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

Norton Travis, CEO, and Dr. Bruce Valauri, Director of Prosthodontics and Chief Dental Officer of ProHEALTH Dental, discuss their unique DSO business model. Their philosophy is that the existing medical-dental chasm is not in the best interest of the patient and that collaboration is essential to address overall wellness. Their model focuses on the oral systemic connection with the motto: Put Your Health Where Your Mouth Is. If you want to understand how a DSO is creating a connection between the disciplines of medicine and dentistry, this podcast is for you!

This podcast is proudly sponsored by Dentrix Enterprise from Henry Schein One. Benefit from the powerful interoperability of Dentrix Enterprise, which works with over 40 different medical systems to help dental organizations improve efficiencies and provide better overall care for patients. https://www.dentrixenterprise.com/gdn

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:

This podcast is sponsored by Dentrix Enterprise from Henry Schein One. Benefit from the powerful interoperability of Dentrix Enterprise which works with over 40 different medical systems to help dental organizations improve efficiencies and provide better overall care to patients.

Bill Neumann:

I’d like to welcome everyone back to the Group Dentistry Now Show. I’m Bill Neumann. And thank you all for listening on, let’s see Spotify, your Google or your Apple devices or wherever you can find us. Or watching us on YouTube or finding us on the GroupDentistryNow.com website, happy to have you back.

Bill Neumann:

And we always promise to have interesting guests. And the two that we have here are no exception. So we’re going to talk about something that’s been talked about in the industry for a couple of years that I think really with COVID, the onset of COVID, and people thinking a little bit differently, medical dental integration. So who better than ProHEALTH Dental to talk about this. So we have the CEO, Dr. Norton Travis, ProHEALTH Dental here. Norton, thanks for being here today.

Norton Travis:

Thank you.

Bill Neumann:

And then we also have Dr. Bruce Valauri. And he is the Chief Dental Officer and the Director of Prosthodontics as well.

Dr. Bruce Valauri:

That’s correct. Thank you.

Bill Neumann:

Yeah, thanks for being here, Bruce. So good stuff. I’m going to let Norton start things off. Norton, if you could give us a just a little bit of like a brief bio on your background, and then maybe talk about why ProHEALTH Dental was created?

Norton Travis:

Sure. Well, let me start off Bill. Well, my mother always wanted to be a doctor. I’m actually not a dentist, my doctorate is in law. And I I started my career and spent the first 27 years of my career in the healthcare industry, doing mergers and acquisitions and understood the regulatory aspects of, mostly on the medical side, touched on dentistry from time to time. But it was after I left the business of law, and went into a number of different entrepreneurial healthcare businesses, that I really came to understand the industry a whole lot better. Which took me to about five and a half years ago now I was fortunate enough to be approached by the founder of ProHEALTH dental, a forward thinking physician named Dr. David Cooper, who had formed ProHEALTH Care Associates, a large medical practice here on Long Island serving Long Island, Queens and the Metropolitan New York area.

Norton Travis:

And David and I had worked extensively together. I was his lawyer going back about 30 years, and told me about his vision to create a sister dental business. Truthfully, I didn’t really know much about the DSO industry, it hadn’t been something that I had touched. And I decided that I would do some research about what we could do to differentiate ProHEALTH Dental from the other dental service organizations, and dental support organizations that were already in development and operating.

Norton Travis:

And so this very much takes us to what we’re all about and why you see our tagline, put your health where your mouth is. And you see our logo, which is a tooth and stethoscope. Which is we are looking to be a disruptor, if you will, to break down the chasm between medicine and dentistry that’s existed forever, and to really look at dentistry as a health care service.

Norton Travis:

And I was shocked when I first started to do some research about this, about how significant adverse oral health conditions could impact so many different medical conditions. And actually the literature on that has been growing and it’s moved from not just the dental literature but also to the medical literature, which as we’ll talk about some more, has been helpful for us to get buy in on our models. So again, background is 40 plus years in the healthcare services industry, both as a lawyer and then in a entrepreneur management role. And now five years with ProHEALTH dental growing our model, which be happy to share more about with you, after hearing a little more about Bruce’s background.

Bill Neumann:

Yeah, that’s great. Thanks for the insight on that. Let me ask you one last question before we get to Bruce. Talk a little bit about geography and number of locations right now.

Norton Travis:

Sure. So our geography, it’s hard to answer that just on numbers or locations, because our geography is really driven by our what we call clinical affiliation model. In other words, while we do mostly de novo offices, we’ve done a couple of acquisitions, all of it is driven by being in the geographic area where our clinical partners are located.

Norton Travis:

So for us, it’s not how many flags on the map, it’s where the flags are, how… I mean, we look at the demographic data that we get from our clinical partners, in which currently, we have five clinical partners. And just this is four medical groups and one healthcare system, but the four medical groups alone cover for different geographies, collectively treat over 3 million active patients. And so we go where they are, we go where their patients are.

Norton Travis:

So we look at demographic data that will show the density of mostly their primary care physicians by zip code, and look to see where their primary care hubs are, and want to be located either in those hubs or in close proximity. So today, we operate 13 locations. If we were doing this three months from now, it would be 16 locations, we have one acquisition that kicks in July 1 in two de novos that will be open by the end of the summer.

Norton Travis:

And we have a pipeline that will take us to a minimum of 20 locations by the end of the year. Again, just moving fairly slowly, obviously, like everyone else COVID was an impediment to our growth, not only because we had to shut down and then restart, but we had to be respectful of the fact that our clinical partners in the healthcare services side were likewise impacted by COVID. They had to shut down and restart. And as we go to them, and we work with them to add a new service line in oral health, we had to be respectful of the fact that they needed to get their core service lines in primary care and primary care subspecialties up and running. So last year was a bit of a bust for us, like most people in terms of growth, but we’re back at it this year, and have a pretty robust pipeline.

Bill Neumann:

That’s great to hear. Good. Thanks for the background on that. And sounds like big things to come in 2021 and beyond. So Dr. Bruce Valauri. Again, thanks for being here. Let’s talk a little bit about why you took the Chief Dental Officer role at ProHEALTH dental and actually maybe before that, a little bit of your background, like a brief bio, if you don’t mind.

Dr. Bruce Valauri:

So following dental school, I went on to do graduate training, general practice residency, and then a formal prosthodontic program which I’ll explain to you very briefly. Most people don’t know what that means, and then a maxillofacial prosthetics fellowship as well. At the time, I had the opportunity to go into a part time academic situation, as well as private practice. So I did both for some 33 years.

Dr. Bruce Valauri:

I practiced in a fee for service practice specializing in prosthodontics, which is the one of the nine dental recognized specialties of the area to restore teeth and structures that are missing in the oral cavity. Without any real specifics, basically, it’s oral and dental rehabilitation.

Dr. Bruce Valauri:

I also had the opportunity to direct the graduate residency program at the New York VA Medical Center where I did my training for some 26 years. So I had an opportunity to be heavily involved in a hospital based dental program for a number of years. I was also heavily involved in dental specialty organizations as well. So my background is really patient care, education, academics. So when I retired from teaching, one of my dental school classmates was one of the co-founders of ProHEALTH Dental and he kind of filled me in on what the opportunity could be here. So I came on part time, initially.

Dr. Bruce Valauri:

True to their word, it was a very care based quality based, care model. And Norton, when he joined shortly thereafter, as he made mention, really focused on integrated care and looking at patient as a whole, there’s no… Patients need to even be educated that their mouth is connected to the rest of their body, something as simplistic as that.

Dr. Bruce Valauri:

So I came on in that role, part time, and then three years ago, full time, assuming the role of Chief dental officer. For me, it’s a tremendous opportunity to do something that is at the very base of a sensible way to care for patients. It’s really impressive how we’ve kind of created this unique situation where it really should be widespread and heavily accepted across all lines. But again, with a lot of effort, we’ve created educational materials for our patients, for our medical colleagues, as well as to make sure our dentists are well oriented in all the facets of integrated care. So for me, again, it was an opportunity, fit perfectly with my background, I think and made sense in terms of how we can best care for our patients.

Bill Neumann:

So maybe just tie into this a little bit deeper, as far as the chief dental officer role goes. Talk a little bit about that. What that means, and then maybe What’s your relationship with some of these medical affiliates and the partners that you have?

Dr. Bruce Valauri:

Sure. So we created our own protocols and procedures and policies that were in line with our mission of promoting proper oral care and its impact on systemic care. So it’s basically a healthcare manual. We have, again, created other documents that show the correlations and links between oral health and systemic health. And that’s something again, we provide to our patients and our medical affiliates. They’re as evidence based as possible.

Dr. Bruce Valauri:

And as Norton alluded to earlier, much of this early on was in the dental literature, but now that it’s been appearing in the medical literature, it’s given us a lot greater traction in terms of presenting it to our medical affiliates, as well. So there’s a greater level of acceptance because, again, some of this valuable data and correlations are very clearly delineated in the medical literature as well. Sorry, I may have gotten off topic there.

Bill Neumann:

No. That’s great. That’s perfect. Norton, let me ask you this question here. I mean, certainly this applies to you as well, Bruce. But as far as probably easier models out there, there’s some proven DSO models. Certainly, medical-dental integration isn’t probably the easiest path, because a lot of education that has to go on right. So talk a little bit about your passion, Norton. Why did you decide that this was the route to go?

Norton Travis:

That’s a really good question, Bill. As I said before, I’ve been fortunate in that I’ve had a long career in the healthcare services, serving various health care services. And when this opportunity came up in the dental space and I learned more about how meaningful these correlations were, how significant they could be, in terms of actually improving people’s health. And for myself, I have to admit I was the… I think fairly the typical patient who felt that you went to the dentist to get your teeth cleaned, or if you had a toothache to get put out of pain.

Norton Travis:

But I never went there thinking that I was going there to get healthier or to stay healthier. Even though healthcare was always a focus of mine and staying fit and staying well. I don’t think I’m different from most of the population and it is because of this historical… These silos that medicine and dentistry have been practiced in. So to me, it was a challenge. It was something that in terms of, and nothing derogatory at all, about if you well, the DSO industry. I think that they serve a huge function and can be extremely successful.

Norton Travis:

Ours is different. I mean, ours is literally going and we want our patients to come and have a wellness visit. That’s how we look at it. I’ll let Bruce give you more detail about some of the current diagnostic and other testings that are part of a hygiene visit. But we want to educate patients about oral health. I mean, if we could, I would rather almost be named ProHEALTH Oral Health. And because we really… The moment you use the term oral health, I think it puts sharper focus on what our mission is.

Norton Travis:

We work with our affiliates, Bill, to actually have them look at oral health as a primary care service. So that for the first time when your physician, as part of your annual wellness checkup says, “When’s the last time you went to the dentist that patients are asking?” Basically, “why are you asking me this question. You never asked me this question before.” And it’s the perfect lead in for because in effect, bad things go on in your mouth, bad things could go on in your body.

Norton Travis:

And we have, as Bruce mentioned, a great deal of literature that patients can take home with them. And I think everyone is surprised, I think there’s a certain level, I can speak for myself of ignorance that I felt that the mouth was really separated from the body and that there weren’t the kind of linkages that we know exist. So my passion on this is that we’re doing something different, I always prefer, and Bruce has certainly heard me say this enough times, how do we differentiate ourselves from others? What can we do that’s different? I think that we can make people healthier. I think actually, another aspect of it is that we can help reduce healthcare costs.

Norton Travis:

We know that if people will come and take care of their mouths, whether they are people who already have diagnosed chronic diseases, whether it be heart disease, diabetes, pulmonary disease, or otherwise, I mean there’s plenty of studies that show that when that population takes better care of their mouth, their health care needs go down. So when we can… And now those studies, as I’m sure you’re aware, Bill, they spread into Alzheimer’s disease, certain types of cancer, big focus on COVID.

Norton Travis:

So get people thinking about taking better care of their mouths. I think the millennial population right now is a wellness oriented population. And it used to be that when you use the term holistic, somebody sort of thought that was equivalent to alternative medicine. And you were going to be… It was a snake oil kind of situation. But we think holistic approach actually makes a great deal of sense. And merging medicine and dentistry is really, for us, the key to wellness. And that’s our mission. We’ll provide what we think are the highest quality dental services at each of our locations, they’re all state-of-the-art locations, they tend to range from 8 to 14 operatories. Most of them are de novos. Full service, adult and pediatric dentistry in general and specialty.

Norton Travis:

But from the moment somebody comes through the door, and they’re screened for sleep apnea, and they are given certain tests, it’s a different experience. And that, to me, is what allows us to develop these relationships with these large, high quality medical groups that now see that there is this direct correlation. So Bill, we have to educate our dentists, we have to educate the physicians, we educate the public, insurance companies, employers who basically are the ones who decide how much money to spend for health care services for their employees. Everyone’s got to understand, as we say, in our motto, if you put your health where your mouth is, you’re going to be healthier, and you’re going to save healthcare costs. So that’s the passion.

Bill Neumann:

Yeah, I love it. Thanks, Norton. That’s good stuff. Bruce, I don’t know if you want to tag on to that at all with your background and your passion.

Dr. Bruce Valauri:

Yeah, well, I think a lot of it has to do with, again, our model was a novel undertaking at the time, but not for us. I mean, I think a lot of literature, as I mentioned earlier, has come from the COVID time and showing some of these correlations. And so it’s become now a focus of other groups to kind of jump on this again, hopefully for their patient benefits. But it’s really what our foundation has been our mission from day one.

Dr. Bruce Valauri:

So the thought of grading medical and dental care is not new to us. Again, this is who we are. And with that, as Norton said, we look at our visits with our patients as wellness visits. Trying not to be reactionary to a particular dental condition for our patients, but be preventative. And preventive care since the early 60s with fluoride and routine visits to the dentist has changed the scope of treatment. But certainly, periodontal disease is the focus of an and the base of many, many of these correlated issues.

Dr. Bruce Valauri:

So our focus is on identifying, diagnosing, documenting, and when appropriate, sharing that information with our medical colleagues to, in particular, if a patient has some comorbidity or confounding medical condition, to inform them that this is their patients dental condition, and that there is strong evidence to show that there’s a linkage for a medical condition that you are managing your patient for, and that this is our scope of care and our treatment plan. And that way, the conversation, and the treatment plan, and the management of these patients, is really coordinated and done in a very collaborative manner with our medical colleagues.

Dr. Bruce Valauri:

And so again, it’s about relationships, it’s about not just having, obviously, an affiliation agreement, but about having a relationship with our medical colleagues and communicating, obviously, for the best interest of our patient. So with that, as Nort mentioned, one of the basic screenings that we provide for our patients is, in this group of screenings that we do is a sleep apnea survey, or sleep disorder survey.

Dr. Bruce Valauri:

And that’s something that’s been identified and managed on the medical side for a number of years. So we identify patients that may have a sleep disorder, we have sleep specialists, we have a director of sleep medicine that trains and educates our dentists in that area. So we take the survey responses, we have a coordinator that reviews them. And basically we do a consult with those patients that score in an area that needs to be evaluated. And then work very closely with the medical affiliate, the pulmonologist that deals with sleep on the medical side. Coordinate sleep study and results of a sleep study.

Dr. Bruce Valauri:

And if the patient can be managed with an oral appliance, then we will manage the patient that way. Or if the patient is going to be managed on the medical side with a CPAP, which is very common and literally the gold standard, but not always compliant with patients for a variety of reasons. But we offer that alternative option to manage their sleep apnea, which, again, there have been a number of… For years, actually, there have been a number of papers to support the severity and the health risks involved.

Dr. Bruce Valauri:

Certainly, there have been things. Unfortunately, there’s some tragic accidents that have been related to some workers that have fallen to sleep apnea, untreated and such. And so those are the things that sleep apnea, aside from obviously, the cardiovascular component to it. And pulmonary component to it that we would like to address. With that we also, as dentists, it’s been standard of care to do oral cancer screenings, and head neck examinations, which we provide at every patient visit, hygiene visit rather, and follow-up visit.

Dr. Bruce Valauri:

We also employ a visual device to help hygienist potentially identify lesions in the mouth. So it’s a light transmission device. We’re always looking at different technologies that would give us a better handle on looking visually and such. And I can’t thank our management team, Norton as our CEO for the tremendous support that they give us, when we come across a technology that we may want to employ. And again, we do it across the board with our providers. And again, if it’s something that’s going to help our patients and provide optimal care, it’s something that we have tremendous support from him, and we’re very fortunate to be in that situation.

Dr. Bruce Valauri:

Pardon me. We also do employ what we call cardio diagnostic screening. We do a four lead EKG, which is a cardiac rhythm strip. It’s not a full lead EKG, but it indicates a normal rhythm or it indicates there may be the presence of some type of arrhythmia. It gives us a printout that we can share with our medical colleague, more so for the start of the evaluation of a patient, because they may present with a cardiac condition that needs to be managed. Blood pressure as well, which we do routinely.

Dr. Bruce Valauri:

And so those are some of the specific cardiac tests. We also since COVID, to do pulse ox screening as well. Actually, patients are very aware of pulse oximetry since COVID and looking at those levels. So we take all this information and again, with abnormal findings, share them with our medical affiliates, our patients, if they do not have an identified primary care physician or specialists that’s managing some co-morbid condition, then we refer them to one of our medical affiliates.

Dr. Bruce Valauri:

And so we feel that the communication, the relationship, and presenting these wellness findings to our patients have all been met with great positive response. We’re healthcare providers, and again, we don’t differentiate ourselves from the medical side. In fact, we find ourselves to be part of that team. As Norton again made mentioned earlier that we look at ourselves from the primary care physician’s side that we are part of our patient’s overall care. So from both sides from the medical side, as well as the dental side that’s how our patient should look at us, equal.

Bill Neumann:

Thanks, Dr. Valauri. So it’s interesting. Talk to me a little bit about, and maybe it’s post COVID, maybe it was a little bit before COVID, started to be a lot more talk around the medical dental integration. Always talked about it prior. But it seems like as I think even patients became a little bit more educated on things. What do you feel you’re doing… Maybe this will be for Norton. What do you feel like you’re doing a little bit differently than maybe some of these other groups out there that might be kind of dipping their toe, so to speak, in medical dental integration. But I don’t see a lot that are fully committed to it, maybe, if that makes sense?

Norton Travis:

Well, I think it does. Yes. And I’ll answer with a couple of anecdotes, and I think you’ll see where we’re coming from. So even way before COVID, in the first year that we opened, so going back to 2016. Because we’ve only been around for five years, or as I always tell people five years minus 2020. But I remember that I attended for the Harvard School of Dental Medicine, they conduct an annual forum on oral health and have been big proponents of medical dental integration. And I was very new in the industry. So I’m the guy sitting at the back of the room.

Norton Travis:

And I saw my now friend, Stan Bergman giving a presentation. And he was so passionate about, everybody is talking about this, but is anybody going to do anything about it. And it really helped light the fire for us and for me, and that’s what helped stimulate the model. We now really focus on this as an essential part of our business. Dentistry is obviously, the… Of course we’re looking at production and collections, and we’re looking at case mix like everyone else.

Norton Travis:

But all of it revolves around this model, to the point that calling upon Stan’s, sort of everybody is talking the talk. So we have a Monday noon meeting, that Bruce and I head up, that basically is the walk the walk meeting, and that’s actually what it’s called. And that’s our medical dental integration meeting. And every week, we want to identify how what we’re doing is working, what the receptivity is in the medical community, in the patient community. And what more we can do to get people focused on their oral health.

Norton Travis:

And we know it’s working, because one thing that I’m really proud of that I think makes a big difference. Bruce described how our hygiene visits are becoming these wellness visits with these various tests. Well using, if you will a COVID expression. Our hygienists have become our frontline health care workers. And as they administer these tests, and we expand their role, we are seeing and Bruce can address this because he sees it on the frontline better than I do, how the hygienists really, they see themselves in a much more significant role than they did historically. As we empower them to be part of a wellness visit I think that the spirit that it engenders, the culture that it engenders, really helps us advance our model.

Norton Travis:

So during COVID, we could share it with you, Bill, we did a bunch of public service announcements about the importance of taking good care of your mouth while everyone else is… While we’re all hunkered down, and we’re focused on not getting sick. And it really gave us the opportunity to do these public service announcements, about putting your health where your mouth is. And it really resonated. And we were doing this at a time that we were essentially closed other than for emergency visits. But we still got such terrific feedback that we did cause people to think about oral health as an important service.

Norton Travis:

So yes, you could go on almost any dentist’s website and there’s going to be something there about oral health and maybe some correlations, but it does generally stop there. And for us, it’s really the mainstay of our mission and our model. The last thing that I’d ever want to do is look for a silver lining in a pandemic, but it certainly caused people to really focus on their health and understand more how keeping proper oral health was going to help with that course.

Bill Neumann:

Excellent. Dr. Valauri, got a question here. But as far as working with some of your medical affiliates, let’s talk a little bit about the highlights of working with them. And then also maybe some of the challenges you may find. And then I’m really curious. You talked about the diagnostic tests that you’re doing and the wellnesses that you’re doing from the dental side. Are your medical affiliates doing any diagnostic work, maybe where they’re finding there might be periodontitis, or things like that. So then in turn that they can possibly send them to ProHEALTH dental.

Dr. Bruce Valauri:

So I-

Bill Neumann:

It was a three-parter.

Dr. Bruce Valauri:

I’m putting it together. So on the medical side, I’ll go in reverse. On the medical side, we haven’t gotten to literally to that place where they’re actually doing examinations. Although, with some medical specialists, like ENT specialist they will be looking and we work very closely with them. Again, my background as a maxillofacial prosthodontist, I worked with plastic surgeons and head neck surgeons all the time. And so it’s not uncommon for because of their medical specialty for them to be looking in the patient’s mouth.

Dr. Bruce Valauri:

Primary care physicians, it’s very unusual. I think if a patient voices a concern, then they will make the referral. I don’t know that they really have the education and training to diagnose periodontal disease. They may see something where the tissues are abnormal, but perhaps nothing more than that, which is fine. And again, if they can get a patient, to the dentist, and more importantly, to us where our focus is just that, then that’s what we hope for.

Dr. Bruce Valauri:

We know that, again, from the relationships that, on the medical side, they very much appreciate and understand the correlation. It’s actually the moving of the patient and disseminating information. That’s really what our thrust of what we’re trying to accomplish to get movement from that side. I mean, there’s no question that we’re making great strides in providing as we said before, educational information and trying to find the best manner to communicate that with the patients and the medical affiliates so that they can share that with their patients in their offices and the patients make their way to us for their routine screenings and wellness visits and care as they need it. The other part, I apologize, and I went backwards, I forgot your first-

Bill Neumann:

That’s okay. That was my bad. As far as working with some of these medical affiliates, I think you kind of touched on it already. But maybe some of the challenges that you may be facing. And then what are the real benefits to it as well?

Dr. Bruce Valauri:

Well, the challenges are that certainly on the medical side, not that we’re not all busy all the time. But I know they’re exceptionally busy. And unfortunately, even for them to pose the question to a patient when was the last time you saw your dentist, that adds another potentially couple of minutes to a visit. And they may not really be able to afford that time. And I respect that. So that’s why we have to do whatever we can do to help them.

Dr. Bruce Valauri:

Again, whether it’s a survey, which we actually have conducted, completed recently, with Harvard dental school. We conducted a survey in our primary care offices, basically a patient IQ of their dental condition, and essentially, are they aware that there is a correlation between that. So once that data is correlated, and we expect to have some nice results to share. Ultimately, we’d love to be able to do a clinical clinical research project where we actually find patients that do have comorbidities, and we do dental care primarily, again, periodontal therapies, and see if in fact, there’s a measurable outcome on their medical condition side, that’s a positive one.

Dr. Bruce Valauri:

And that would just be groundbreaking, it truly would be. And so we’ve had that conversation. And so hopefully, we’ll be able to go down that road, in not too distant future. So the benefits, when we do have, and we’ve had tremendous support. Our cardiac screening program actually was done in collaboration, in close collaboration with one of the medical directors here at ProHEALTH Medical. And really, we have to give a lot of credit to Dr. Stephen Goldberg, who really worked very closely with us, initially, to provide us with some structure to what he felt would be appropriate ways of screening patients, and kind of not stepping on the medical toes in a very respectful manner.

Dr. Bruce Valauri:

But again, creating some valuable documentation that we would be able to share as we do, and then manage our patients in a coordinated manner. So that’s been just a tremendous asset. And again, having that kind of background, going through our medical colleagues, because it wasn’t something that we kind of thought up and came up with on our own, but really did it in conjunction, this just speaks to exactly who we’re about and why we do things the way we do. So we don’t do things on just on the dental side and devise a plan and a protocol. We do it based on really very in depth research and communication with our medical colleagues.

Dr. Bruce Valauri:

Because it’s got to make sense and it needs to make sense for them. If we create something that doesn’t fit in any way shape, or form with how they look at patients or how they feel they need to care for their patients, then it’s not going to be able to be implemented on their side and essentially, it would be a waste of resources.

Bill Neumann:

Thanks, Dr. Valauri. That’s good information. Norton, I don’t know if you have anything more you wanted to tie in to that as far as of the challenges and highlights working with medical affiliates.

Norton Travis:

Just really, Bill, at a macro level, we know that if we’re going to change decades of what we see as adverse history, we have to do all the heavy lifting. Medicine, for better or for worse, is not seeking out dentistry or oral health as a service. And unless we can deliver a finished product of all of the clinical protocols that Bruce described, how we can work together, how we can share clinical information for the betterment of their patients, how we can share patients, how we can generate patients. I mean a lot of people don’t realize that generally, people go to the dentist more frequently they go see their physician.

Norton Travis:

And so we are a source of patients for them just as they are a source of patients for us. One of the, I guess I’ll call lubricants that helps us do this is that as part of our model, we’ve talked a lot today about our brand, ProHEALTH dental and working with ProHEALTH care associates on Long Island. But I think it’s an important visual to understand that when we go to other markets. For example, our newest affiliate is up in northern Westchester, going into the Hudson Valley, a group called Caremount. And Caremount Medical has 700 physicians and treats three quarters of a million patients.

Norton Travis:

As we operate there and open up offices this summer, we operate as Caremount Dental. Because we want the public to understand that this is now part of this trusted health care system that they have relied upon for their health care needs for many years. And we think that by doing that, that they will now see this as more of a healthcare service. I mean, if we went up there, and we went up there as ProHEALTH dental, even though we think it’s a good name, it doesn’t resonate the same way as being…

Norton Travis:

If Cleveland Clinic or Mayo Clinic opens up Cleveland dental, that’s going to have an impact. So that’s part of the model. We need all the help we can get. When you’re trying to disrupt many, many years of, again, what I would call adverse history, you have to come up with as many tools as possible to make that change, to bridge that gap. We think that the clinical literature is helping us, the branding is helping us. Bruce’s efforts in working with his medical colleagues.

Norton Travis:

But as I said before, Bill, this is our burden, this is our heavy lifting, that we need to take it to them. And we know it will take time. But we’re getting a lot of traction on the model. We’re getting a lot of interest from other medical groups who are familiar with our existing affiliates, and see that they’re doing something unique and broadening their service offering. So we feel more so than ever that we’re onto something, this is the right model. As I’m sure integrated medicine and dentistry is practiced in limited pockets right now, either as part of a FQHC Medicaid clinic, or perhaps on the West Coast as part of a Kaiser comprehensive care clinic or in some academic settings. But when we look to where most of medicine and dentistry is practiced, in the community private practice, you don’t see integration of medicine and dentistry. And that’s where we are. And that’s the space that we’re looking to make that change.

Bill Neumann:

Great. So got a couple last questions. I know we’re getting close to the end of the podcast, but you talked a little bit, and I always feel like I still need to address COVID. So let’s talk a little bit about, you talked about being shut down for a decent amount of time. You also talked about the public service announcements that you did during that time to help get that message out about making sure that you keep brushing your teeth, you keep flossing and keep that oral health going and how important it is. Talk about the challenges there. And maybe Dr. Valauri, I’ll let you start.

Dr. Bruce Valauri:

Sure. So we had during the shutdown, as Norton mentioned, we were open for emergency care by the directive of what the guidelines were in New York State at the time. And also management, administrative wise, we, our clinical leadership, with our management team, we would have conference calls, oftentimes several times a day. From the moment we shut down, we were planning how we were going to reopen. And how we are going to reopen in the safest manner possible.

Dr. Bruce Valauri:

So we were focused on looking at, without altering the need on the medical side, which was critical, was the PPE that was necessary to provide safety to our staff and clinical staff and our administrative employees as well. But without impacting the medical side, which again, initially there was, as you well know was such a difficult situation to manage. We also instituted teledentistry at the time, to provide an avenue for our patients to be screened to manage what their particular issues were dentally.

Dr. Bruce Valauri:

We found, interestingly enough, we were able not only to reach our own patients. But unfortunately, some offices didn’t have the ability to communicate with their existing patients. Either they didn’t have phone systems or whatever to manage that. So we found ourselves managing patients that were from other offices that had need.

Dr. Bruce Valauri:

So we provided that service, again, with support from our management team. We got that up and running very quickly. We vetted a number of different groups. And together we decided to go with one collective group that we’ve been working with, since that point. And so that was something that COVID… not that teledentistry wasn’t something that was be utilized. But we hadn’t really found the need to do it, but certainly catapulted us with COVID.

Dr. Bruce Valauri:

And then, we also spent quite a lot of effort looking into air filtration systems and such to create a safe environment, going back to reopening, again, for our patients and our staff, as well. With the support, again, of our management team after the research was done, and we identified what we felt would be the most appropriate way to mitigate the aerosol created during our dental procedures, we were able to identify and procure the proper aerosol reduction units for all of our offices for when we opened.

Dr. Bruce Valauri:

And we opened very robustly we were prepared to open on June 1, and literally open wide and running. So obviously patient return was sporadic in the beginning. The concerns went beyond the dental visits, initially. But here we are literally a year later. And it’s been quite a year. I mean, I did see a patient last month that it was her first venture out, literally since COVID, although she had been vaccinated.

Dr. Bruce Valauri:

She told me she really hasn’t gone anywhere, done much of anything. And practiced the same safety precaution since the shutdown. But again, emotionally feeling a little bit more comfortable, which fortunately got her back into the dental office. So that’s kind of where that journey’s taken us. But there’s no question that I live through the AIDS crisis. And that changed the profile of dentistry and how we do what we do in terms of safety and precautions. And COVID definitely brought it to another level. I will tell you that dentists, some of our younger clinicians, that hadn’t gone through that time of AIDS in the late 80s, mid to late 80s, it had definitely a greater impact. I’m not saying that I was less fearful, but I guess I was more prepared to manage the emotional part of it, than many of our clinical staff.

Dr. Bruce Valauri:

But again, with knowledge, not with just an acceptance of well, this is the way it’s going to be. And so, fortunately, we’ve done I think very well in terms of staff working very hard and dedicated to, again, taking care of our patients. Which is what we’re here for.

Bill Neumann:

That’s great.

Norton Travis:

Hey, Bill, can I just jump in on one thing?

Bill Neumann:

Sure can.

Norton Travis:

It occurs to me that it’s maybe a good way to summarize or maybe even, if we’re running out of time, wrap up and correlating COVID and ProHEALTH Dental and what we’re all about. So, as I’m sure you’re well aware, because being so attuned to the industry. I was going to say this time last year, but it was really more in the spring of last year, New York, like many states, it was very uncertain, where dentistry fit in within the state’s definitions of what they were calling essential services.

Norton Travis:

And actually, here in New York, we couldn’t get a clear answer from anyone. And with all due respect to the dental associations and others we didn’t know if we should be treated the same as other healthcare services, or as what appeared to be the case, we were pretty much in the same bucket is beauty salons and tattoo parlors. And we decided that when that was such an uncertain situation that we were going to take this upon ourselves.

Norton Travis:

And there was actually a process in New York where you could apply as an essential service in case the state made a mistake or overlooked something. And we created a very comprehensive file of the same kind of clinical literature we’ve been talking about as to why oral health has to be looked at as healthcare service. And fortunately, through having been around the New York State Health Department and the governor’s office and having some relationships, we believed that we were, if not the final motivating factor, but had a huge influence.

Norton Travis:

As the same reaction that I had five years ago that when I talked to my friends about what I do, we went up to Albany. And we were sitting with… And these were healthcare officials, these were public health care officials. And they were incredulous that here we were talking, as a dental organization, we were talking about why should we should be treated as an essential health care organization. And I am 110% confident that that accelerated the reopening of dentistry in New York, and I think now has us on par with other health care services. So again, never like to find silver lining in such god awful things as a pandemic. But it did really give us an opportunity to educate the public health officials on why oral health is so important. And it was a project that we took upon ourselves. And we’re very proud of the work that our team did.

Bill Neumann:

That’s great. Yeah, you’re right. I mean, there is a silver lining there for sure. A year ago weren’t sure where dentistry stood. As far as on the scale of important or not, we knew. But I think a lot of people, whether it’s state, federal, and then patients maybe didn’t even know, so if anything, it elevated the industry. Although it was probably a fight to do that. But that’s a good thing. And we certainly appreciate that, and hopefully going forward, people don’t forget. Let’s talk last point, and then we’ll wrap it up. Future for ProHEALTH Dental. We’ll go with Dr. Valauri. And then Norton, you can have the final say on that. And then we’ll wrap it up.

Dr. Bruce Valauri:

I hope next time we have a conversation in the very near future, we’re going to be telling you that we’ve made tremendous progress in terms of patient response from the medical side. I think our goal, and it’s going to sound a little strange, but we’ve had this conversation before, would be to find a patient in our screening process that has a medical condition that they were completely unaware of. And it’s going to be managed by our medical colleagues. And the patient will go on to live a healthy and normal long life, undiagnosed, God knows, God forbid, what could have happened. And I think that would be the stories that we would like to tell you going forward that would have been us feeling as if we’ve made tremendous strides in doing what we are trying to do on a daily basis and helping our patients.

Bill Neumann:

Great, Norton?

Norton Travis:

So Bill, I think the answer the question is that we believe in our model, we believe that how we are changing the public’s perception of dentistry as being more than a bright smile or getting put out of pain. But actually is a healthcare service is here to stay. I’m aware that large organizations are starting to look at this issue. And we think it’s a good thing. We don’t have monopoly on this concept. We just think that we’re the first movers on it. And we think that our model of taking it to medicine is the right approach.

Norton Travis:

We see what we’re doing here in the metropolitan New York area, which is not the easiest market to start in. Because Lord knows there’s no shortage of dentists around here. But there’s a lot of people and there are some large organizations like the ones that were affiliated with that we see this as our proof of concept. We see that this is working, that we can continue to strengthen those relationships. And we see this as something that we plan to grow both regionally and nationally as the model continues to catch on.

Bill Neumann:

Great. All right well, that’s a great way to wrap it up, Norton, we appreciate it. Thanks, everybody for listening in or watching us today, if it’s on YouTube, we definitely appreciate ProHEALTH Dental, taking some time out of their busy schedules, as they really talk about medical and dental integration. And again, we’ve heard it a lot past couple of years. But these folks are actually doing it day in and day out.

Bill Neumann:

And sounds like they’re going to be growing and we’ll make sure we keep on track of that. And I also wanted to mention, congratulations on being on our emerging groups to watch list for 2021. So we want to make sure we follow your progress. And also a quick shout out to Henry Schein One for sponsoring this podcast. We appreciate that. So that’s it for me, thanks to Dr. Bruce Valauri who is the chief dental officer and also the director of prosthodontics for ProHEALTH Dental and Norton Travis who is the CEO for ProHEALTH Dental. Thanks both of you for being on the Group Dentistry Now Show today.