The Group Dentistry Now Show: The Voice of the DSO Industry

Steve Thorne, Founder & CEO of PDS Health, and Dr. Tom Schwieterman, Chief Medical Officer & VP of Clinical Affairs of Midmark Corporation, discuss the integration of dental and medical services. Highlights include:

Pacific Dental Services’ rebrand to PDS Health
Dr. Schwieterman’s perspective as an MD
Understanding clinical support in med-dent
New diagnostics
How medical-dental integration works

For more information on PDS Health visit https://pdshealth.com

To learn more about Midmark Corporation visit https://www.midmark.com/

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Full Group Dentistry Now Podcast Transcript:

Bill Neumann: Welcome, everyone, to the Group Dentistry Now show. I’m Bill Neumann. And as always, we appreciate you listening in. Maybe you’re on Apple Spotify or Google, or maybe you’re watching us on YouTube. We appreciate your support because we couldn’t get great guests like the next two guests we have on the show today.

Just a little bit of background here. We’re gonna be talking about medical-dental integration. And one of these guests has been on our show. This will now be his third time on our show. And you probably know him unless you’ve been living under a rock in the DSO space. His name’s Steve Thorne. He is the founder and CEO of what was formerly known as Pacific Dental Services, now PDS Health.

So we’re going to dive into that name change, which just happened, I think it was about a week ago or so. Yeah, last week. Yeah, thanks for being here, Steve. Good to see you. Good to see you. And of course, since we’re talking about medical dental integration, we have a medical doctor on as well. And he’s also part of an organization, a company called Midmark.

So we have Dr. Tom Sweeterman. Tom is the chief medical officer and vice president of clinical affairs at Midmark. And Midmark works in both the dental space and the medical space. And Tom’s really going to give us that medical doctor side of things that we don’t always hear when we talk about medical dental integration. So I think this is going to be a really interesting podcast today. Tom, thanks for being here.

Dr. Tom Schwieterman: Thank you. So topic of passion for me. So this will be exciting.

Bill Neumann: So like I mentioned, I think most people know who Steve is, but Steve, for the two people that are listening that don’t know who you are, maybe a little bit about your background and a little bit about PDS Health.

Steve Thorne: Hi, everybody. Thanks for the warm welcome. I am Steve Thorne. I am the founder of what was formerly known as Pacific Dental Services. We just announced our new rebranding to PDSL. Last week, we moved our corporate global headquarters here to sunny Las Vegas, Nevada, actually in Henderson, a suburb of Las Vegas. I say Las Vegas because everybody knows where that is. And right, we’ve reorganized our company around dental medical integration about the fact that oral health has such a major impact on our overall health.

And we’ve been working on this for years. Most of you that follow me know that this probably isn’t a shock to you. because we’ve been working on it for years. And we are super excited about where we’re at. We are super excited about the future. When I think about oral health care, and I also now start thinking more and more about primary care physicians, too, out there, and nurse practitioners, we’re really coming into the golden age for all these practitioners. And it’s such an exciting time to be in this space. And looking forward to this conversation.

Bill Neumann: Thanks, Steve. Tom, a little bit about your background and what you do at Midmark, and maybe for the folks who don’t know, a little bit about Midmark.

Dr. Tom Schwieterman: Yeah, I appreciate you having us on the show here. It’s fantastic. Yeah, my name is Dr. Tom Sweeter. I’m the chief medical officer and vice president of clinical affairs at Midmark. As Steve alluded to, we’re in both the medical market and the dental market. We’ve been in the medical market slightly longer than the dental market, but we see a lot of interesting parallels. And to Steve’s point, the amount of interest and scientific validity between the oral health and systemic health has been building for nearly a decade now.

I had the pleasure of being in the audience during Steve’s grand announcement. And I think I told Steve I was smiling from ear to ear because as a primary care physician myself, it’s high time that we bring these two disciplines together into a form of holistic care. And so with Midmark’s understanding of both medical and dental on the ecosystem level, we’re really excited about how we might be able to contribute to this visionary lead that Steve is taking.

Bill Neumann: Thanks, Dr. Tom. And for everybody in the audience, you have sat probably on a piece of Midmark equipment. They make just about every exam table out there. So if you’ve gone to your, hopefully everybody’s gone to a primary care physician. You’ve definitely experienced Midmark before. And in quite a few operatory designs, cabinetry and in the dental space as well. And thank you to Midmark for sponsoring this podcast. really relevant topic, and the timing is great. Steve, you’ve been talking about medical-dental integration for a while. This isn’t a new thing to Pacific for sure, or new to you.

You’ve done the name change. You’ve done quite a bit. You’ve had that partnership with Memorial Care. You talked about Henderson. I know you have a practice there, at least one practice that I’ve been to that is medically dental integrated. So we have, I think if I remember, you’ll walk in and on the right side is pediatric and dental care, and then to the left side is primary care. So this isn’t new, but why the name change and tell us what’s going on now and why you’re so excited about this.

Steve Thorne: So thanks, a little history. So I’ve been studying this area for about 11 years, 12 years now, and just watching the number of studies released, and especially the science that has come out of all sorts of universities all around the world. This just isn’t US-based. all around the world about the connection between oral health and overall health. And the connection has gotten tighter and tighter and tighter.

And the things that are happening in our mouth, it doesn’t take a rocket scientist to figure out that What goes in here affects the rest of our body. It goes into our mouth, goes into our throat, it goes into our gut. And if you were watching your reels in the last couple of weeks, it goes out the other end too. They just connected oral bacteria to colorectal cancer and that it’s in 50% of colorectal cancer deaths.

So the timing is so right to bring oral healthcare providers back into the core primary care health care team. I think you’ll hear some more about that from Tom. We are moving that needle, we’ve been moving that needle, so we have about 20 integrated practices now in Arizona and Nevada. We intend to have thousands as we continue to scale. The way I think about it, Bill, is Almost all Americans, and in most industrialized countries too, they access their care through four main providers.

Dentists, through physicians, right, MD or DO, nurse practitioners, or a pediatric dentist. And I call them the gatekeepers. And from there, 80, 90% of people, that’s where they first see their care provider. And then we go out from there to experts in different areas. And so dentists are set up so perfectly to be part of that primary care team, so uniquely set up to be part of that care team. And there’s a lot of obstacles, which we’ll talk about, but we’re busting through them. I don’t have all the answers yet for sure.

But we have a lot of answers because we’ve been at it a long time. But it’s just, it’s an exciting time and it just makes sense. It’s where, you know, I use this term OODA, Observe, Orient, Decide, Act. And it’s actually a military term of how we’re, as leaders, where we are supposed to be looking out ahead. We’re supposed to be connecting disparity events. We’re supposed to be connecting the dots of what’s happening in our field or area of interest in order to stay ahead and stay relevant.

And I think that’s the key. I really believe that this move to dental medical integration, it’s going to take time, but I believe it is the It is going to happen and it’s going to happen for the vast majority of dentists who want to stay relevant and the vast majority of physician groups that need oral health care providers as part of their offering as they continue to move towards value-based care, incentive-based care, whatever we want to call it. So the timing is great to make this move and we’re doing it.

Dr. Tom Schwieterman: Bill, if I could add a little bit to where Steve was going. I’ve noticed since the COVID pandemic where virtually every immunological physician or infectious disease doc was focusing on the basis of disease for this new pathogen. And what we discovered in that round of research is that there’s an inflammatory basis for disease that is fairly fundamental to all disorders, or most of the major ones at least.

Diabetes, cardiovascular disease, kidney disease, CVAs, even cognitive disorders like Alzheimer’s. So I think the groundswell around the need for the oral cavity to be part of the conversation in every single chronic disease management paradigm is because the oral cavity is so incredibly vascular and creates an enormous amount of inflammation all by itself. So what we’re discovering on the medical side is you cannot effectively treat the systemic disorders without the oral health care being minded as attentively as everything else. And it’s a bi-directional model.

So the oral health care paradigm and inflammatory condition leads to disease, and the disease makes the oral cavity inflammatory situation, whether it’s periodontal disease, even worse. So that’s basis number one. And then on top of that, in the medical side, we’re seeing a huge push, again, where Steve was going around value-based care. We have to reduce costs, improve outcomes.

So the health care providers are beginning to realize that their goals and their key performance measures include the necessity of sending that patient to an oral health care provider or the oral health care provider being a member of the primary care physician team, which I think is where Steve’s also going. So all of these forces are aligning. It’s not simply a, hey, it’s time and we got the opportunity to do this. I think there’s a mandate clinically, there’s a mandate financially, and I think the industry is ready to go. There are many, many barriers, but one by one, those are getting checked off.

Bill Neumann: And I think we want to certainly talk, we’ll talk about some of those barriers as we get further into the podcast later. But let’s talk a little bit about how you see, start with you, Steve. How do we see this evolving? So you started off really, I know it evolved with PDS, at least, from you actually, you being PDS, having those co-located, right, primary care physicians, and dentists in one location, and then you had that partnership with Memorial Care.

How do you see, you know, PDS evolving? And then how do you see the industry as a whole? Because you’re really one of the first movers here. There are a couple of other providers out there, dental providers that are doing this different ways, but they’re still out there. But right now, you’re definitely in the minority for sure. So, you’ve got a real good, you’ve got some insight as to how you kind of see this taking place, what it may look like.

Steve Thorne: Yeah, there’s definitely been some others to your point that have started in this area before us and we’ve been helping each other out working together for sure. But to your point, we’re the first to go make a statement to do this on scale. The scale I’m talking is thousands with serving tens of millions of people. So there’s three things that I think are the most important here. The first one is the mindset of the clinician. And it doesn’t matter which clinician. It can be a cardiologist. It can be a general practitioner. It could be the dentist. It can be the hygienist. It can be the oral surgeon. You know, Dr. Schwederman is awesome at this. He gets it. So it’s a mindset that I am there to care for this person in the best way I possibly can and oral health really matters. That’s the first thing is that mindset and clinicians are mostly, you know, they’re scientists. That’s what they do. They’ve studied science through their whole careers in college and schooling, the four years of schooling, and then if they’re specialists beyond that. So they want it based on science. The science is there, that horse has left the barn, and now they have to have the mind shift of how they do that. The second step is then is how they use it and integrate it. And that’s where a company like MedMart comes in, where we can integrate the systems. Now we’ve integrated with Epic, whether it’s on the dental side or the physician side. So the integration of that health record is critical. We’ve tried it without it. They have to see the same data. And it’s not just about interoperability. It is much more than that. It’s about chart reconciliation. We can get into that if you want and what that means. And then lastly, which we’re working on, which we are not there yet, is the reimbursement system. Once the reimbursement system takes hold and physicians are reimbursed properly and especially dentists are reimbursed for areas that they weren’t, I think that’s when it’s really going to take hold. We work in two systems. Dentists are the only health care providers that have their own coding system. That has to change. We’ve got to cross that chasm soon. We’re working hard on it and growing this area. There’s just massive demand. So we know how to do this. We know how to scale. And it’s not for lack of demand. We’re still working through the economic model, Bill, to make sure this all works.

Dr. Tom Schwieterman: And Bill, if I could jump in on that last nice, beautiful segue on the economic model. Where we’re seeing a real heightened interest in this is around those who are vertically integrated between the payer systems and the provider systems. And for instance, federally qualified health centers, community health centers, academia, They’re very much aware that this clinical science is beyond possibilities. It’s an absolute fact at this point that the two disciplines need to be brought together. So we’re seeing that. And when the dentists now coming out of the professional schools and the physicians coming out of their professional schools are understanding this comorbidity of disease pattern, They’re coming out knowing this clinical information from out the gate, which is really powerful. What also we’re seeing is the ability for both medicine and dentistry to identify particular biomarkers of disease. A biomarker is really a situation where you detect something in the system of the individual that indicates that there is some pathology going on underneath. And so it could be a simple blood pressure test. It could be an ankle brachial index. It’s a different blood pressure variation. It could be a serum level of a certain biomarker. And those are very good early indicators for identifying areas where the patient is suffering from something that they’re not aware of symptomatology-wise. And to Steve’s point about the perspective, We need dentists and physicians alike to learn from each other. I see that dentists are so much more far down the path when it comes to just a standard preventative care visit, where every twice a year, you know, since you’re from cradle to grave, you’re expected and often do go see a dentist. Physicians don’t get that luxury right now. where people sometimes are a little more arbitrary on their visit to the physician. So if we can kind of dual purpose the physician and the dentist around biomarker detection and sharing of that information on the, in Steve’s case, an Epic database, That information sharing gives you a better holistic view and you can then do something on an execution side of the therapeutic management that’s proactive for the patient’s health. And you’re asked what’s sort of driving this. One thing that we’re seeing on the medical side that is really exciting is the value-based medicine measures are incentivizing earlier detection and early interventions on disease states. The firefighter mode of payment models where you go when you’re sick and heroic measures get taken to resolve your health issue are given way to a fire prevention mode where we’re looking at how can we stop Susie or Joe from developing diabetes. And if you’re seeing your dentist and not your physician, Why not utilize that resource in the equivalent powerful way? And to Steve’s last point, I think it’s all about workflow. What we’ve discovered in the medical world, which has gone through this revolution before the dental group, is if it doesn’t work in a professional workflow, at a very elegant, seamless way, whether that’s data or the execution of the test or the integration of the behavior modifications, it doesn’t happen because it just needs to be an inherently beautiful way to engage with a patient where you’re not interrupting your normal, you know, procedural type work. So that’s what we tend to try to bring to the equation is understanding what that workflow could be and should be, and then designing the systems and operations to make that work.

Bill Neumann: So we’ve got a question. This is a two-parter. So you’ve got the patients coming in, right? And from a patient perspective, they can either be coming in to see the primary care physician, they could be coming in to see the dentist, and then there potentially is a referral from primary care physician to dentist or dentist to primary care physician. So Steve, what are the dentists at PDS doing? What are they looking for? What are they testing for where all of a sudden they go, oh, we then need to in turn refer to a primary care physician?

Steve Thorne: Yeah, it’s a great question. I mean, really simple things like blood pressure. Does every dentist in America take the blood pressure of every patient every single time? And then what do they do when the patient has a blood pressure of 140 over 100? Do they actually make that referral of a hypertension patient? In our environment, we’re working on getting to 100%, but they can walk next door and bring over a nurse practitioner or a physician and have a talk with the patient. We’re doing A1C testing constantly throughout our network. I think saliva diagnostics is the next big thing because we don’t have to get stuck with a needle. And we can learn so much about a person from their saliva, especially around inflammatory markers and some DNA. So we’re doing all of those things too. And then you can, with a complete family history instead of a traditional medical history that dentists have you know, traditionally been taught in schools, they can definitely go further and learn about any family history of the chronic diseases that Doc was just talking about there. Any chronic inflammatory diseases the dentist should know about, especially when they look in the mouth and they have red puffy gums, And we know the difference between different inflammation and chronic inflammation. We realize that that patient’s mom died at 45 years old of heart disease or had dementia at 60 years old. The dentist can now engage with that patient at a whole nother level for the proper referrals. What Doc was saying there, and I don’t know if everybody heard it as clear as he and I would both like everybody to hear, is early intervention is the key. The earlier we can intervene in any of these areas, the less, or the more we can help people, first off, and the less healthcare costs will be down the road. And people are programmed to go to the dentist a couple times a year, whether something is wrong or not. People in the United States are not programmed to go to the primary care physician world whether something is wrong or not. We go there only when we think something is wrong, generally. That whole paradigm has to change. That’s why I say dentists are so perfectly and so uniquely set up. And they can do many more screenings in the chair or in the offices than they already do and help catch things earlier. Let’s just talk about Medicare Advantage as an example. Medicare Advantage is paid to help people stay healthier, keep them out of the hospital, That’s how they all make it. I think we generally all know how Medicare Advantage works. If not, we’ll let Doc talk about that. But it’s over 50% of seniors in America. And in the next 15 years, we’re going to see a 50% increase in seniors in America. In the next 15 years, that population is going to explode. Their health, for almost all those people, is the most important thing. And so we have such an opportunity in the integrated care model to help them be healthier, help them learn about any areas that might be problematic earlier. help them in so many different ways, breaking down the silos that currently exist. It’s these silos out there that are crushing the system. And that’s what we’re working on together to break down those silos and help people stay healthier, live longer, live stronger.

Dr. Tom Schwieterman: Steve, I’m going to jump in on your Medicare Advantage hook because that’s exactly where I wanted to go. I’ve been studying Medicare Advantage for a decade, but in the last six months it’s gone to a whole new level of investigation because while I love our government, I don’t always give them the credit of proactive thought on the care management thing. And I started to see the trends in the Medicare Advantage world. First off, I think 90 plus, I think it’s getting close to 95% of all Medicare Advantage plans include some form of dental. Now, it’s not adequate for what’s required, but it’s there. Secondarily, what Medicare Advantage is doing is where Steve was just describing, is they’re really proactively incentivizing earlier detection of disease to the point where the 50% mark of people under Medicare Advantage plans, in fact I think it’s 51% now, it’s 60% of the expenses on CMS. And the reason it’s a 10% delta is that CMS or federal government is actually putting the cash back into the system for that proactive disease care management concept. They’re just tired of seeing ER visits, complicated hospitalizations, implantable stents and things that could be avoided. And so I think it’s a bit of an every hand on deck kind of scenario. whether it’s your neural health provider or a physician, is this proactive management game I think is upon us. I don’t think this is no longer a theoretical scenario when the largest payer in the world is putting a 10% premium on their reimbursement model to drive this initiative towards value care. it’s going to hit everybody. And the thing I want the dentists and the DSOs to understand here is that there is an enormously positive economic model involved in this. Four cents of every dollar or roughly therein goes to oral care in this country. And what I’m seeing is that that 4% is the mouse that roared because it can dramatically influence the other 96%. And when you start talking to $2 trillion industry and the 4% can drive values for the whole system, people are going to wake up real quick that this is where the game should be played and will be played. Lastly, I’ll say is that there are indicators in the marketplace, and rather they’re not everywhere, that these early preventative, hands-on, behavior-modifying solutions around advanced primary care, as they’re calling it, is reducing these long-term costs to a point where it’s in the high percentages of reduction of cost of care in a lifetime. And so the model’s been somewhat proven with some of these Chenmeds of the world and Oak Streets. They’re showing that they can do this preemptive management to prevent long-term costs. So I guess the takeaway from this is the procedural side of the income for our DSOs is always going to be there. It’s a requirement. There’s procedures involved in the root planting and scaling for periodontal disease just as well. But I don’t think you dare minimize the advantages that dentists have. and driving down the 96 cents of every dollar, there’s going to be a heavy reward that comes from that. And it’s time that I think dentists start paying attention to simple things where Steve is going, accurate point of care blood pressure that is usable by both sides of the equation, hemoglobin A1Cs to measure diabetes. I mean, those are not complicated things to do at the point of care, and I think they’re just going to become major mainstays of every operatory visit.

Bill Neumann: Dr. Tom, so I asked Steve the question about dentists referring to primary care. What about primary care referring to dentists? What do you see?

Dr. Tom Schwieterman: The ultimate, I guess, example that’s already on the books is every time I would see a diabetic patient, I would make absolute certainty that they saw their ophthalmologist, their eye doctor, once a year for a retinal screen because it’s, again, a two-way street. The diabetes induces retinal pathology, which most people realize that diabetes can cause blindness. And then secondarily, the retina contains a lot of information about what the diabetes looks like in the human body of the medical patient. I am quite confident that in my career and certainly in my lifetime, we’ll see this where doctors who see anybody with a metabolic disorder, which just for the audience who doesn’t understand what that means, that’s diabetes, heart disease, strokes, vascular disorders, and now increasingly cognitive disorders like Alzheimer’s disease and other dementias, I think every one of those patients is going to have to require to have a good oral exam, to do, you know, assessments of the oral cavity for, like, gingival hyperplasia, gingival redness, to make sure that I’m not, you know, fixing the problem on one side and filling the bucket with more problem on the other side when it comes to the, problem with oral cavity inflammation. It’s that fundamental. I’ll throw one stat at you, which I think embodies every, two stats actually. One is the research shows very clearly that periodontal care, periodontal disease impacts preterm birth by 30%. Meaning that if you don’t have good oral care, you have about 30% more likelihood of having a preterm birth. The number one or two, depending on what state of Medicaid funding goes to preterm infants, you know, the complexities of NICUs and that sort of thing. That’s an enormously powerful metric. Number two, The stat I recall is almost a $2,000 delta to a patient with diabetes who also has periodontal disorder. And the treatment of that periodontal disorder, in many studies, reduces that spend significantly. So the bucket of money that’s available to have oral healthcare providers integrated into the care models of every major systemic disorder, I think is closer than people think.

Steve Thorne: I’d like to add something to that, Bill, because we do have data on that. They are incredible at referring over. They are much better than the dentists at this point. Physicians have been trained on that as far as how to refer when they’re catching a problem or seeing a problem. So they are great. And those patients in the dental setting have the best show rate. So if they are referred from the physician or the nurse practitioner, their show rate is much higher. Their willingness to engage in the care they need it’s typically periodontal disease, to reduce the bacteria load is higher. And most, not most, every dentist out there can measure the bacteria loads of their patients if they chose to. Most do not today. Many of our docs do, but not all of them yet. But we can measure bacteria loads, and Dr. Tom was talking about where for a preterm low-weight births, we know what that bacteria is. It’s typically FN. We can measure that, and we can help people out with that. But we’ve got to get all that moving in the right direction to help that. But I can tell you for sure, physicians, nurse practitioners, once they understand how to do a good oral exam, which frankly, they aren’t trained in school, so we have to train them on that, they are incredible referrers over to the dental side. to help get the care they need.

Dr. Tom Schwieterman: I’ll jump in there, Steve, because I was a guest of your announcement that you had one of those setups for testing your saliva, and I did. And I was ignoring a molar issue in my mouth, and I got the results back. And I think it was less than two hours later, I made an appointment to get my oral care managed because it was not where I wanted it to be. And to your point about this simplicity of a biomarker like that, to Steve’s point, physicians are scientists, they love objective data, they like the concept of something that can be done relatively quickly in their point of care. And so things like that can really drive an industry because it’s a red, yellow, green thing where you get a result and it’s either red, like you’ve got a problem, you’ve got to do something about this, yellow, let’s pay more attention to this, or let’s have ourselves do a little more aggressive management, or green is, hey, let’s worry about something else. And that’s another trend I’m seeing in medicine is the ability for physicians or the requirement of physicians to point to the exact risk profile of that patient in a very specific way, in a very sensitive way, is really where we need to spend our efforts because you can’t afford to send somebody to a diagnostic screening test or a consultant when that problem is a very low probability of being a consequence. But things like oral health are so systemically wide in their impact that having a salivary study like that, which was, you know, I think, Steve, designed by the Harvard people and high-end clinical experts, it really drives a sense of quick response, therapeutic decision-making, which I think is what the game’s all about. On the medical side, To Steve’s point, we are better in many cases at well child visits. That is a standard fair two, four, six, nine months checkups. So what we’re seeing in the FQHCs is the implementation of fluoride, varnishes being applied by the primary care team, the pediatric office. It just feels like there’s an opportunity where we could align these resources as I think Steve’s, I know Steve’s doing with PDS Health. It’s just really powerful to see where this is going.

Steve Thorne: I’ll give a plug for that and then get back. We’re working on the CDC study that most of us cite. It’s old now. It’s 10 years old. That CDC study said roughly 50% of Americans over 30 years old had some form of periodontitis. I think we’ve all heard that study, right? So I think we should have in the United States every 30-year-old has a periodontal check with the right tests. We have the tests available today, there’s nothing new, so they can understand where they’re at with their periodontal disease by 30 years old, just like we would with a colonoscopy, just like we would with a mammogram, just like we would with the well checks that he was talking about for babies. I think it should be standardized in America.

Dr. Tom Schwieterman: Yeah, now, sorry to take over your show here, Bill, but I also think care acceptance is a real issue in the dental community and the DSOs. There’s a lot of beliefs, and I think it’s unfavorable, perhaps, that it’s a cosmetic issue, or, well, I’ll lose a tooth, or at some point, you know, I’ll get this situation in my mouth. It’s not hurting me now. I think the care acceptance for periodontal care and managing, you know, entries of bacteria for, you know, deeper inflammatory conditions like cavities and other restorative requirements As a dentist has the patient, I should say, has awareness that this is not just in that small cavity in my mouth of an issue. This is a systemic issue. I think the care acceptance of doing something more substantial and definitive and caring for that is going to go up. And so I think all dentists and DSOs suffer from a care acceptance issue. And I think the ability to connect these two will drive a much more cohesive perspective on the patient that this is important, that this … Because I always remember sending people to ophthalmology, they would go every single time. And so, because they sense the importance when their primary care doc’s saying, you need to do this. And I think that we should have the same perspective on a lot of this.

Bill Neumann: That really leads into the next point, which is patient engagement. So how are we educating patients? How are you communicating with them to explain the importance, to get them to the dentist, to get them to the primary care physician? What are you doing, Steve, at PDS? Because this is a bit of a mindset shift for the patient as well as the provider.

Steve Thorne: Yeah, and again, it’s a great question. For us, it’s been years in the making. So it takes time. I got taught by one of my mentors, when you’re teaching a new subject, you’ve got to keep repeating yourself over and over and again until you want to throw up. And once you feel like you want to throw up, no, you just begin the messaging. And so you have to stay on the messaging about the connection. Now we focus on five key areas. We focus on cardiovascular disease, early onset dementia, diabetes, preterm low-weight births, and cancer. So we’re really intense on that area and have gotten the the communications down across our network of a thousand plus offices and we’re probably about 5,000 providers working today of how they talk to patients to keep it simple so they understand. We also have it on our main website, SmileGeneration.com. You guys can all go check it out. It’s free. Just go look at all the materials you want and understand the connection. Here’s the basic principle, Bill. The basic principle is patients don’t care how much you know until they know how much you care. I’m going to repeat it. Patients don’t care how much you know until they know how much you care. You can’t just come out as an encyclopedia of the former name, oral systemic health. We call it the mouth-body connection. That doesn’t work. We have to demonstrate to them we really care about their overall health. Everybody gets trained so we all understand the link. between what’s going on in our mouths and those bad bacteria or bone loss and other problems in our mouth, abscesses especially in our mouth, and how they can affect our overall health. And we have the data now after doing this for years. So what Tom was talking about there on patient’s acceptance levels, it’s clear as a bell to me now because we have the data. Definitely better acceptance once we start talking to patients about the connection between the mouth and the body. Definitely better case acceptance.

Dr. Tom Schwieterman: Steve, I think I’d like to, yeah, go ahead. I’d like to add to that, trust is such a critical part of this whole equation. And the beauty of oral health providers and their physicians and VAs is that there still is a tremendous amount of trust there. And secondarily, behavior modification and being a proactive manager of your own health requires that trusting relationship with a physician saying, this is important, or an oral provider saying, this is important. And so that trust is something that we take extremely seriously at Bitmark. We make sure we design our ecosystems in a way that that intimate encounter can be very much preserved. We don’t have any barriers between the doctor and the patient, you know, both disciplines. And on top of that, the trust also comes in a way of making sure what you’re doing at that point of care is accurate, whether it’s the actual test itself or the data transmission. Because that sacred bond you have with that patient to make sure you’re doing the right things at the right time are critical. And that’s one of the things I really love about PDS is their deep attention to the connection between the provider and the patient. It’s a fundamental basis for which you can get some things done that are proactive because it takes a lot of trust for a patient to walk into any outfit and the person, the professional behind the counter says you have hypertension, you’re going to need to take a pill for the rest of your life or you’re going to need to do this multi-thousand dollar procedure. There’s a lot of trust that needs to be brought into that equation. We’re very attentive at our side of the fence to make sure that we are fostering that exact sort of ecosystem dynamic where we can get that done. And the beauty is we’re starting from a point of strength, whether it’s the industry’s perspective on these providers, and also I think the companies you’re speaking to on this podcast are very deep in that vantage

Bill Neumann: talk about Roblox. Certainly, both dental and primary care are siloed, right? And they’re just starting. And really, it’s, I think, because of PDS and maybe some others out there trying to come together. But besides being siloed, with practice management software, you’ve got Epic on one side and you’ve got one of a number of other solutions on the dental side. Let’s talk about some of those roadblocks and maybe how you kind of work through some of those. And that’s probably like three podcasts, but maybe we can highlight some of those roadblocks and how we can get through some of them.

Steve Thorne: Well, the roadblocks are starting to come down in the schools. I don’t know as much on the medical schools, but I sit on a lot of boards at dental schools and work with the deans. So the first roadblock, I think, is the education process. And that’s starting to break. That’s starting to come together. So as they start learning about the importance of the connection between oral health and overall health in schools, There won’t be such silos and they won’t operate in such different manners as we’ve experienced in the past. I’m seeing that happen now. Many schools are breaking down those silos. Next, We have got to work on the education once they’re outside in practice and how they work together. And the key to that is the electronic health system. We happen to use Epic. It’s great on the integrations. And that’s why I went with Epic. There are others out there too. But it’s not just the integrations, it’s the chart reconciliation. So clinicians are so busy. And so they have to have screens that are popping up that kind of tell them what to look for. And it goes the whole spectrum of clinicians. So whether you’re a hygienist or you’re a cardiologist, you want to see what’s important to you. That’s still not quite there yet, but it’s coming. Companies like ours and lots of others on the medical side are way ahead of us, by the way, in developing, and I call that the chart reconciliation process of getting in front of the clinician what they need to see, what they need to see for their area of kind of expertise. And then the big one to really make this work at the end of the day is the reimbursement system. We have got to solve that area Ultimately, the payers, and we’re seeing it with MA, Medicare Advantage, we’re seeing it some with Medicare actually providing some benefits for dental services, we’re seeing it with some corporate plans, we’re seeing it with some self-funded plans. The payers of the health care for everybody here in the United States has got to get the connection and be willing to pay for that service because what dentists do, what oral health care providers do, can, and I believe will, will reduce their overall health care costs when they’re looking at their annual budgets for what they spend on their health care. We at PDS, we invest heavily in it because I’m so convinced. that everything we do on the oral healthcare side will reap big rewards on the medical side. It’s now getting it done, getting the integration done, getting the reimbursement systems working together. I can’t say it enough, and I do every time I get a public audience, the fact that dentists work in a different coding system than everybody else is a major barrier, and we have to solve that barrier.

Dr. Tom Schwieterman: Yeah, I know we’re getting short on time, Bill, but I’ll throw a couple additions to where Steve was going. I couldn’t agree with him more on the EPIC and the data integration requirements. You can’t treat what you don’t see. So the physicians seem to be armed with the oral health paradigm and vice versa. And that’s coming together. There’s new interoperability requirements now from the federal government on data interoperability. The data systems are getting better. And the systems like Epic, which is the biggest of all, is starting to realize that the dental care community is a core part of their fundamental mission in life. So that’s number one. Number two, I think the mindset change that’s going on, I’m seeing in healthcare around value-based care, is settling in. I’ve talked to a lot of physician leaders around the country, and what they’re saying is they’re absolutely putting their money and their investments around the areas that can improve chronic disease management, lower total costs of care. And they’re doing this because of many of the Medicare Advantage incentives that are out there, and also the fact that they know that they’re getting graded increasingly on these clinical outcomes. Now I end this with this, is this inflammatory basis of disease is just starting to become the next big wave in medicine, scientific, clinical. And what that’s saying is that inflammation is the big evil as far as health concerns and long-term chronic disease progression. And it takes a while for the medical community to shift from, you know, clinical idea to implementation, finally to pair models. But I’ve seen all three of those things starting to gel together in a way that creates a fairly powerful unified force around this. And once the health systems, which control the majority of the health care now in this country, realize they can’t get to their goals without rural health care providers, this is going to move very, very quickly. So I would advise the listeners of this to pay attention to this because this isn’t an esoteric concept of an idea. This is actually real dollars and cents and real business opportunity. And I’ll credit Steve to having such a proactive vision around it.

Steve Thorne: And can I add, the most chronic inflammatory disease in the world is?

Dr. Tom Schwieterman: Diabetes. Cardiovascular disease. Oral periodontal disease.

Steve Thorne: a continuous and you can’t get rid of it. We all know. They’re trained in dental school, right? Bill, we know that from years. You can’t get rid of periodontal disease, you just have to manage it. Well, there’s a reason you have to manage it. If you want to stay healthy, you want to prevent a heart attack, prevent early onset dementia, prevent a preterm low weight birth, help lessen or reduce diabetes, which is clear as day, and help prevent different forms of cancer, see your dentist often. I go in six times a year.

Dr. Tom Schwieterman: I’m going tomorrow.

Bill Neumann: There you go. So as we wrap this up, final thoughts from you, Steve, what does the rest of 2024 look like? I mean, we’re only not even halfway through it. You’ve already changed the name of your organization. What’s the rest of the year look like?

Steve Thorne: So our PDS, what we’re doing here at PDS, our PDS dental is our core. Our PDS medical is growing and accelerating. We have a few things left to do on the value-based care initiative. It’s a little complex on how The administration works there, so we’re doing that. We have a new company called PDS Health Technologies, where we’re providing Epic primarily for schools now, but any other progressive organizations that want Epic and some of the other things we have. So that’s called PDS Health Technologies, and a bunch of different schools are switching to Epic right now because they see the same thing. This is where things are headed. And then our new business, like I said, is Pedias Plans, and we are going to recreate, I’ll call it, what dental plans should look like in America, and also a We’re not getting in the medical insurance business, but a medical health plan that can help people understand these inflammatory markers and genomics in a much better way, so that they can work with their primary care physicians and other care providers in a much more sophisticated way about their own personalized care. Because at the end of the day, It’s about our personalized care. Each of us have either two X chromosomes or an XY chromosome. All of us, we know what we have, but the genetic expression of those is different for every one of us. If we really want to go after taking better care of ourselves, we have to have that personalized care. And it’s actually not that hard given the latest science and the latest tests and the latest screenings that are out there. So we’re going to be going after that in a big way. And I know Midmark’s going to play a key role in that because they’re all about integrations, helping physicians and dentists be more efficient. And we’ve got to all work towards that.

Bill Neumann: We will drop the latest press release with the name change announcement in our show notes. You can also go to pdshealth.com to find out more. So thanks, Steve. And then, Dr. Sweeterman, on Edmark’s side, what do you have planned for 2024? What products and projects do you have going on?

Dr. Tom Schwieterman: Well, I have a downstream marketer staring at me right now, so I got to be careful what I say, but we’ve got lots of things coming out that are very exciting for the industry. My email blew up on Monday, Steve, actually, your announcement because of what’s going on. And we look for canaries in the coal mine. When a canary dies, something’s going on that you need to pay attention to. And you’re one big canary or more like a bald eagle that died in a coal mine. So we’re very attentive now that we need to be on full hands on deck getting a medical dental or dental medical integrated solution sets around our ecosystems going. We’ve been looking at this for 10 years to see each point about EPIC integrations. We’re aggressively pursuing to optimize our ability to bring on new biomarkers, new concepts to the EPIC world that we live in today. Just for the customers to know and the people on the podcast to hear, we’re the first device to be integrated in Epic in an ambulatory sense. So we know how to do this. We were doing it for decades. So that’s a big part of our area of focus is to get this integration between the medical and dental community going, especially on a device level. And finally, we know that behavior modification, proactive health management, intimacy and trust between the doctor and the patient are critical. So we’re always looking at ways our ecosystems where we can borrow the knowledge we have in dentistry, 12 o’clock, 9 o’clock positioning and all the issues with musculoskeletal issues from those dentists. We’re trying to take that and bring it to our medical community. We’re trying to take the medical side, but they do a lot of more point of care testing on the physiologic side, bringing that to the medical. So we got this beautiful mashup that we’re looking at, but it’s going to take us a little time to get things out to market, but it’s happening a lot faster and fun to see that. And Steve, thank you for We’re getting some of my vision work here at Midbar going faster because of 800 pound gorilla comes in the room. You got to pay attention. Thank you.

Bill Neumann: Well, thank you both. Thanks, Steve. That was your third podcast with us now in the record book, so thank you. And Dr. Tom, thanks for being on. This is the first time for you and hopefully not the last. Oh, by the way, I forgot to mention, if you want to find out more about BidMark, easy enough, you can go to bidmark.com. and go to their main page, and you can go click on dental, and they do have DSO-specific solutions. If you happen to be on the medical side, you can go down that section of the website and find out what they have for primary care. But that’s it. It was a great conversation. I know there’s probably another hour’s worth of content we can talk about, but maybe we’ll do a follow-up. But again, thanks, Steve Thorne, PDS Health, and Dr. Tom Sweeterman from Midmark. Thanks so much for joining us, and thanks, everybody, for watching us today, or maybe you’re listening in. Again, without a great audience, we couldn’t get these great guests, so until next time, I am Bill Neumann.