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[00:00:31] Welcome to Think Oral. Where we connect the unconnected between oral and physical health. I'm your host, Dr. Jonathan Levine. And I'm your host, Maria Filipova. Let's get at it. Welcome everyone to this next episode of the Think Oral Health podcast.

[00:00:57] This is a lovely day today and a great morning because we're starting the day with Dr. Jonathan Levine, who you know very, very well and a new conversation partner for us, discovering the ways we could innovate and shape oral systemic health. And so I'm very pleased to be able to introduce our guest. And without further ado, I will pass it on to Dr. Jonathan Levine to tell us about our guest today. Yes.

[00:01:26] Well, Maria, excited for this podcast with our very good friend, Jeff Ligabel. I almost called him Dr. Jeff Ligabel. But he is a doctor in his own right as it relates to changing and improving healthcare and especially dentistry. His background is one of an investment banker with Houlihan Loki.

[00:01:51] And he's currently the president and CEO of an amazing dental service organization. The new trend in dentistry of organizing dental practices, 42 North Dental. It's a growing DSO. They've been at it for longer than many. They've seen trends that are happening in the industry and they are really leading the way

[00:02:16] in changing the delivery of care through an organized approach. Mr. Ligabel started really in the healthcare group, Houlihan Loki, really going after certain transactions, including hospitals, dental groups and physician groups. And he is perfectly positioned to help us today, Maria, give us some insights in the new trends in dentistry with the dental service organizations.

[00:02:46] What are the advantages of them? And what are some of the challenges that he might be seeing in the road ahead as we look to improve the quality of our delivery of care at dentistry? And we understand that oral health is and can lead to overall health. And connecting those dots between dentistry as medicine is what this podcast really is all about.

[00:03:17] So let me lead it off by asking Jeff. First of all, Jeff, welcome to our podcast with Maria and myself. Yeah. Thanks for having me. I chuckle hearing you call me Dr. Ligabel makes me laugh. There's only one Dr. Ligabel. My older sister is a doctor. There you go. If she happens to listen to this, I'll get a lot of ribbing about that. You know, you're not a doctor and I certainly don't pretend to be. I am very passionate about healthcare and improving people's lives,

[00:03:46] but I will never claim to be a doctor and you will never sit in my chair. True to our expectations, we're already starting stirring trouble, Dr. Ligabel. They don't call me a... In a legal family, there is... They don't call me a troublemaker for nothing. That's for sure. So Jeff, let's start it off. The dental industry today, dental service organizations used to be called dental practice management companies.

[00:04:14] You're leading one of the top DSOs in the country. You've been in the industry for the DSOs over a decade. You've seen the changes, the consolidation. Where are we today in the DSO world and where do you think we're going? Great question. And I have been leading this company for coming up on nine years. So that's my true being sort of headfirst into DSO space.

[00:04:43] But for 15 years prior to that, you mentioned my stint at Houlihan Loki. I actually started the dental group at Houlihan Loki. So I've been working with DSOs for close to 25 years and have seen the evolution of the space back to your comment about dental practice management, the early organizations, and just being serving as an advisor. I still think we're early. If you look at it, it's still a very...

[00:05:12] While consolidation has been ramping up in the last couple of years, it's still very fragmented. And I don't see that changing. I think there will continue to be a trend towards consolidation driven by a couple things. Number one, I think there's a lot of interest in investing in dentistry because people view it as a very good place to invest. It's a very stable industry.

[00:05:38] There's a lot of growth opportunities in dentistry just because a lot of patients don't receive care and need care. And so that's if you think about an investment, whether you're an individual dentist or a group of investors, it's good to know that you have runway to grow in the future. The second thing, I think the industry has just gotten more complex. COVID alone changed a lot.

[00:06:02] If you think about the OSHA requirements changing rapidly and CDC guidelines, it's very difficult to stay on top of just how rapidly things change. The need for better electronic medical records, obviously in medicine and going forward in dentistry, the payer dynamics are more complex. Staffing, there's a shortage of dental workforce across really all categories. And so it's just harder to find good people.

[00:06:32] So you really have to invest in training and development programs. There's just a lot of reasons why being part of a group can be a benefit. It's not the only way to practice, obviously. But I think a lot of people are seeing some of those benefits. And I think that's the other thing driving consolidation towards the group model. But Jeff, what has changed today? The DSO's have been around for north of 20 years. Why today is the money coming in? Why is private equity so exciting?

[00:07:00] Why are the Blackstones of the world in? Why are these large private equity firms all over dentistry? Valuations are going up. There clearly is a trend where it's pretty steep as far as the growth and the impact of DSO's in the overall industry. What has changed more recently? Is it post-COVID? Is it they're realizing how stable it is? What's your insights there since you've been living on both sides of that coin? I really think there are some groups.

[00:07:28] I'd like to believe 42 North Dental is one of them. But there are some groups who I think have really demonstrated a model that is a really good model that is really promotes growth in dentists and their teams and is really a good place to practice dentistry is really demonstrated an ability to drive a higher standard of clinical care and also a better and more consistent patient experience.

[00:07:58] And I think with some of those winning models, you mentioned some private equity behemoths that are very well known. They don't invest in flash-in-the-pan type companies. They invest in companies that have really proven that their model works and that they're able to drive growth. But the only way to drive growth is by really establishing a patient base and providing great care to that patient base. It's really the only way to do it.

[00:08:28] And so I think there are a number of companies that have really demonstrated a successful model and that has attracted money coming in. Now, I will say there's a lot of money coming into dentistry and there's a lot of companies popping up every day. And one of the things that I'm always talking about, I'll be at a conference next week talking about is it's just making sure that people know it isn't just trying to gobble up grand

[00:08:54] practices and grow revenue because you have more practices, which means more revenue. If you really don't figure out why somebody is better off being part of your organization, and it's the things I mentioned, it's really providing benchmarks, clinical training, mentorship, support, all of those kinds of things, then all you're doing is trying to grab revenue. And that's not a successful long-term business model.

[00:09:21] And I think for anybody coming in and really trying to build a bigger business, a successful business, you really have to figure out what are you going to be great at? And why are people going to be better off being part of your organization versus another organization or being on their own? Yeah. So let's go right there because I love what you just said. So if we're looking at an industry that's changing, if we look at the opportunity to improve the

[00:09:48] delivery of care, because now we're 20 years out really on this kind of DSO industry. And if you look at the successful ones, the predictably successful ones like 42 North, the focus, and let's just go with 42 North, the focus on the quality control, on the ability to raise up and to enhance the lives of your clinicians, of your team. Can you go there?

[00:10:18] The differentiation for the different DSOs and where you see this potential, where you can really have optimism of the future of dentistry by DSOs doing the right thing for everyone, both patient and team and providers. Yep, absolutely. And I would say for us, I know the other players and I could try to articulate their value proposition.

[00:10:45] I could do a decent job at it, but I'll leave that to them. But there are some really great companies out there. For us, it all starts and frankly ends with that culture of delivering excellent clinical quality and a great patient experience. And the investments that we make and the strategic initiatives that we prioritize across the organization are always centered around those two things. That's our mission that we talk about regularly.

[00:11:14] And so anything we do, any investment we make, whether it's time or money, should be driving either or both of those things further. And so when you talk about Dr. Shalava, who's our chief clinical officer, my key, our key clinical partner and leader at 42 North, his focus is really on driving a culture of quality, a culture

[00:11:39] of safety and a culture of efficiency and really thinking about things that will help us in those areas. So I could go through a whole bunch of examples. I'm happy to talk about them in as much detail as you want. But a very simple one is let's talk about safety and let's talk about quality together. And we believe that compliance is critical. And so we are investing in compliance and really automating compliance and making sure that

[00:12:07] we're able to really efficiently help the practices ensure that they are compliant with all sorts of regulation. I talked about OSHA earlier. We talked about the different waterline testing and all the things that go into making sure that your practice is compliant. It's hard to keep up with that on your own and know, am I really doing all the right things? So we're automating it and making it easy so that people know exactly what needs to be done.

[00:12:36] And we have a team of people, a compliance team that really helps both explain things and help people if they're struggling in an area to make sure. And it's just one of the areas that we believe is the foundation. If you're not excelling in that area, it's hard to talk about being a good business or how you're going to be successful next year if you're not covering those basics. I'm glad that you went down the compliance path because people don't appreciate how important it is.

[00:13:03] And actually, there's a lot of room for innovation in that area. You could call it back office processing administrative side of care. That's true, actually, both on the medical and the dental side. And so I spent one of my time thinking and advising companies on where should we apply our innovative mindset and startups trying to solve problems in dental.

[00:13:28] And most people gravitate towards the shiny kind of splashy things where there's so much opportunity, especially when you know that more than half of every dollar that's spent on medical costs goes to administrative stuff, right? The claims processing, the administration, the compliance side. Only a fraction of what we spend actually goes to the medical, the actual care.

[00:13:53] And so, Jeff, maybe, and that goes to both you, Jonathan, because you're applying that, you're running a business at the end of the day. That business needs to be profitable, to be sustainable in the future. And that business needs to be compliant. And your value prop obviously has to do with patient quality outcomes and safety and patient experience. But the compliance piece and the profitability piece is also equally important there. So maybe from that pragmatic lens of running a business and delivering a high quality care

[00:14:23] that Dr. Shalaba is committed to, where do you see the biggest opportunities that you would, if you were a well-funded, hungry startup right now, looking to solve a problem, make an impact? Where would you guide them to go? Yeah, that's a great question. And we did recently make an investment into a software technology that really automates. I probably shouldn't name them, but I'm happy to talk offline about our experience there. I'll call those the table stage.

[00:14:52] And if you go around to the providers that are part of 42 North Dental, whether it's a general dentist, a specialist, or a hygienist, or any of the team that works in the practices, if you say to them, what are you most excited about that has happened recently or that's coming? I would venture to guess that very few of them would say, oh, we invested in this great automated compliance tracking software to make sure that to really streamline our compliance protocols and

[00:15:20] make sure that we are in front of things. But I'll put it in the category of things that people take for granted. And I mentioned that because it is very time consuming. It takes a lot of time and energy. And I can't ensure that every one of our practices is compliant with every regulation, nor can Dr. Shalaba. But if we provide tools to make it easier, it's something the practices are very well equipped.

[00:15:47] They understand what they're supposed to do. The question is always, do they have the time to do it? Do they sometimes forget or they get a little behind because something else is pressing and something has to give? So really putting in place and we've invested in this technology to provide to the offices a scorecard real time and alerts on, hey, you need to do this in the next week or you're coming up on this in the

[00:16:15] next 30 days just to make it easy for people to make sure that we don't miss anything. And again, we think that that's critical and really the table stakes. And I do believe that somewhere down the line, and this maybe gets a little ahead of where we're going. But if you think about medicine and the investments that medicine has had to make in technology and software and electronic medical records, and you start to get the quality initiatives and all the

[00:16:43] things that have happened in medicine, they're going to happen in dentistry. Whether we all like it or not, it may not happen in the next three months, six months, 12 months. But eventually, I believe that payers will be either paying or not paying based on meeting certain thresholds. They might be paying extra if people meet certain thresholds, if you want to go down a carrot path versus a stick path. But I think that's coming. And I also think it's coming

[00:17:12] where patients can understand what the compliance track record is of their practice and determine if they want to go to that practice or if they want to choose a different practice. Right now, patients don't have access to that information. They really can only look at a Google review and those are helpful. We believe in Google reviews and we don't always love them, but we work really hard to make sure that our patients have a great experience and that presents itself on Google and other forms

[00:17:39] of social media. But I think in the future, people will be able to look and see, is this practice up to date with all of its compliance metrics? Is this practice, do they have a high remake rate or a low remake rate? Like none of that exists today, but I think it will in our lifetimes. And we're trying to be, or we are, we believe really getting in front of that and trying to create a culture at 42 North where we are looking at those things and we are tracking those things and we are promoting those things within

[00:18:09] 42 North so that we can be leading in those areas. Yeah. Patients as empowered consumers, that would be truly the step function change that we would need to see some of the changes in behaviors and maybe even incentive structures. On that front, how are you and would love to see the other side of it, right? We all talk about empowered patients as consumers. What's the,

[00:18:32] that is not the current state, right? Change is difficult. And so do you, maybe just for those listeners who are outsiders of the dental industry or even the medical space, is that always a good thing, right? Let's just give the argument for somebody because there's a lot of folks who don't believe that patient having an education, or maybe we, there's folks who are not so comfortable having rankings and there's all kinds of limitations to how do you measure the rankings and what's

[00:19:02] specifically, how do you evaluate Dr. Levine versus another doctor? Just give us the, and maybe Jonathan, I'll ask you to be the contrarian here. Is there a downside of being transparent in terms of evaluating doctors, oral health physicians, maybe I should call them? Is that always a good thing? And what are some of the pitfalls that we might end up in that kind of scenario? That's what you're saying. It's always a good thing.

[00:19:28] Yeah. And any of these things are, can be fraught with good things, bad things that are cumbersome, make it even more difficult to run a successful practice. And even right now there's a fairly high profile hospitals are pushing back on rankings and are they good? And are we going to take ourselves out of the rankings because we don't believe that they're good rankings? That's always a fear and a

[00:19:56] reality at some level. I think that if the metrics are objective, I think that on the whole, they are positive. Now, I'll talk about AI as a perfect example because we are working with AI and we've also talked to payers about how they're working with AI. And so we're comparing notes there and seeing how that possibly

[00:20:18] could result in better care ultimately for patients. And so I believe that with the technology that's available today and coming into dentistry, I do think that there are objective measures that people could be held accountable to and it would provide more transparency for patients about the practice and why they choose a practice or don't. Now, obviously, a lot of people may not love that

[00:20:48] concept because there's always you're going to have winners and losers, right? Anytime you have rankings, there's people at the top of the rankings, there's people at the bottom of the rankings. So if you're a provider that really has conviction that you would show up on the top of the rankings, you'd probably love the concept of having these tools available for the public. If you're towards the bottom, you'd rather not, right? But as a consumer, as a patient, I would love to know some things about being able to

[00:21:15] benchmark different providers. And you have that in other areas of medicine. And I guess my ultimate point is I believe that whether we all like that or don't like that, I think there will be a day when that information is more accessible for patients. And so we are taking the position. We're not shying away from it. We're going to lead in that area. And we're doing that now within our own practices. We don't

[00:21:43] put it on the internet and patients can't look at remake rates among different practices that are supported by 42 North. But Dr. Shalaba and our clinical management team know what they are. And they can leverage that to say, hey, there's something going on here. We need to go in and figure out how we can help this particular practice or this particular provider because they have that ability to benchmark. And so maybe

[00:22:08] there's some continuing education needed or something that can be provided to boost them. And I guess ultimately, we're believers that if you measure something, it's a great starting point to say we're going to improve that. And improving the important metrics is good for patients. And that's really what it's all about. It goes back to John Doerr's measure what matters, right? That's been the model. Yes, exactly. Go ahead, John Doerr.

[00:22:35] Well, you get what you measure. But just to weigh in on that, I couldn't agree with Jeff more about as we look at technology and as we look at something like AI, of course, I might be a little biased in this, but only because ChatGPT4 ranked the top five dental practices. And I'm not going to tell you who might have been on that short list. But what ChatGPT can do,

[00:23:00] right, is synthesize everything on the internet. And if on the internet, you had all of these things about a healthcare practice, a dental practice, it's very possible that if you actually created AI focused on this, you really could understand what the top practices might be for you as technology really improves. So that will probably help us distinguish the differentiation within the industry

[00:23:29] And I love also, Jeff, where you were going with leadership and culture, because as you think about what you're doing at 42 North, you have as a company comment for us a little bit on that focus of enhancing and improving these dental practices, that focus of organic growth and not a company just trying to put revenue together and getting that arbitrage of that, but really having real value added

[00:23:58] for these dental practices and your experience with that. Yeah. So I think the first thing I would say for us is we are a multi-specialty group practice organization. And so we have a large team of committed specialists that are part of our organization full-time and work upon the practices. In some cases, we have some standalone specialty practices,

[00:24:26] but we also have specialists that are working within the four walls of a multi-specialty practice that's also providing general dentistry and hygiene and everything that goes along with that. That is one way to immediately grow a practice, not immediately, but near term grow a practice and really provide that

[00:24:49] convenience and access for patients of a practice by leveraging our specialty network and having specialists that can come in and take care of patients right there in the practice. And that kind of side-by-side general dentist specialist working side-by-side, we find to be a really powerful model to have that level of collaboration and care. And that's one thing. We also,

[00:25:15] the practices that we support are all multi-doc practices in addition to having specialties. And so out of multiple doctors, multiple hygienists, and we really believe with putting some marketing, whether it's digital or just being available and accessible for patients, that we're able to develop and build a large patient base by having multiple providers. And those are the things that we look for.

[00:25:44] I can't tell you how many practices we've talked to about an affiliation. And let's say a practice has a full-time doctor that owns a practice and then a part-time dentist working in their practice. And we sit down and talk about, okay, we're a company that is going to want to figure out how to grow the practice. So what are the ways that we could do that? And a lot of times in that conversation, someone will say, well, we'll talk about, hey, let's talk about your part-time dentist.

[00:26:09] Is there an opportunity to have a full-time doctor working alongside you who has more capacity for patients? And someone will say like, well, maybe, but... And then when you really get into it, you find out that the practice is booked out, hygiene's booked out six months, and it's really hard. You can always get in that emergency because a lot of practices are really good at doing that. But if someone has to cancel their appointment today, there's nothing available for three months.

[00:26:35] And we think that's an opportunity where you need another provider in that practice. And let's not just put them in and let them be bored all day. Let's put them in and figure out... I've had other practices, similar concept where they've got five full-time hygienists and one and a half doctors. And you look at it and you're like, there's five patients in a hygiene chair all day long. And how are you even doing exams on those patients, let alone doing other forms of dentistry? If I know, well,

[00:27:04] our exams, we try to keep up here and there, but if the hygienist sees something, we'll do an exam. We don't believe that is the standard of care, right? One of my things I said, I've been to the dentist twice a year my entire life, and I don't think I've ever gone to a dental appointment and not had a dentist pop in and take a look in my mouth. I believe that's the standard of care. And so we look at that and say, well, okay, if you have five full-time hygienists,

[00:27:32] one doctor can do all the dentistry and do the exams. And so you have a capacity issue. You need to bring in another provider. And so growing the practice, growing the provider base, having effective patient communication tools, both to potential new patients, making sure you're accessible. But also there's so many, every practice that we support, every practice we look at, there's so many patients that have been in 12 months ago, 24 months ago, 36 months ago, and

[00:28:01] haven't been back for one reason or another. And there really needs to be a really easy outreach to attract those patients back in. And some of them moved and obviously they live in a different state. They're never going to come back, but some of them have just gotten busy and they need a reminder. And it all comes back to that capacity and having a good patient outreach program. Yeah. I want to pick up on two things that both of you brought up. One, Jeff, the shortage of

[00:28:27] providers and the provider hygienist ratio is really critical. And that is the state that we find ourselves in and we have been. And it's very easy to start looking at business optimization metrics and be like, wow, if I can only have one more hygienist and stretch the time of the provider I have. And that quickly gets into some of the other metrics because that something needs to give, right? Either a patient will not have a positive experience or something will get missed. So

[00:28:54] that balanced scorecard, if you will, of evaluating care is really important. But where Jonathan started us with this whole example of chat GPT, I also ask myself a question very often. How can we use technology to augment our provider teams as a team? So technology becomes an augmentation tool and everybody gets to work at the top of their skill set and top of their license.

[00:29:23] We know that chat GPT has passed the MBA final exam from Wharton and the medical boards and some parts of the bar exam. I don't know if anybody has tried chat GPT to get a dental degree, but with all joking aside, I think there's some, given all its limitations, right? It's a large learning model. It's been trained on a lot of data, sometimes gives us incorrect data, inconsistent data, facts,

[00:29:50] non-facts represented at facts, all kinds of limitations. That said, these large learning models like chat GPT could be helpful for some of those repetitive, administrative, menial tasks. Like with all due respect to all the payers out there, writing a prior authorization form, right? If there's something that the provider could tee up and say, give me a, write up a prior

[00:30:16] authorization form for a patient with these types of characteristics, covering those types of reasons, and then the provider gets to review it before it gets sent. I think that might be a good example where technology like chat GPT augments our, it lightens up the administrative burden, right? There's probably things around basic education things like write a blurb on why is

[00:30:40] periodontal disease important for cardiac health for a seventh grade level, right? We don't want our providers to be doing that, but if somebody could write this for them, they could review it at a seventh grader level and then that could be used. I'm throwing out opportunities there for both to get your reaction, Jeff and Jonathan, but also for our listeners out there who are looking at all these news headlines of chat GPT and Microsoft and AI to really think about those kind of safe spaces, areas

[00:31:10] where for me, AI cannot, should not be touching patients directly just yet. And as long as it's confined in a very discrete task that's administrative, that's well studied, and then has the oversight, what I call clinician in the loop, then I see some opportunities that can be very interesting. Any thoughts, reactions to that? Yeah. Absolutely. And let me, I'm going to come back to AI in a minute because we are actually working with

[00:31:37] AI currently, but the first thing kind of chat GPT, we're not, we have not used chat GPT. Actually, maybe we have, we have about 1700 employees across 42 North Carolina. I have no idea if any of them have gotten creative and used chat GPT for something that I'm not aware of. I'm sure somebody asked. Well, I've had my team put together presentations for me at using chat GPT. And I got it.

[00:32:03] I have some friends who've talked about things they've used it for, including one told me they used it to change his, his LinkedIn profile and bio and all kinds of things. So I think the things we've talked about, and it seems sort of potentially obvious to me, I mentioned, we have a clinical management team that Dr. Shalaba leads, the team of practicing dentists, and they get together and talk about new clinical technologies and standards. And, but they also do,

[00:32:29] they put out a lot of information, the organization using our intranet, and they have a clinical corner, if you will, where they're publishing articles about anything that they read about that they think would be helpful for our clinicians. That's an obvious one, right? If we wanted to do something this month on periodontal disease or implants or whatever, I'm certain you could use chat GPT in

[00:32:53] a powerful way and say, I'd like to do a blog or an article on this topic, covering these three or four things and make it at this education level, whether it's a basic or an advanced, I've heard some really cool uses of chat GPT for stuff like that. Same thing on marketing, right? We are constantly thinking about how to effectively market the dental practices that we support. And some of that's local showing up to the town fair like that. I don't know that chat GPT is real helpful with that

[00:33:22] because you have to be present and, you know, hand out toothbrushes and have a smile on your face, but other things like what should your website say to drive good SEO results? I'm sure chat GPT could be helpful with that. Content is really important. Putting out content. So same thing when you're talking about marketing your practice and different audience, right? You're trying to attract patients as opposed to educate your clinicians. But if I want to put a blog out to my patients so that I'm visible

[00:33:51] and I want to educate them on periodontal disease or the benefits of fluoride or whatever, I'm sure you could just pop that into chat GPT and save yourself a lot of time. So I do think there are a lot of applications that you could use it for. I personally haven't, but I may be behind the times in that area because I have heard some people really leveraging it. On the AI side more broadly, we do see real power

[00:34:16] and value in AI dentistry right now. And we're using AI to basically provide right real time in our practices. When you take a radiograph, we have AI overlaid and we're actually going through a practice management software change that's going to make this really slick because it's going to be right in the base software that our practices are using. But think of it as a lot of times the x-rays

[00:34:46] are taken by a hygienist and that hygiene visit and a doctor's popping in to do an exam. In this scenario, doctor can come into x-rays being up on the screen with things already highlighted for them to make sure that they take a look at. Not because they were necessarily going to miss it, but it's right there for them to come in and say, hey, here's the four or five things that AI has highlighted and I want to make sure that I

[00:35:15] take a look at these. And when I present a treatment plan or discuss what's happening with the patient, I have this kind of already at my disposal. And it's not because somebody's right or somebody's wrong. It's almost like a real time second opinion. And at least the practices we've been using it in, the providers feel like it helps them really efficiently and effectively look at an x-ray. And a lot of the patients have been really

[00:35:42] interested to say, hey, well, tell me more about this. And for the most part, they've been really supportive and it just really helped to highlight and articulate for them what the dentist is telling them. It's ultimately the dentist patient, the dentist diagnosis, the dentist treatment plan, but it sure doesn't hurt to have some technology really highlighting things and making sure that sometimes things get missed, right? You're in a hurry. You just don't see something quite the same way.

[00:36:11] And the AI is not telling you what to do or telling the patient what to do, but it's a pretty powerful tool. Yeah. Yeah. It's a general comment about technology. When technology hits and people are asked to change or to learn new things, fear takes over. So when AI first hit, just let's think about it. I was on a panel. I was honored to be on this World Innovation Conference. And the question was asked, is AI going to

[00:36:37] take over being a dentist? What's that going to be about? But really, when you listen to the experts in AI that's driving all of this change, it's really the notion that AI is going to be a copilot for us in everything we do. And I really look at it as AI, not artificial intelligence personally, but really amplified intelligence. It allows us to do things so, so much better. The notion of having up on the

[00:37:05] screen and I've been working with AI in my practice for about five years with a company called Denti AI, and now you've got a company called Pearl and Overjet. And there's a number of new people in this realm. At first, when it came out, Jeff, the conversation was, oh my God, big brother's looking over me and they're going to question my diagnosis. But the truth of the matter is that you now have validation. And the truth of the matter is these companies are coming out with patient-facing

[00:37:30] graphics to make it easy to understand why there is a 70% chance that that small little lesion is important either to hold or to figure out how do we stop it or how do we take care of it and get it out. So AI becomes this way of us doing what we do, and that's all of healthcare and really all industries. How do we do it better? Which then gets to the point, Maria, and weigh in here,

[00:38:00] and I think it's important for the listeners, is the advantage of an organized approach to dentistry because it is so complicated. The delivery of care, dentistry, medicine is complicated. And you do need people with individual skill sets and capabilities bringing their superpowers to the table to improve business models, to improve, in this case, delivery of care to our patients and

[00:38:25] to the people also doing that. And that's why it's so exciting to see the growth of organized dentistry, and I'll call it that, and this phrase of dental service organizations, and I'm sure it'll have a couple of new names in the next 10, 15 years, but the advantage of having a clinical team, having this organized collaboration, having QA, QC, and compliance focus is just very difficult for

[00:38:54] the individual practice and clinician to keep up with all of these changes, all these innovations, and all the things that they have to know and do. I want to make sure that I'm highlighting, hopefully our listeners are picking up on all the different threads when it comes to, I think we've been all answering the question, what is a good use case for AI in dental? And from my perspective, and just playing back our conversation so far,

[00:39:21] number one, you have to start with a space, a use case where there's enough data so that these algorithms could be trained. At the end of the day, irrespective of what kind of AI use case you're looking at, you have to be able to train that model. And Jeff, in your example, the radiographs, that algorithm that you're using for illustration to illustrate and mark up the radiographs before the

[00:39:48] dentist look at them, that model has been trained on volumes of images before that. And so you have some level of confidence that the training data was accurate versus scrape from Facebook, scrape from somewhere else, right? So number one, do we have a good training data set that we could train those algorithms on, right? And there's all kinds of methodologies to that. Number two is the use case

[00:40:13] allowing for a clinician in the loop. I can't stress this enough. You can't just get like a radiograph that was read by an AI and present it in the app to the patient and say, here's what your diagnosis looks like, right? All of these AI decision support tools need to have validation in the second set of eyes from a clinician trained clinician. And the third one is what I call the New York Times front page peer factor,

[00:40:40] right? I still remember in my days at a large health plan provider, we were looking at using data from electronic medical record to identify patients who are at risk of depression, suicide thoughts. And we were very excited that we were getting up with some high predictive power algorithms. However, the company was using data from Facebook, from Twitter, that person's profile. If left and checked,

[00:41:09] these algorithms are always hungry for data. They'll always go out there. And frankly, the data that's in social media is not always equitable. Accurate. And frankly, sometimes these algorithms get very offensive and they've actually profiled people. And so that's that explainability factor. You have to be comfortable with that answer and going to somebody saying, because you live in a zip code area or poor area or because you have this ethnicity within your high risk of mental health issues. That's not

[00:41:38] what we want to happen, right? So that's my perspective. And those three things alone, if we only focus on those three things alone, then we could start drawing up lists of other use cases for AI. But let's keep it contained, keep clinicians in the group, and then let's not land on anything offensive. Yeah, I know. That's amazing. And let me just add a little context to this conversation, because I'm

[00:42:03] going to roll back. Dentistry don't have to go long. Go eight to ten years ago. Individual dentists making a diagnosis, drilling a tooth that might not need it to be drilled. No AI, no ability to have some oversight or a co-pilot that validate and communicate extremely well to the patient. That's where we are today. So context is decisive. And if we think about how far we're coming within

[00:42:33] healthcare with our new technologies, with our machine learning, and with all of these things that are happening in dentistry, Jeff, you and I could talk about the digital workflow for a very long time. Our better diagnosis, the hygiene room, the center of innovation of a dental practice. There's so much that's happening in all of healthcare. And it's a very exciting, very exciting future.

[00:42:58] Maria, you headed up innovation, one of your team at Anthem Health. You understand the medical side. Now, we're fortunate to have someone like you in dentistry. And dentistry is even a slower adopter than medicine. But right now, it's catching up and we're starting to really get there in the profession because of these new innovative business models like the DSL. So we've come a long way is my

[00:43:23] message. I hate to sound like a commercial, but I really do believe we have. It's a really exciting time in dentistry. You think about the opportunity to leverage technology to drive better clinical outcomes. It also is more efficient. You think about, as you say, the digital workflows all the way through and then all the way through to the payment, right? And making sure that you get the proper insurance

[00:43:49] coverage and you pay the bill appropriately. Like that whole thing can be seamless and just much enhanced. And then you layer on some of the clinical advancements, CBCT and laying AI on top and providing that validation. As you said, it's a really exciting time. And I think that there's a lot of

[00:44:12] exciting advancements in dentistry that will only help promote what we all stand for, frankly, which is better oral health and the importance. That's the other piece we haven't really talked about, but the increasing awareness of the importance of oral health and it's not just a pretty smile or white teeth. It's really critical to your overall health and the exposure around that is exciting. And you're

[00:44:37] hearing more and more about it in the mainstream media, not just from dentists who are talking about how important it is. Yeah. Well, on that note, which here you go, President, CEO of 42 North, one of the leading DSOs is talking about the connectivity of oral health and the impact on overall health, which is what my partner in crime, Maria Philippover and I, the reason we started this podcast.

[00:45:02] I would say, Jeff, thank you so much for joining us. It's been an engaging conversation. Exciting to hear about what your thesis is behind 42 North, the growth and development of your company. There's so much more to come. I know with you in that leadership position, Maria, amazing. My partner in crime to have you on this journey with me, feeling very blessed to have someone like Maria Philippova,

[00:45:27] helping us unpack these conversations, especially with somebody like Jeff Ligabel. Jeff, thank you so much for joining us. Thank you both. Really enjoyed the conversation. Thanks for listening to the Think Oral podcast. For the show notes and resources from today's podcast,

[00:45:49] visit us at www.outcomesrocket.health.com or start a conversation with us on social media. Until then, keep smiling and connecting care. This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency.

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