacle in miracle because these

[00:24:39] especially for children they're dependent on the parents who were obsessed with teeth

[00:24:44] because we're in the dental industry but not everyone is obsessed with teeth.

[00:24:48] So if something comes up they may forgo their dental appointment for other things in their

[00:24:53] life.

[00:24:54] So we want to make sure when they're coming for cleaning, if we have the time to provide

[00:24:58] the treatment for them let's do it because we care about the patients and I think that's

[00:25:04] for me that's the most important thing and that's what keeps me here and I think that we

[00:25:09] have this great mission but we also need to make sure that we continue to meet the margins

[00:25:13] so that we can carry out the mission and that's where the DSL and Brian and his team I think

[00:25:19] supports us with that.

[00:25:21] So it's a partnership at every level of the company and I think that's unique.

[00:25:26] A lot of times you have operational leaders who are overseeing health industry but you

[00:25:33] need that partnership, the clinical partnership so that we work together and I think that's

[00:25:38] what we have at the NIVIS which I really appreciate as a clinician.

[00:25:42] Yeah, you're beautifully describing servant leaderships where everybody is looking to make

[00:25:46] each other much better and in turn we be better.

[00:25:50] Brian in your own thinking about culture and as it relates to certain business metrics

[00:25:55] of turnover and retraining and training and the expense of that and longevity of the

[00:26:02] employees, the happiness of the employees.

[00:26:05] How has the build of the culture impacted those metrics?

[00:26:10] How do you look at that and how do you think about it?

[00:26:13] So I just have to be candid and honest, we're not as good at that as we need to be.

[00:26:18] We do a really great job of when a dentist joins Benavis providing them training and care

[00:26:26] and support to be successful.

[00:26:28] We have not traditionally done as good a job at that with our hygienists and our dental

[00:26:33] assistants who are so critical to our care delivery model.

[00:26:38] So we've actually just started to really address that in three ways.

[00:26:43] One is it's really hard because we all know the shortage of healthcare workers at particular

[00:26:48] in dental and I have said they are not going to be on the back providing care for 40

[00:26:55] hours.

[00:26:56] They're going to be trained supported and as much as we have patients waiting and everything

[00:27:01] like that, it's just not going to work unless we're giving them time and room to be

[00:27:06] trained in our care delivery model.

[00:27:09] The second thing is that we are making sure that there is some engagement because our

[00:27:15] offices are really busy and we're actually measuring the number of times that an office

[00:27:20] manager and a doctor have had a conversation with that new employee.

[00:27:25] And then finally, we are trying to come up with more ways of certification levels so

[00:27:32] that someone has been with us six months and they were able to now do whether it's

[00:27:36] radiography or other things that we are recognizing that not just in their compensation, but

[00:27:42] really in terms of their role in the office.

[00:27:45] It's a huge challenge.

[00:27:46] We are not as good at it as we need to be, but I think we have the model because we've

[00:27:52] done it for our doctors.

[00:27:54] We just need to make sure we're doing it for all of the care delivery professionals.

[00:27:58] That's the 1% rule, right?

[00:28:00] We get better 1% every day by the end of the year with 365 up.

[00:28:04] And as a clinician, healthcare provider, educator and businessperson, it really is so

[00:28:11] important.

[00:28:12] These things that we do really well, we do more of that and things where we can improve

[00:28:18] we build the KPIs in the metrics.

[00:28:20] We have to measure that and just focus on a power of intention as business people but

[00:28:25] also of course as clinicians.

[00:28:28] And today just to pivot it back to you, we all know service businesses, it's all predicated

[00:28:32] on that culture on your people side of the equation.

[00:28:35] How do you educate your teams?

[00:28:39] Are you a hygienist, assistance, operational people, doctors?

[00:28:42] How do you think about educating them and is that also an area that you're constantly working

[00:28:46] on and growing in development?

[00:28:48] Yeah, and I think Brian's on a good point about the training because what we're doing is

[00:28:53] we're investing in people.

[00:28:54] I think that when you invest in them, it you allow them to be supported and grow within

[00:29:00] the organization which is important.

[00:29:02] I think that in terms of having a robust training program allows the employees to understand

[00:29:09] that hey, we believe in you, you know that you can be successful with the right tools

[00:29:13] and we're going to do that for you.

[00:29:15] And one of the other great things within the organization is that we have a lot of upward

[00:29:19] growth for our team members, which I think is really exciting.

[00:29:23] We have district managers who started as dental assistants or front desk receptionists.

[00:29:28] And I think that to recognize those individuals, because I think that's one of the biggest

[00:29:33] things that sometimes people have rights about at a workplace where they feel like they

[00:29:38] work so hard and they're not recognized but we recognize them and we provide them if

[00:29:43] they have the potential, provide them with opportunities for growth and they are now

[00:29:49] get, they get to mentor and invest in other individuals to be, to create people like them.

[00:29:54] And I think that's really important.

[00:29:56] And I feel like that I'm a great example of it where I started as an associate dentist.

[00:30:01] I joined the company 13 and a half years ago thinking, hey, let's see, I like the mission.

[00:30:06] I like the people that I met among the way while interviewing.

[00:30:11] And then here I am where I get to be the voice for the associate dentist and the field as

[00:30:17] I'm visiting offices.

[00:30:18] And I think that's not something to take lightly.

[00:30:20] I know that and I love that it's an organization that gives me a platform where I can speak

[00:30:27] on behalf of the field.

[00:30:28] I speak with Brian all the time about things that are happening in the offices.

[00:30:32] And I think that's part of how the training program even started where Brian was visiting

[00:30:36] the offices and he realized, hey, we need to invest in the assistance and the support

[00:30:42] team so that the dentist can be even more supported and grow and provide better care for

[00:30:48] our patients.

[00:30:50] And I think that's important.

[00:30:52] I love the conversation because it's highlighting the depth and the richness of your thinking

[00:30:59] in how we deliver care that's affordable, that's high quality care because these are not,

[00:31:04] these are artificial trade-offs, right?

[00:31:07] High quality care doesn't have to come at a cost or at a cost of innovation.

[00:31:13] You could do all of these things if you're focused on optimizing the patient and centering

[00:31:19] around the patient, right?

[00:31:21] This whole conversation is how do I deliver the best quality of the care to the patients

[00:31:26] where they need it.

[00:31:27] And the rest of it, the bottom line metrics and everything else falls off of that first

[00:31:33] underlying question.

[00:31:35] The other piece that I love here is that we have a great, if I have an ideal view of what

[00:31:42] the most insightful conversations in oral health look like, it's probably a representation

[00:31:47] of the tapestry we have on the call here.

[00:31:49] We have 50% of folks who are non-clinicians, non-dental insiders and 50% of the room

[00:31:57] who are who live, breathe and deliver care on a daily basis.

[00:32:04] And 100% of the room is mission aligned, right?

[00:32:07] So if I have a formula for what a productive conversation looks like, it's a diverse group

[00:32:13] that is insiders across silos and all rowing in the same direction, that's that mission

[00:32:18] piece.

[00:32:19] And I do want to give a shout out to all of our listeners who are maybe faced with

[00:32:24] a little bit of trepidation of, I'm not a dentist or I'm not an expert or what do I know?

[00:32:30] I think there's so much room for growth and need for innovation and need for smart, hungry,

[00:32:36] brilliant, curious minds to come in and do work in dentistry.

[00:32:39] So if we're seeing anything from this conversation, I think that's probably an invitation.

[00:32:44] I don't know if Brian and Janey would be joining that but it's an invitation for non-traditional

[00:32:50] paths folks to come in and solve some of these problems with us.

[00:32:54] But are some of those biggest problems that you want to, you think that are worthy of

[00:32:58] innovation and some new solutions that we need so that your model and your organization

[00:33:03] can grow, continue to grow and scale in the next three to five years?

[00:33:08] Where would you want to put your efforts behind?

[00:33:11] What I've been new to dentistry and being new to pediatrics, it just never occurred

[00:33:18] to me that before you can enroll in school, you have to have an annual physical but

[00:33:25] you don't have to have an oral exam.

[00:33:28] And just how is it that we're saying that this is really important and we've always used

[00:33:33] schools as a key leverage point because parents will do anything to make sure their kid

[00:33:39] gets to school.

[00:33:40] And therefore, we use that to say let's make sure they get their annual physical.

[00:33:45] And why don't we also say there should be an annual or all these 50% of the children

[00:33:51] who have Medicaid benefits do not get to an dentist in any single year.

[00:33:56] And we need to do everything we can to support the families and to me, one answer is let's

[00:34:03] just make sure that it's a box you just checked that you've had that oral exam.

[00:34:08] And I know it will significantly increase the number of kids that get there and then we'll

[00:34:13] have diagnostic and preventative care which is really what's going to help us all.

[00:34:18] If we connect the dots having a foundation, our global foundation and we go into the schools

[00:34:23] what we've learned right and change deeply is that when we get to the children early,

[00:34:30] what happens?

[00:34:31] They get preventative, they don't develop the decay and the tooth loss and the loss of

[00:34:37] function and the loss of self-esteem that their adult parents have.

[00:34:41] There in a loop, there's no access to care people can die from a bee sting.

[00:34:45] They think walking around in pain not being able to have teeth extracted or ruchin out

[00:34:49] because they would have to fly the NASA, no access.

[00:34:53] But here we are in this country and we don't have a national model that says let's at

[00:34:57] least go into the schools.

[00:34:59] Let's get the basic screenings, the exam, the fluoride treatments and then treat those

[00:35:05] small capitals so they don't end up like some people that do with small little decay

[00:35:11] turns into a life threatening event.

[00:35:14] How do we then connect the dots between the public health themes of our dental schools because

[00:35:20] that's where I'm seeing is a very important stakeholder here.

[00:35:25] To a state or national business model, to the not-for-profits like our global foundation,

[00:35:30] to what you folks are doing, we have figured out how to create a viable economic model.

[00:35:36] How do we connect those dots because it seems to me that we really can?

[00:35:39] I think there's a terrific platform being somewhat new to this field.

[00:35:45] I am incredibly impressed and I never thought I would say this with the managed care organizations

[00:35:51] that are active in Medicaid.

[00:35:53] Because these states are ultimately their clients, they do really have both a structure

[00:35:59] and an orientation towards a public mandate.

[00:36:03] I just think we have to find more and more ways to connect that to education because there

[00:36:08] is so much that they are doing with the states and they do have progressive models around

[00:36:12] a dental home and around oral e-vows, but there's just not enough connectivity to the education

[00:36:19] system.

[00:36:20] That to me, I think that's the best platform to do it.

[00:36:24] I think the schools are important and then but in also partnership with the parents because

[00:36:29] I think that the parents need to take ownership over the children's oral health care.

[00:36:35] I think that's why we are able to provide that dental home for the children where parents

[00:36:41] come back with the children when they are getting their cleanings and when the hygienists

[00:36:45] are giving the oral hygiene instructions to the children, parents are listening to it

[00:36:49] and they are checking themselves out to see what they need to do for themselves but also

[00:36:55] for the children because the children are younger and may not be able to follow up with their

[00:36:59] care.

[00:37:00] So when we tell the child, because oftentimes the parents will be like, oh my four-year-old

[00:37:04] child loves to brush their teeth and I want to tell them that's great.

[00:37:08] I love that they care enough to do it, but as a grown-up, why don't we go in and help

[00:37:13] them because sometimes they may not be doing a thorough job as an adult.

[00:37:20] And then also to remember that with children, they have different pain threshold.

[00:37:24] When they have that dental pain, there may be an access too but the child may not feel it

[00:37:29] and that's when it's critical that they've been following up with their care where we identify

[00:37:34] it because within adult, when we have something that hurts a little bit, we're able to voice

[00:37:39] it but children may not be able to voice it so we need to make sure that they continue

[00:37:43] to follow up with their regular cleaning appointments and check up so that we can identify it in

[00:37:49] case the child is not able to identify it.

[00:37:52] And I think that's important.

[00:37:53] Also on the in terms of just providing that access to care, I think that another part

[00:37:57] is to we need more dentist dental providers and to be on this submission with us.

[00:38:03] We have about, I think only about 20% less than 20% of our providers accept Medicaid insurance

[00:38:10] and we need more providers to come on with us, come along with us, join our organization

[00:38:15] or other organizations like us to provide care and want to do that.

[00:38:20] And I think that that's the living you can't, you mentioned it where it needs,

[00:38:23] it starts at the dental schools but we talk about it and educate our dental students too

[00:38:29] about the importance of playing a part in a community where we can do good and play a part in it.

[00:38:37] You know, I think that's a very big connect because Carly were working with four universities

[00:38:42] at our foundation and you said it before chain, you said we're putting together like-minded people.

[00:38:48] People understand that we do well and do good at the same time and you have to find those people early

[00:38:53] but you can create an environment for them to thrive with that mindset.

[00:38:57] It's a very specific mindset that some people really have it and if you can foster that early

[00:39:02] to your point in dental school and connect into an organization like yours that has a viable

[00:39:07] sustainable business model, I think you're going to not have any doctor shortage or high

[00:39:13] generous assistance. It's all about our people that really help us execute on our vision and our

[00:39:19] planning. It's amazing. Jane and Brian, this has been just a great conversation.

[00:39:25] I personally learned so much and I have to tell you I'm so excited to follow up with you after

[00:39:30] this because I have some ideas that maybe we can work together a little bit and help solve

[00:39:35] some of these problems because we really believe in the equality of healthcare and that people have

[00:39:41] the rights to have it and to have the access to care that we all enjoy. Absolutely, it's an absolute.

[00:39:48] What do you say Maria Filippova? I echo everything that was really planted

[00:39:55] as seeds in this conversation. I think it was a really productive way to take a lot of complex

[00:40:01] issues and figure it and put them in a much more manageable bite-sized thing that we can wrap our

[00:40:07] arms around. I would like to also think about love, Brian's idea about hey if kids have a

[00:40:14] required annual physical, they should have a required oral health exam. I also think that by the

[00:40:19] time we need to really start earlier with the parents and the pregnant mom and family planning

[00:40:25] because having a relationship with your dentist and thinking about your dentist as part of your

[00:40:30] overall care team is mission critical. That's my challenge in invitation. There is no such thing

[00:40:37] as thinking about your child's oral health to early. Pediatricians are not necessarily sending

[00:40:43] that message or BGYS fertility clinics are not sending that message but we know

[00:40:48] that the risk of preterm labor increases multiple if your period on disease is not taken care of

[00:40:54] and if you are a high-risk pregnancy. To all the moms and young families looking to start one,

[00:41:00] please talk to your dentist, talk to your pediatrician or your family doctor about your oral health

[00:41:06] needs. That would probably mean my parting thought and invitation and I'm hoping that we find

[00:41:12] our listeners will find that interesting and find ways to connect. So Brian and Jane,

[00:41:17] what would be the best way for if our listeners want to be part of your journey, part of your

[00:41:22] mission and what's the best way for them to connect with you? Yep, the bed of us doc. We are in 120

[00:41:28] communities this year we're going to treat about 750,000 children. Our goal is to get to a million

[00:41:34] children a year very quickly and then get the 2 million and as Dr. Wang said we would love to have

[00:41:41] more people not just join us but also do what we're doing and we're happy to help others who

[00:41:46] are looking to do that in their community. Thank you so much for sharing your thoughts and

[00:41:50] for inspiring us and our listeners this was quite exciting. Enjoy it and look forward to

[00:41:55] work with you. Yeah thank you for having us on. Oh it was great to have you. Thank you Jane

[00:42:00] and thank you Brian.

[00:42:08] Thanks for listening to the Think Oral Podcast. For the show notes and resources from today's

[00:42:14] podcast visit us at www.outcomesrocket.health slash think oral or start a conversation with us on

[00:42:24] social media until then keep smiling and connecting care.