The Group Dentistry Now Show: The Voice Of The DSO Industry

Dr. Cindy Roark, Senior Vice President and Chief Clinical Officer & Jonathan Kaufman, Chief Marketing Officer of Sage Dental, discuss AI, marketing and the future of the DSO industry. Dr. Roark is engaged as one of the earliest global leaders in the adoption of Artificial Intelligence to improve the patient experience and overall outcomes of dental treatment. Jonathan heads up marketing for Sage’s 60+ supported dental practices. If you want to understand clinical strategic planning, developing and improving clinical protocols, as well as new technologies and services and how to market them, this podcast is for you!

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

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Full Transcript:

Bill Neumann:

I’d like to welcome everybody to the Group Dentistry Now Show, appreciate you coming back for this episode. And we have two people in one screen, so they went from two brady bunch blocks to one. But we actually have John Kaufman and we have Dr. Cindy Roark from Sage Dental. So we’re going to talk all things Sage, we’re going to take you from March of last year, during COVID all the way up to present day and some of the really cool things that they both have going on at Sage. So welcome to both of you, I appreciate you being on the Group Dentistry Now Show.

Jonathan Kaufman:

Thank you.

Dr. Cindy Roark:

Thank you Bill, thanks very much.

Jonathan Kaufman:

This is fun.

Bill Neumann:

Yeah, this is good stuff, and they did not know they were going to be on camera either today, just kind of sprung it on them at the last minute, I thought it was going to be audio only.

Bill Neumann:

So Dr. Roark, why don’t you introduce yourself, a little bit of your background, and kind of your journey in the DSO space and then we’ll talk about John.

Dr. Cindy Roark:

Sure, happy to. I will say that my background… I went to dental school in Boston and my background actually is, it falls into three categories. One, I had a private practice for about seven years, didn’t know what I was doing but it did well, right? You come out of school thinking you know it and you don’t. So I ran a private practice for about seven years and then I headed up Vanderbilt University’s General Dentistry Program at multi-specialty dental center and was also on their faculty of the medical school. And so I did time in non-profit, as I say, and I’ll explain that a little bit more in a minute. I realized that it’s tough for me when you’ve gone from private practice life to do non-profit because I’m counting every piece of gauze and all that, and that’s just not the life that you live when you work in a non-profit. So it was a very interesting journey, I loved it and learned a lot. But I had private practice and then non-profit, and then I was moving to Florida and I said, “I’m just going to do this DSO thing for one year,” because I was a hater and a snob. And I thought I’ll just do this until I know where I want to hang my shingle and that was almost 20 years ago, it was a long time ago.

Dr. Cindy Roark:

Because what happens is when you’ve had a private practice and you’ve done okay with it, you sell, coming into DSO land is really easy. I loved it. I mean, and the people I hire that stay with us forever are people who have done that exact thing. They’ve had a private practice so they realize the man’s not making all this money, that it’s actually a good model. And so I’ve done that for many, many years and it’s almost like serendipity how I ended up going into management. If I looked at my young dental school self, I would never believe I’d be in a C-Suite role today. But what I did end up doing, as I moved into that type of role, is I ended up going back and getting a Masters of Health Care Management at Harvard because I realized that when I’m sitting in this room with executives, I needed to be bilingual. Because I knew dentistry but I didn’t even know EBIDA was, back in the day, I mean a long time ago.

Dr. Cindy Roark:

But there’s a lot you need to learn and so that’s sort of my background and how I ended up even sitting around the table kind of figuring out strategy and going down the AI hole, and working with John, we’ve worked together forever, so you’ll hear us be pretty blunt, but super creative, one of the biggest talents I’ve ever worked with, which is why we keep coming back to one another.

Bill Neumann:

That’s great and I didn’t mention… So Cindy’s title is she’s the Senior Vice President and Chief Clinical Officer at Sage Dental, I don’t think I mentioned that. But I did, I just mentioned it again. So thanks Dr. Roark. So let’s talk about John Kaufman, you’re the Chief Marketing Officer, you were also a Dental One and a couple of other DSOs. So it’s interesting because the marketing role, in particular, has really changed over the past decade probably, and it keeps evolving as technology evolves, and I think really influences how you reach patients, how you maybe reach potential acquisitions, and then from a recruitment standpoint as well.

Jonathan Kaufman:

Yeah, I mean Dr, Roark dental school, knew she wanted to be a dentist, didn’t know she wanted to be on the management side. I, on the support center role or in the management role from a non-clinical standpoint, fell into dental I think the way most people fall into dental on this side which is completely by accident. So my dental story started in… exactly. 2012, I was sitting next to a gentleman on an airplane and we just started talking and he was the CEO of Dental One at the time, and come a few years later, he asked me to come on board and that’s where my dental career started. I never ever thought about going into dental. I never thought in a million years that this is the marketing direction I want to take.

Jonathan Kaufman:

My background is technology and digital assets and branding and things like that, kind of a strong statistical background so I like the analytic side. And coming to Dental One, it was fascinating to be in dentistry because I think a lot of people find the overall kind of corporate support and resources, the technologies that are available for dentistry, are behind kind of the medical field. And so what going into dental allowed me to do was take a lot of the stuff that we would do in other industries or other verticals, and really just apply it to the stuff we were doing in dental, have fun with it, look at analytics and statistics and figure out how to use that to market, how to use that to recruit, build brand campaigns. But yeah, I mean, when I started in dental, there was a big focus on brand and messaging and positioning and it was very kind of traditional marketing advertising, and it has just evolved so much from there.

Jonathan Kaufman:

I think every CMO has to evolve, right now I think it’s changed where it’s so much analytics, so much creative application technology, but we’ve had a lot of fun together. Cindy’s brain, in terms of being able to take this kind of serious clinical piece and evolve it into something that’s exciting and fun and technological is really kind of special, and so we’ve had a lot of fun, as she said, for many years just kind of taking stuff that quite literally we think up while sitting in an office, take it to our CEO, who we’ve been with for a while, incredibly supportive of kind of the direction we go on some of these things, and launch some completely random AI based tool or technology or CRM tactic and it’s a blast, we’ve had a lot of fun with it. And again, I got into this by accident and never thought it would be so much fun but I think about dental all the time, it’s bizarre.

Dr. Cindy Roark:

He can’t get out now.

Jonathan Kaufman:

I think I’m a lifer.

Bill Neumann:

Yeah. Well, that’s what they do say, “Once you get into dental you never get out,” which is certainly the case. I came in very similar to you, kind of by accident and happy that I landed here. Great industry for sure and really still in its infancy I think as far as the consolidation that the DSOs and the different models that are kind of evolving and that that stigma that Dr. Roark kind of mentioned, she said snobby or something like that. I think maybe it’s not as prevalent as it once was and I think a lot of the younger clinicians, and maybe some of the older ones as well, realize that there’s value in the model and it’s not just trying to do as much dentistry as possible, it’s really taking care of the patients and the DSO is there really to support that that goal of the clinicians providing that patient care. So it’s just interesting how things have changed and I’d say in a relatively short time, the perception and I think it’s changed immensely in five years. I don’t know if there are any stats out there but it’s a feeling that I see and I hear.

Dr. Cindy Roark:

Well, definitely. A couple points I would bring up about that is, I think COVID is a huge factor in terms of where we go from here, not necessarily where we’ve been. I think DSOs were about 20% of the marketplace even a year, year and a half ago. And if you look at COVID, this is a situation where suddenly providers that may or may not have been interested in this model realize, “Now I’ve got to figure out PPP funds and how to source PPE and landscapes changing every day and today we’re shut down and tomorrow you need to stay home 14 days and then it’s 10 days, now we’re not sure.” That is a lot to take in if you’re a single provider and you just want to do dentistry and so I think what I have seen one is that a group of clinicians that never would have considered going down the DSO road are actually open to it, because they realize there’s a lot to manage here, this is very, very different. And then to your point John, you said earlier, we’re so far behind medicine, because if you think, when you graduate from medical school in the United States today you don’t go, “Where am I going to hang my shingle? Where am I going to build my single practice?” I mean you just don’t, that everybody’s part of an academic medical center or a health system, there’s support in that.

Dr. Cindy Roark:

And the reality is dentistry still had the cottage thing going for a long time, and still will for a while, but we’re certainly seeing this divide now between people who never would have considered it are now knocking on the door. And then you’re seeing, I call them kids but they’re not, people graduating from dental school, they’re tech savvy, they are digital natives, and a DSO can quite often give them the tech piece. For us, the AI piece, nobody else can give them, private practice just isn’t like that. So I definitely see consolidation continuing and I see happier people with a little bit more support versus that snobbery that even I had coming out.

Bill Neumann:

Yeah, that’s a great, great point. So let’s talk a little bit about Sage Dental. So you’re at 65 practices, give or take, and then you just recently acquired six practices in the past month or two. So talk a little bit about what’s going on at Sage, and then I’d love to, after you kind of focus on that, maybe let’s talk about, because we have to talk about COVID still, so I’d love to hear kind of the journey and how things look for you as an organization.

Jonathan Kaufman:

Yeah. I mean, Sage, it’s been a pretty incredible journey through COVID. I know Cindy and I will talk about that in a second just in terms of what happened kind of in March and then what we did during that. But coming out, I say that we’re growing based on two factors. One factor is being well positioned and well supported, and that’s definitely a huge part. But we’ve also gotten incredibly lucky, right? We’re in Florida and Georgia. And you’ve got roughly 1000, 1250 people moving to Florida every single day. And so we had transplants who came out here from New York, New Jersey, Pennsylvania, Ohio, Michigan, California, so we have this incredible influx of population, and population needs a dentist. And so part of that was, we’ve gotten very lucky just we’re not in California, not that anything’s wrong with California, but we have a very open system, a system that opened quickly, and so we’re able to see and serve a lot of patients. And we did a lot of things during COVID pretty immediately to continue to see patients. We just acquired six additional practices, opened up brand new facilities. We’ve got a whole lot more in the pipeline that are set to open here soon. We expect to be somewhere around 100 to 120 practices in the next 12 months.

Bill Neumann:

So double.

Jonathan Kaufman:

There’s a lot of opportunity, both on the de novo opening new practice front, and then some of those providers that have practices that have just said, “Look, I don’t want to deal with this anymore. I want to sell my practice to a good organization and be a part of that,” as well as some some groups that are really looking to be a part of something that’s really special and growing. So we’ve got quite a lot of fun happening, this is what we call the fun, is building and growing and we’ve really had an opportunity, our development team has worked really hard to find and meet partners that are going to be great for us as we go forward. So a lot of growth to come at Sage Dental in the next 12 months.

Dr. Cindy Roark:

And the only thing I would add to that is the type of growth built, it isn’t shotgun and all takers kind of growth, we’re really trying to be strategic about fit. I want people who are ready to embrace new technology, I mean, we want to be the AI driven DSO, and that takes somebody who’s willing and open to change, and lots of times you might not find that. And so I’m looking for somebody who’s excited by what things we can offload from you by using an AI platform versus somebody who thinks someone’s trying to get rid of their job or all those irrational things, we’re really hiring for fit and we’re requiring for fit because I want that, it’s not young gun, there are plenty of guns of all ages, but I want somebody who wants to be a part of the ride versus somebody I’m gonna have to constantly talk to about, “Hey, let’s incorporate this.” I want that person who wants to be the best and the first in the world to do that kind of stuff. So if you can see our excitement…

Bill Neumann:

Yeah, it’s great to see that and talk to me a little bit, I know you touched on it Dr. Roark a little earlier, but you feel that with COVID it’s actually kind of almost accelerated this thought process that some docs had that they’re kind of maybe looking for some shelter from the storm, they don’t want to deal with another lockdown or whatever the next thing might be. The great recession 2008, a lot of people kind of had that in the back of their mind too. So do you feel like that’s bringing some potential acquisitions to you that might not have been there?

Dr. Cindy Roark:

No question. In fact our metrics would show you. I think what’s interesting for us is we have a little internal joke and I guess it’s not funny, but the odds are good but the goods are odd, right? We’re not for everybody and there are certain practices that have been kind of cottage and maybe worked three days a week and been really comfortable doing that for a long time and not real tech forward and just very different, right? And that’s going to be a real struggle. I wouldn’t rule that person, it’s the person I want to hire and retain because that’s the magic in a practice. I’m not looking for a facility, I can do a de novo for that. When I’m trying to acquire, it’s because I believe in the doctor and in the team really, it’s not just the doctor. But I think that’s probably the thing I’ve seen the most is that we have gotten an influx. But out of that influx of interest, we’re a little bit selective about who we’re actually going to date.

Jonathan Kaufman:

There’s another head space kind of change, so we’ve obviously seen a lot of people interested in becoming a part of Sage. But the other head space changes… If you look, prior to COVID, there were some really great emerging technologies in dentistry, a lot focused on AI, some focused on some analysis and just a variety of technologies. And the instinct to change, right, as a provider to say, “Yeah, this is something I want to add on to my practice or this is something I want to adopt into my practice,” it was not really there because you kind of needed to… If you had a well-performing practice or a well-programming provider, why do you want to adopt that, things are going well, right, change is hard.

Jonathan Kaufman:

Well. March hits, COVID hits, and if you don’t have a tele-dentistry platform, if you don’t have an diagnostic tele-dentistry platform, you don’t the triage program, how are you going to stay open, right? I mean, within four days of the shutdown in Florida, we had a tele-dentistry platform which we were lucky enough to have been setting up for the prior 12 months that we were ready to go live with, and we turned it on to four days. So Monday, anyone that needed care in our, at the time 59 practices, was able to get care and then we were able to triage those patients to 25…

Dr. Cindy Roark:

Emergencies…

Jonathan Kaufman:

…. open, urgent care dental facilities where they could get care. So whereas, if I had an individual practice that was closed for three months in COVID, we could see any patient that we needed to and determine whether that was an urgent situation of which we needed to treat the patient. And so the desire now to accept those changes has ramped up investment in different technologies and has ramped up adoption. So there’s kind of a double mentality change.

Bill Neumann:

Yeah, I think that’s a great point, leads me to that next question which is, this is going to be the technology focused segment here. So you talked about tele-dentistry probably being hopefully one of the most obvious, right, that you’ve taken on. If you don’t have it now, I mean, I don’t know what to tell you. But I think most groups were looking at some… Either they had it before or they certainly implemented something, they had to during COVID. So beyond that, and this is for both of you but I want to save the AI for DR. Roark because I know that that’s your thing and you’re an expert in that field. But what other technologies, maybe from a marketing, whether it’s patient acquisition, patient retention, communication, there’s so many great communication tools. I mean, like you mentioned earlier John, there’s the analytics that are out there now, if you’re an analytics geek, which you really can’t avoid to be now in the DSO space. Let’s talk about what you’re doing and then kind of what’s new out there that you’re excited about?

Jonathan Kaufman:

So we’re doing a lot in terms of… One of the things that came up, and the first thing I’ll say is that a lot of the fun marketing technology stuff that we’re doing cannot exist without the AI stuff. And AI’s this big term that everybody throws around, what does it really mean? Dr. Roark will talk about that, but 92% of the stuff that we’re doing is leveraging off that, right? There is so much information and so much knowledge in terms of what we have out there and what is best for patient care and how we can communicate that better. So the evolution of communications is really around how can we take the insight that we’re learning from some of these various tools and technologies and then communicate those out to the patient?

Jonathan Kaufman:

We decided about a year or two ago, to build our own internal patient communication CRM system. And the reason that we did that was because a lot of the tools out there today are kind of what I’ll call, bit in bit out systems. So you put in a piece of information, a bit of information, and the system then does something with that. So I say that Patient A is due for a hygiene recall and the system, whatever dentistry platform it is, sends out an email or a text message and says, “You’re due for your hygiene appointment,” right? What we have decided to do was we didn’t want to have this kind of input-output system, we’ve taken a huge amount of the data that we have, which many other industries would call kind of big data analysis, and we take all that data and we use statistical models to identify how we want to communicate with that patient, whether we have capacity to see that patient, where the best place for them to go to see that patient, and we’ve also used it to open up more capacity in our practices where we just we simply don’t have more chairs to offer in that practice.

Jonathan Kaufman:

So a good example of that would be, an existing patient that we know that has a family that just, due to life circumstances, is going to cancel more often than someone else. And so we actually run some statistical models to understand the likelihood of that patient actually visiting the practice and we can reach out to them ahead of time and say, “Look, you’re a busy person, are you going to show up on Friday?” Not press here to confirm your appointment, but are you going to show up on Friday? And give them options right then and there automatically to reschedule their appointment, right in an app or right in their online platform, so that they don’t have to call the practice, they don’t have to do anything else. If they want to talk to us, they can call, but they can also chat with us. And so we basically can identify, this is just one example, identify somebody that may have a higher likelihood to not show up, communicate with them and give them an option to reschedule for a better time and then we can open up that that patient slot for someone else that might need care ahead of time.

Jonathan Kaufman:

So instead of kind of just, this is what you have, let’s go do it, it’s a lot more diverse in how we talk to people, who we’re talking to and we’re building our own kind of different models of communication so we can talk to people in the right way. And so that’s kind of the other 8% of stuff that we’re doing you know 1200, 1000 people moving to Florida every day, it is the highest level of patient demand I’ve ever seen in my career in dentistry and so we have to be sensitive to the fact that there’s only a limited amount of supply that we can offer, right? There’s only so many patients that we can see on such given day and give the right kind of care and so we’re factoring all these different tools and technologies into the equation. And the other kind of baseline stuff that I think that if you’re not doing as a DSO right now you’re kind of left in the dirt, is online scheduling, patient chat, being able to chat with patients, having a contact center where you can communicate and just communicating with them where they are and how want to be talked to. And the rest of it is all tied on to the intelligence that Dr. Roark and some of the systems that they have are developing and they’re just providing better patient care.

Bill Neumann:

Well Jonathan teed AI question up so Dr. Roark I’ll let you talk a little bit about that. Obviously, you have a keen interest in it and have spent quite a bit of time. So the question always is, I think most people know AI from you’ve got your iPhone and you talk into it and it’ll type something out or you can you have SIRI you have Alexa so that’s I think the basic kind of AI that we know or maybe you type something into Google and all of a sudden it’s kind of autofill and but let’s talk about it from a dental perspective.

Dr. Cindy Roark:

Sure, absolutely. And what you’re talking about is actually natural language processing. And AI is not one thing. For instance Pearl, and before, they do mainly computer vision. And so what’s interesting about the whole journey is that I’ve always tried to, instead of just fall in love with new tech, fall in love with what it can do for you. And so when AI first came out and started to be involved in dentistry, I just didn’t understand it. So just like everything else in life, when I don’t get it, I’m a geek. And so I took a course at Berkeley online, thank goodness for COVID, right? So I got to study online. And what I loved about it is really understanding the capability of it, because in the reality, AI is used in medicine every day, skin cancer, MRIs, I mean you have a heart attack now, any imaging they take is going to be run through an AI engine of millions and millions of indexed images to let the doctor know, before they even walk in that room, kind of what they expect to say is going on with the patient, right? That’s every day in medicine.

Dr. Cindy Roark:

But dentistry, since we weren’t part of the High Tech Act, we didn’t go computer crazy, we didn’t get our systems up the way medicine did, frankly, so that’s another point of where we’re behind. And so as I was looking into it, what can this do for us, one of the funniest things is the first place we started in terms of being interested in it was a company called Dental Monitoring and Philippe Salah out of Paris. And John and I got so interested in it because here I am, I’m a mom, my daughter’s 16, and we’re all busy and the thought of putting her in braces and being anywhere 22 times in the next two years it’s just not going to happen for me, right? I don’t know where I’m going to be next week so I certainly don’t know if I can get her to this appointment.

Dr. Cindy Roark:

And so as we were thinking about braces and ortho, we were looking at dental monitoring and John and a few others actually, but we hopped a plane and we went to Paris to talk to them, just understand this, right? Which is what I love about Sage to be honest because nowhere else in DSO land does someone say, “Sure, go to Paris, figure it out.”

Jonathan Kaufman:

A week after we asked.

Dr. Cindy Roark:

A week after.

Jonathan Kaufman:

We should go learn about this. Go to Paris.

Dr. Cindy Roark:

Go learn. If you can make a business case for it, go learn, right? And so we sat down with Philippe, we’re sitting there and I’m like, Oh my gosh, what AI does in terms of ortho is, if you think about it, when you’re in braces, we have this traditional model where you’d come in every month or sometimes every three weeks, but every month, and they change the wire, tighten this and that. But the reality is, that’s a mechanical process and that orthodontist has no idea whether your wire that’s on is still working or not, it’s just time for a change. Well, now you’ve got AI and it can measure, with the scan, every tooth, every surface, every time you scan. Well, everybody has an iPhone, all these kids have iPhones. If they’re in braces, they’ve got an iPhone.

Dr. Cindy Roark:

And so scanning, it’s got a scan box, and you teach the patient how to scan, they scan once a week and it’s going through the AI software, you can literally toggle and watch the teeth as they’ve moved, where are they, is the wire still active or is it passive, and then it triggers a notification automatically from the doctor with notes you’ve done telling you to come in. So it’s on demand, it’s when my teeth need it, I’m going to show up. And so what that means is that a traditional 22 month banded and bracketed case would really only come in about six to eight times but you’ve got millions of images and tracking the case in a way we never could medical legally documented in the past. And so you look at COVID, and that value prop, busy mom that value prop was already there. I would love to come in less not more.

Dr. Cindy Roark:

But a lot of people, maybe old school people think, “Oh no, I need them to come in every month, they want to see me, I need to get that money.” Well it’s a different proposition when I may die if I go out. I mean, the public’s perception is I don’t want to be going over and over. So what’s cool about us sitting down with them and already incorporating this is we had this solution that was already here when COVID hit. And so our value prop to a patient is very, very different from someone who had not already incorporated that. And that’s the first part, but the second part is, which is why I think our CEO is pretty cool to let us do this crazy stuff, we got over there and Philippe’s like, “Well, let me show you this GP thing just get your opinion,” and so we worked with him. I’m like, “This has a ton of promise, this is awesome.” And GP-based scan which now we’ve incorporated on all of our new patients coming in and it does an aI scan and it basically consumerizes it, it’s going to be going to the patient, it’s all these images, it’s telling them kind of tooth alignment and basically, I’m not going to use the term dumb it down, consumerize is the periodontal piece. “Your gums are an issue, blah blah blah.” It’s consumer facing but it’s AI and so it’s objective.

Dr. Cindy Roark:

Versus, so they come in to the office, they haven’t gone back to see the doctor or anything and we’ve got this scan and we’ve got a report and it’s giving them an idea of how they stand right out of the gate. And it’s almost like going to the eye doctor when they measure everything and then the doctor comes in and looks at it you don’t go, “Oh, you’re just trying to buy a Porsche,” nothing like that, it’s objective, and they believe it. And so for us, incorporating that AI scan technology on the GP side has been insane because patients really, really soak up that kind of data, they enjoy that objective nature of it. And so that would never have happened if we hadn’t been hanging out with them and saying, “Hey what if we use this or that?”

Jonathan Kaufman:

So let me say two things on that. So the first thing on ortho, right, you asked me about marketing technologies, and marketing technologies are fun and statistical analysis is fun, and we’re even doing some quantum computing stuff which is kind of fun. But what she just said about ortho is we came back and I said, “Well, I don’t need any technology for this.” If you Google right now, orthodontic treatment price or orthodontic treatment near me, you are going to get everybody talking about their price, their offering, all that. Who else can right now say, and there are a few others, but who else can say, “Well, you’re a busy mom and both parents work and you’re going to have to take 22 trips to the dentist, take off work, pull your kid out of school, travel time. But actually with this tool, we can do the same thing and see you six to eight times. So you’re gonna reduce your overall visits to the dentist by about two-thirds in this process.” How about that for a sales pitch, right? I mean that is just convenience galore and if we know anything about the dental customer convenience it’s the number one thing they’re looking for, in addition to price and value.

Jonathan Kaufman:

The other piece I’d say is what Dr. Roark described about the general dentistry piece, let’s talk about tele-dentistry for a second what happened in COVID, right, the thing I talked about four days later. So we had been working on all these pieces, and when COVID started and you say tele-dentistry, you think about somebody calling you up and saying, “Well, my tooth hurts.” And you know you and I, we’re talking to each other right now I’m not going to do it because it would be kind of strange but if I just bent into the camera and smiled, I don’t care how good your camera technology is what are you going to be able to do, right? And so what is the dentist going to really be able to assess other than you’re in pain, you’re not in pain or it’s obvious that you’re missing a tooth, right, we need to fix that.

Jonathan Kaufman:

So what we did is we actually incorporated the AI tele-dentistry piece where it’s not only an integration with speaking to the provider, but you actually, without a scan box, can take a series of images with your phone, upload it directly to our portal and then the general dentist can take a look at those images and say okay, “From the AI scan, I can see that there’s some recession and it looks like we’ve got some decay over here that may be kind of troublesome and you’re in pain, this may be a situation where we’re going to need you to come in, I think there’s a there’s an issue we need to deal with.” And so it’s not just saying, “Hi, I got a tooth problem,” which is kind of what happens in medical tele-dentistry right, it’s, I’ve got sniffles, a cough and okay here’s the prescription, it’s we’re actually able to see on a computer screen the images that you just took, uploaded to a database of 14 million plus images in Paris.

Dr. Cindy Roark:

And benchmarked.

Jonathan Kaufman:

And benchmarked to be able to say, “Okay, this is something we need to deal with,” and it’s not a complete answer, right, it’s not an x-ray in that particular case, but it’s much more objective for the provider and for the patient to be able to interact. So that’s what we did during COVID and that allowed us to pretty much treat every patient that we needed to during the period without even having to see them.

Bill Neumann:

That’s pretty cool.

Jonathan Kaufman:

It’s super cool.

Bill Neumann:

And you got to go to Paris.

Dr. Cindy Roark:

Yeah.

Jonathan Kaufman:

Before COVID. But I don’t think there was anybody else, who at the time, when that launch had that capability available.

Bill Neumann:

Yeah, that’s incredible stuff. So good, you’re certainly using it to your advantage and I’m sure COVID probably… I know from a consumer standpoint, has made people look at things, “How can I be out less,” right? And so to your point, especially on the orthodontic side of things, aside from being somebody, busy mom or busy parents, I think right now, you have, in certain parts of the country, people that want to go out as little as possible. And we’re becoming kind of a culture of convenience anyway, so that’s the progression of the way things are, right? The Amazon Nation of things, right? Where everybody expects it in two days or a day.

Dr. Cindy Roark:

Oh yeah.

Jonathan Kaufman:

I mean, to be honest, in dentistry, if you do the same patient survey I did seven years ago, the number one thing patients wanted was convenience. You do the same survey today, the number one thing patients want is convenience, right? Yes, safety and price and value, those are all there but convenience. And so everything that we’re doing in AI has something to do first with patient care, but then with patient convenience.

Bill Neumann:

Yeah, and that’s something I think that DSO’s probably learned a while back and Dr. Roark, you talked about being a private clinician and having a private practice and I just my experience has always been, “Well, open three days, maybe three and a half days a week, most of the time not on Fridays, God forbid a weekend.” So DSO’s already saw that convenience is something that made sense.

Dr. Cindy Roark:

Right. And… Sorry, go ahead.

Bill Neumann:

I’d love to talk a little bit broader about Sage Dental, talk about, you obviously like to have a lot of fun it seems like you’re doing a lot of creative things, you want to take chances with technology and use things that that may or may not work, in this case it worked. Talk a little bit about just what’s going on at Sage, the type of culture you have there and just your thoughts on the future. I mean, you talked about basically doubling your footprint, right? In a year, a little over a year, so you’re going from 65 to 120. So does that mean you branch out beyond Florida and Georgia? Are you going to stick to… Since you have that great population boom in probably both states, do you just stay there and expand? I know it’s a bunch of questions but…

Jonathan Kaufman:

So we’re always looking for great opportunities, right? And I think that we see a ton of opportunity right now in Florida, we see a lot of opportunity in Georgia, and if we were to focus on that growth strategy, to that kind of 100, 120, I think the majority of that we’re looking to do in Florida and Georgia and quite frankly be the largest provider of dental care on kind of the Southeast area, if you will. Go ahead

Dr. Cindy Roark:

Regionally, I think you definitely wouldn’t see a shotgun… Do a shotgun approach just because it doesn’t make sense from an economies of scale. I love Oregon, but I don’t see myself buying a group right now there. But I think for me, a couple different things. Number one, you’re absolutely correct, Florida and Georgia, a lot of area to grow there and Southeast plenty of area, but I also see, and I hate to keep circling back around, but AI has an incredible capability to do some things in the dependent care senior community people who are in nursing homes, that we’ve never seen before. And I lost a parent during COVID and so I was first hand able to see no one can get in there, no one can get out, no one’s looked at their teeth, and nor will they anytime soon. And so there are opportunities there, believe it or not, for us to have other business verticals that can really impact how care is given in the United States today, and that’s a different mission entirely from, let me just grow, let me be big, let me be a dominant DSO, we really have our eyes on changing how dentistry’s delivered the US and that is a broader approach, that’s something that has reached far beyond the Southeast, and that’s really what I would say on that.

Jonathan Kaufman:

That’s a very good point. So beyond just the physical growth, right, we have ideas of growing the tele-dentistry platform to allow for greater access to care, right? And there’s some stuff where we will be launching here in six months or so that can’t really talk about right now, but basically provides anyone in any kind of health network to access Sage Care anywhere they are at any time. And even those who are not with Sage, can get care from Sage in a remote environment and either choose to come to a Sage practice thereafter or choose not to. So there’s not only the physical growth, but there’s kind of the vertical growth of some of the other opportunities we are developing within kind of this whole network of AI. And we call the whole thing, Envisage. So AI is kind of like the buzzword everybody talks about, but for us, it’s not AI it’s an entire ecosystem of patient care and care enhancement tools and convenience tools that just deliver kind of a new evolution in the dentistry experience.

Bill Neumann:

Yeah. So you’ve giving us a little bit of a peek into the not so distant future of Sage. So I try to end my podcast on this kind of question, if you get your crystal ball out and you say, okay, where do we see the industry… And Sage maybe let’s go out a little bit further like in five years time, five years is five years, right, we didn’t know COVID was going to happen, but assume there’s no COVID. Crystal ball it I’ll let… Jonathan can talk about this and then Dr. Roark you can finish it up.

Jonathan Kaufman:

That is a tough question.

Bill Neumann:

No pressure.

Jonathan Kaufman:

Only in January of… Actually in early March of last year, we were planning all these things that we were going to do and then three days later it completely changed, so how we think about what we’re doing but… I think and this may steal Cindy’s thunder a little, but the evolution of care is going to be on convenience and objectivity, in my framework. I think that if you are not a provider or a DSO or a group or a practice or whatever you are that is not providing a technologically objective approach to dental care, you are going to be thought of as a used car salesman. And that’s just what I believe, is that there are so many objective tools to enhance the care and interaction experience of your patient, both in the practice and external of the practice, that there’s no doubt in my mind that that will be where we are in five years. And I also think that the way care is delivered will be moving from the Monday to Friday, or in some cases Monday to Thursday, nine to five platform, to the Monday through Sunday, I don’t want to say 24 hours a day, but kind of the morning to evening, seven days a week platform of delivery of care. And that is what we’re striving towards as we kind of go throughout the next couple years, and for us that’s not five years, we’re hoping that that’s twelve months.

Bill Neumann:

Okay, that’s great okay.

Dr. Cindy Roark:

No pressure

Jonathan Kaufman:

No pressure

Bill Neumann:

No pressure. So Dr. Roark, I’ll let you finish it up. Any predictions on where you see the industry going or echo what John said?

Dr. Cindy Roark:

I would echo that and add another. First off, objectivity is really crucial. I think we owe that to patients and so companies like Pearl, who is going through FDA right now with their second opinion software, that really can detect about 30% more lesions than your naked eye would. I think that, from an objectivity standpoint, is pretty critical. We really do owe that to patients instead of me looking at something and, “Oh, you have decay,” right? I mean they believe it or they don’t, it’s real or it’s not, objectivity is key. My third thing, I think you’re really gonna see is more of a convergence with medicine. Because February 3rd of this year, that article came out and said the really sentinel study on COVID and periodontal disease release. I’ve got statistics in front of me but it said, if you have gum disease and COVID you’re three and a half times more likely to be admitted to intensive care, four and a half times more likely to put on a ventilator and nine times more likely to die.

Dr. Cindy Roark:

So when stuff like that really gains traction and then I want to say even this week, somebody put out that the American Heart Association had just looked at good oral care versus antibiotics to prevent infected menocarditis. So yeah, inflammation’s a killer, we all know it, but now suddenly with COVID, patients are understanding more, “Hey, I might actually have to take care of my teeth.” And that gives us a different mindset and I really think you’ll see a lot more of that convergence between medicine and dentistry because there’s more of a mandate to deal with this oral area than there ever has been. So that’s what I would add on to what you said.

Jonathan Kaufman:

That is right.

Bill Neumann:

That’s good stuff. Go ahead John.

Jonathan Kaufman:

I got one more. I think…

Dr. Cindy Roark:

Crystal ball time.

Jonathan Kaufman:

I don’t think it’s five years, but you’re already seeing these kind of concepts come out of New York with Floss Bar and some of these other places where it’s just a more Apple-esque retail experience. And if you go back like eight years, there were tons of groups that were pitching the patient experience. We were at IDS in Germany like three or four years ago and I mean it was incredible the type of patient experience that some of these European practices give. We were even in china a few years before that and some of these dentistry clinics are just so much more clean and sophisticated and I think that you’re going to see kind of an evolution from, finally, I don’t think it was there when they were pitching it seven years ago, but I think you are going to see an evolution in kind of the look and feel and application of a dental practice, especially when you think about waiting rooms maybe not being a thing anymore, right? Virtual waiting rooms we have in every one of our practices so you’ve got more space, you’ve got more options.

Jonathan Kaufman:

And I think the days of blue, green dentistry and taupe walls and just kind of that universe, it just has to become more retail based, more pleasant.

Dr. Cindy Roark:

More pleasant is exactly…

Jonathan Kaufman:

I think we’re trying to be more fun, right, we think we’re fun, we want to have fun with our consumers and we’re not under some sort of misunderstanding that dental consumers are going, “Yes, I’m going to the dentist today,” right? In fact we truly think of it as most people are going, “Oh, I got to go to the dentist today,” right? And so our goal is not to create this amazing exuberant experience that is incredible, it really isn’t, it’s simply to provide something that doesn’t make you… It makes you not think of dental as poorly as you may think of it before, right? So instead of going, “Oh, I have to go,” it’s like, “All right, I’m going the dentist,” That’s our aspiration and I think that that’s a realistic aspiration and not some sort of 5,000, 10,000 foot perspective that it’s got to be beautiful and wonderful and spas and fingernail, whatever some of the other groups have done which is completely respectable, but that’s where I think it’s going to go.

Bill Neumann:

Good stuff. Well, you’re both right, this was a lot of fun. So you’re fun and this was a great podcast.

Jonathan Kaufman:

Fun Dentistry Podcast, okay.

Dr. Cindy Roark:

Job is done.

Bill Neumann:

Dr. Roark did promise that. Well, thanks everybody for watching the Group Dentistry Now Show, or you might just be listening to us. I’m Bill Neumann, I’d like to thank again Dr. Cindy Roark and she is the Senior Vice President and Chief Clinical Officer at Sage, and Jonathan Kaufman who is the Chief Marketing Officer at Sage Dental. Thanks both of you for joining us today.

Jonathan Kaufman:

Thanks Bill.

Dr. Cindy Roark:

Thanks so much, thanks for having us.

Speaker 1:

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