The Group Dentistry Now Show: The Voice of the DSO Industry – Episode 87

🎧 Melissa Marquez, Director of Operations & Success of Jarvis Analytics (part of Henry Schein One) joins the Group Dentistry Now Show. Takeaways from Melissa Marquez’s conversation with GDN:

📊 What metrics your DSO should be monitoring.
📊 Setting goals that create accountability and drive change.
📊 Incorporating dental analytics in your business planning to improve business performance.

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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. The Group Dentistry Now Show: The Voice of the DSO Industry has listeners across North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Bill Neumann:

Hey, I’d like to welcome everybody back to the Group Dentistry Now Show. I’m Bill Neumann and as always, we appreciate everybody listening in today or you may be watching on YouTube. So however you consume the content here, whether it’s the audio podcast or you’re watching us today, thanks for joining us.

Bill Neumann:

So we have a guest here, second time on the Group Dentistry Now Show. She was actually part of our DSO study club webinar and we turned that webinar into a podcast as well. So welcome back, Melissa Marquez, to the Group Dentistry Now Show. Thanks for being here again.

Melissa Marquez:

Thanks for having me again, Bill. So we’ve had some changes since the last time we talked so I’m happy to be back.

Bill Neumann:

Yeah. We’re definitely going to talk about those. Melissa is the COO of Jarvis Analytics and just saw Melissa not too long ago at the Women in DSO event. It was great to see you in-person and what a great event. For an inaugural event, everybody was happy to get back and over 500 people so it was pretty cool.

Melissa Marquez:

It was awesome. I’ll definitely be there again next year. And I would encourage any women in our field, and men, to join that next year. It was a great event.

Bill Neumann:

Yeah, yeah. I agree. And I think it was like 15 percent men so there was a good showing for the men. So yeah, it’s not just for women. I checked.

Bill Neumann:

So little bit of background on Melissa. Oh, and one other thing. Besides being on our webinar series probably about a year, maybe a little bit over a year, I also had the opportunity to moderate a panel discussion with Melissa and a couple other panelists at the DSO Leadership Summit. So it was just great. Did a great job there so this is going to be a really cool podcast here.

Bill Neumann:

So little bit of background on Melissa. If you don’t know her and she is at about every single DSO show out there, she began a career in dentistry 20 years ago and initially, she was looking to become a dental hygienist but then, and let me see if I have this right, the dentist that you were working with really somehow said, “Hey, this is interesting but maybe not so interested in clinical. I really like the business side of dentistry.” And from there, she joined a national DSO back in 2004 and spent 15 years there helping the organization grow in various operational and executive level roles. She’s been at Jarvis Analytics since 2020. And then Jarvis, it’s the fastest growing analytics platform for smart DSOs and recently became part of Henry Schein One, one of the family of technology products that Henry Schein One has. She continues to lead the operational and customer success departments at Jarvis Analytics and you now support over 1500 dental locations with analytics and business intelligence needs. So I know that’s a mouthful. Did I miss anything?

Melissa Marquez:

No. You got it. And you were right on my history as well. I started with all these intentions to be a hygienist. My whole family is in medical but I’ve always really been drawn to dental. And so those first few private practices I worked with, I worked with some awesome dentists and have so much respect for them. But I was really drawn to how they make things work. How the bigger picture comes together. And then when I moved to the Dallas area, I had the opportunity to join Dental One Partners. And at the time, it was a smaller DSO but over the course of 15 years, just had so many great mentors and partnerships and the opportunity to really help that organization grow into a national DSO. And then joined Jarvis. So I get to talk to all kinds of people whether they’re from DSOs, groups, or private practices today and how they can use data and analytics to keep growing their practice and serving more patients.

Bill Neumann:

Let’s talk a little bit about Jarvis Analytics. Tell us about the organization. Tell us about what a data analytics platform is and how it’s helping, whether it’s an emerging group or DSOs [inaudible 00:04:43].

Melissa Marquez:

So Bill, since 2017, Jarvis has been helping DSOs solve a lot of their unique problems. Whether it’s from understanding really, truly where their new patient attribution is. A lot of times, we can ask a patient how did you hear about the office? And they’ll tell us their version but until you have something like Jarvis that can actually track that back to the true lead source and the campaign that that patient came from, you don’t always know where to invest. So those types of problems that DSOs were originally facing.

Melissa Marquez:

Even problems like how do you compensate and pay your providers correctly when you’re in [inaudible 00:05:20] Practice Management Systems? Just getting to the correct production and collections in one place for those types of groups was really challenging. So that’s really where Jarvis started. We were a solution to DSOs that were really struggling with those types of issues.

Melissa Marquez:

You mentioned briefly a little bit earlier that we’re now part of the Henry Schein One family and that’s really just compounded our ability to serve more customers. So we’re just continuing to grow with that infrastructure and support and the power that it comes along with being part of such a big technology group that is really visionary. Wanting to move everyone into the cloud. Dental is a little bit behind in things like that and so we’re really proud and happy to be a part of the HS One family now and just see it as a way that we can serve more practices and ultimately more providers and patients.

Bill Neumann:

Excellent, yeah. So big news there with becoming part of Henry Schein One. Talk to us a little bit about what is being measured. So this is really interesting. I might have a lot of questions in this area. So top metrics by role and department. So maybe we’ll start there and we can figure out our LDSOs measuring the same types of things. Are there some that don’t necessarily want to let other people know what metrics they’re measuring?

Melissa Marquez:

Yeah, absolutely. Yes to both of the above. And when we’re working with customers that are DSOs, we really want to respect that decision to maybe not share some of their proprietary KPIs. So we do have customers that have their very own unique KPIs and ways of measuring.

Melissa Marquez:

There are commonalities though, of course. I mean some of the industry standard metrics are very common that you’ll see. One of the things that we encourage our customers to do and that I really love to talk about is identifying what your North Star is. What makes you unique as an organization. And so if you don’t know what a North Star metric is, a lot of larger organizations outside of the dental world identify their North Star metric. And it’s a metric that you need to choose in alignment with your vision because it should be something that indicated growth for your organization. So it’s not production. You don’t want to use production as your North Star. It’s really more of a metric that helps you achieve your end-goal of improving your production. And it really signifies what does growth mean for you? So in the dental world, this might look like to us, maybe this is the number of referrals for new patients that we’re receiving because it’s growing our practice but it also aligns with our vision to provide really great service.

Melissa Marquez:

So a lot of DSOs haven’t even really landed on what their true North Star is and it may change year to year. And that’s okay. But we find that it really helps align the organization around what’s most important to them regardless of the department that they’re in.

Bill Neumann:

So as far as various roles, can you give some examples? Like an operations … Well, here’s a more general question. So if I have multiple locations, am I measuring, do I have some KPIs at the top [inaudible 00:08:48]. And so maybe the COO’s measuring those or somebody that’s in charge there. And then at the practice level, do we have office managers or perhaps regional managers that might be measuring different KPIs? So KPIs that are more important to them at the practice level. Tell us how that works.

Melissa Marquez:

Absolutely. And I’ll share with you my top three or four for each function or department or discipline in the DSO. The short answer is yes. What’s going to be important maybe for your chief financial officer or your CEO to measure on a daily, weekly, monthly basis, is going to be different than what your practice manager is looking at. Ultimately, they may all impact your greater vision or that North Star, where your organization is headed. But because each person really has their own accountabilities and their own world that they’re living in within your organization and leverage their pulling every day, they need different KPIs and different ways to measure their effectiveness. So we can kind of break these out.

Melissa Marquez:

Let’s start with operations. So your operations team, that really consists of maybe your regional leaders, your directors. How are our practices functioning and our centralized services team from an operations perspective? When we think about the field and the practices in your DSO, I would say try and slim it down to maybe three or five things that you measure them on frequently and regularly and with transparency. Some of my favorites in this category are collections efficiency. You may be driving production but if you’re not collecting at a rate, at least 95 percent or better, you’re really leaving money on the table. And sometimes I see organizations focusing too much on production and not enough on collections. If it’s not in the bank, it really can’t help you with your cashflow and with being able to grow your business and potentially even acquire new practices. So really watch this. And when we get to the financial function that we’ll talk about, there’s another way that we can look at collections that’s really beneficial.

Melissa Marquez:

But for the practice team, your operations team looking at what percentage of the production are they truly collecting without writing off. And then also look at the patient copay portion. So are they collecting over the counter from patients their estimated portion? A lot of times, this gets overlooked and there might be issues with your front desk team feeling uncomfortable asking for that patient portion. Or maybe they’re just missing some processes that could help them estimate that more accurately before the patient comes in. So from a collections perspective on your operations team, those are really vital.

Melissa Marquez:

Your case acceptance rate is huge because it’s typically someone in the front office team or your practice manager that’s working to go over the financial side of the treatment plan with patients. You may have done a great job clinically teeing them up and helping the patient understand what they need but a lot of treatment walks out the door because people just don’t have the right tools for how to help that patient over financial barriers. So that’s a big one that I would measure every single day, talk about in your huddles, have in your end of day reports as an accountability of what was presented, how much really made it to the schedule today or was even actually completed same day.

Melissa Marquez:

And then the third one for your operations team I would say is your reappoint rate. That will really lead to stronger tension. So if you are proactively scheduling patients, not just to come back for their next restorative visit but going ahead and making sure they also have their next hygiene visit scheduled. That’s a future-building metric and you’ll be able to see much more early on how full your hygiene schedules are getting so that if you need to add hygiene days, you’ve got more of a heads up on that. So you can actually see an advance when it’s time to grow your hygiene department.

Melissa Marquez:

So those would be for operations. I have a few more functions. Did you have any questions on those? I know I talked-

Bill Neumann:

No, that’s great. Let’s keep going.

Melissa Marquez:

Okay. So for finance. Everybody looks at aging. I love what Jarvis can do with our historical aging. Not all practice management systems can go back to a point in time and tell you what your aging was. Jarvis can do that. So you’re able to see over time those balances in the various aging buckets, 30, 60, 90 day and above. How are those changing over time? So you can actually go back to a prior date and see what it was last year versus what it is this year. So that’s huge.

Melissa Marquez:

I would also say, I know I mentioned earlier a different way to look at collections. I love our waterfall report for this and CFOs and finance teams really love this for helping them understand how to predict things like cashflow. The waterfall report can look at the production and procedures that occurred in a given month and then we can trail the related collections out over time, over the course of 24 months, so that you can actually see of that production, what did you collect in the same month? And then what did you collect the following month that’s related to that production and beyond? So it really shows you for the future where you should be if you keep with those same trends and how much you’re collecting in the same month. And in our industry, with insurance and payers, that’s really important.

Bill Neumann:

Absolutely.

Melissa Marquez:

I would say those for the finance team. Clinical, for your doctors and hygienists, I think measuring not just their total production but really digging into production per day, production per patient visit and production per procedure can help you when you have providers working different schedules, different … Some are part-time, some are full-time. So really digging into what does it look like on a per patient or per procedure basis is super helpful. And then for hygiene, I love perio percent and retention. Those are two that will really help you if you see a big difference between your hygienists and what they’re performing at. I think everybody has their thumbprint on the fact that your hygienist should be earning about 30 percent of what they produce. If they’re seeing only pro fees, then there’s not a lot of perio taking place in their schedule. That can absolutely impact that number and drive your profitability down.

Melissa Marquez:

And then for your marketing team, everybody measures new patients but we don’t see a lot of people measuring things like the lifetime value of that patient as well as having account of leads. Whether those are coming from calls or forms that you’re utilizing with SCO. And so that and your cost per new patient acquisition is really important. So not just are you achieving your budget by spending three to four percent of your revenue on new marketing efforts but are the efforts that you’re putting that budget towards bringing in the patients that can add the most value to the practice? And which campaigns are really working the best for you?

Melissa Marquez:

So that’s my long version of the different departments and really things they may not be measuring today that they should consider.

Bill Neumann:

That’s great. And that leads to a question that I have. So they might not be measuring it today. So when you start to talk to groups before they work with you, what in general … What art would they be measuring? Are some doing one or two different KPIs but certainly not the breadth of KPIs that you gave us. When you come in and somebody’s like, “Hey, we need to start to really measure what’s going on here.” What do you encounter? And I’m sure it depends on the group.

Melissa Marquez:

It does. I think in general, most DSOs and groups have an opportunity to start forecasting more effectively. They all look at production. They all look at their P&Ls. They all look at things like adjustments and collections. But a lot of them don’t have a good system in place for saying when are we going to look at next month? And I think that’s important. I know that today and tomorrow are the most important days in a dental practice. But we also try to encourage them, now let’s look at your schedule production. So as a regional manager, do you look out at your set of practices, maybe when you get into the second or third week of the month. Yes you’re paying attention to this month and what’s happening, but how are you shaping next month so that you can be more proactive and really lean into some of the centralized services like your marketing team? If you know that every September, you struggle, then I would say about the second month of August, let’s keep our eye on August but let’s start looking at September and talking about what we can do now to really start building that month.

Melissa Marquez:

So not a lot of them really look at schedule production down to the provider level and then compare that to their budget. And that’s usually very eye-opening and helpful for them when they start thinking about their metrics and production. Don’t just look at actual production. Really look at your schedule production and exams so that you can be working ahead and get to a point where you’re going into the month with maybe 70 percent of your production already on the schedule.

Bill Neumann:

So that brings up the next question which is if they aren’t measuring a lot of these things and they start to measure these KPIs, talk about the buy-in or the issues you have may at the practice level from team members. They’re going, okay, why are they starting to look at things like this when maybe in the past they haven’t. That could be a challenge, I’m sure.

Melissa Marquez:

Yeah. And having been in a lot of those roles myself, I can tell you from personal experience, it always goes over better if we understand why. Why are we measuring this? How does it fit with the greater vision for what we’re attempting to do with patients? I’ve seen it in prior life or prior experiences and I’ve worked with a lot of great leaders that give you the why and help you really embrace why we’re measuring what we’re measuring. But sometimes we get in a hurry for no fault of our own and we decide to push out an initiative or a metric without really taking the time to build with the team the why behind what it is we’re doing and why’s it’s important. And that can be met with a lot of defensiveness because people then start to just make their own assumptions about why you’re measuring something.

Melissa Marquez:

And it’s especially important with your clinical team that they understand that when you’re putting in your clinical KPIs, those are being developed by your clinical leaders, not your operations team, and that they understand it’s because you share some common goals for standards of care in your organization. And so if you can have those conversations early on with them and then even with your operations team so that there is buy-in to what metrics are most important and why we measure them and how they’ll help us achieve our goals this year. That really can be met with a lot less resistance because they’re not left to their own assumptions about well, what does this mean? If my perio pro fee isn’t this percent, am I going to get fired? People start to create their own conclusions to things and I think DSOs especially don’t need that type of culture. I think they really need a culture when they talk about metrics that everyone’s aligned with and it’s very patient-centered, that aligns with the values and the goals that the organization has put into place. So I think conversations are really important early on.

Melissa Marquez:

And then when you’re having one-on-ones with your team members, making sure that they understand what their goals are and really helping them come up with plans that help them improve those areas where they may struggle that’s showing up in the metrics.

Bill Neumann:

So it seems like a lot of groups out there are starting to incorporate specialty into their practices where they might have been [GP 00:21:04]-focused as they start to scale up, they feel like they’re sending a lot of business out. They’re referring it out. So as they start to bring endo and oral surgery, orthodontics, perio, into the practice, what KPIs should they be measuring? It’s probably a new area for them so probably not really sure where to go.

Melissa Marquez:

Yeah. They will want to add some new metrics to their dashboards. And again, here’s really where team involvement is important. If you’ve got good buy-in from your team on referring to those specialists that you plan to bring in, you can measure the effectiveness of that. So I would say the first thing to measure is your referral count. So if you can, use your practice management system to … For example, let’s create a ledger code for every time we refer to ortho internally. Or let’s treatment plan that so we can track it in a dashboard like Jarvis. That will help them understand where they’ve done a good job of getting buy-in on that provider that you’re asking the team to refer to, or that you’re giving them an option to refer to that comes in-house. That will signal you early on if there might be trouble with that. If we have a practice that maybe isn’t on board with referring or maybe they’re just not used to looking for some of those opportunities to refer patients. So I’d say that’s the number one that you need to get in place from day one, what those referrals look like. That can be tracked as a metric in your system.

Melissa Marquez:

And then next, I would add things like conversion rate. So you might have a practice that’s doing a great job of sending consults over but maybe they’re the wrong type of consult for that doctor. Or maybe, again, we have an opportunity to improve how we discuss ortho with our patients and how we allow them to pay for it. So conversion rate can be really important and that’s simply just your consult to start ratio.

Melissa Marquez:

And then you might also want to add some additional KPIs on certain procedure counts. So when you’re adding that endodontist to the practice, make sure you have a KPI that shows you the various types of procedures that that endodontist does and what the count looks like for them so you can see that continue to increase over time.

Melissa Marquez:

And then last but not least, definitely look at the scheduled production and actual production per day. Depending on how, your own model and how that new specialty provider is coming in, they may only be in your practice one to two times a month, initially. And many times, you are paying them a higher percentage, possibly. You may also be paying them a per day rate in order to come to your practice. So you’ve got to make sure that per day guarantee is something that you can really beat and overachieve so that you’ve got some profitability left in the practice. So I would say really give your team a target of this is the number you need to aim for by next month so that this doctor can have a profitable day. All those are really important to think about when you start to think about introducing specialty.

Melissa Marquez:

I’ll also say before you introduce specialty, make sure you’ve got a good pulse on the demographics of your practice. So if you have a system like Jarvis, we can actually look at the age ranges of your patients, male to female. We can really understand what the makeup of that practice is. Obviously, if it’s 80 percent geriatric, you probably wouldn’t want to put ortho in that practice. So these are things you want to think about so that you’re setting the practice up for success and then you can measure that success with some of those KPIs I mentioned.

Bill Neumann:

Great information. Let’s talk a little bit about … So we’ve got all this data. We’re measuring KPIs. But really, it’s just data. So it’s really the actions that you take. You interpret that and then what are we going to do? It’s either we look at it positively or where we can make improvements. So let’s talk a little bit about best practices. Whether it’s benchmarking or goal-setting. Because I think it’s important. Data, data, data, it’s really great but it’s how you use that data to grow or to provide better patient care or whatever that KPI may be.

Melissa Marquez:

Yeah. And it can be really tempting to just constantly look at different KPIs and different metrics because there’s so many data points that we can gather that initially, it may feel overwhelming. Initially, you may be … This month let’s focus on this and next month let’s focus on that. But I really try and encourage customers to really work with their leadership team on those key metrics, get that buy-in from your team, and then really work hard and fast to those wildly important goals and those things that really matter to your organization that year.

Melissa Marquez:

When you initially set out to set some benchmarks, it can be tough because you want to make sure there’s agreement with your leadership team, number one. That we agree on what the benchmarks should be. And sometimes a good way to land on that is to see where you’re at today. So if you’re looking at where you’re at today with a metric that you want start holding your team to, look across the landscape of your enterprise and at your different providers and then bucket them into the top 20 percent and the bottom 20 percent. And see where you’re at today but then maybe a couple that, especially if it’s a clinical KPI with what do the organization’s … Like American Academy of Periodontology or what is the research tell you should be happening in your practice? And maybe you’re not where you want to be today.

Melissa Marquez:

And so it can be tempting to set your benchmark very high. But I think initially, if you see where you’re at, set your benchmark for somewhere in the middle of the top 20 percent range. Because if you had everyone performing where the top 20 percent are, you would be in a much different place. And so sometimes it’s not about necessarily … Yes, it would be great to have 80 percent case acceptance, for example. But if you’re achieving only 35 percent today, maybe initially set that target and benchmark closer to 50 percent. Make it achievable for your team so they’re not feeling demoralized by it. And then use where you’re at to show team members it is achievable. There are team members just like you that are performing at this level within the organization so we know it’s possible. I think those are great places to start.

Melissa Marquez:

When it comes to your annual budgeting and planning process, that can always be a cumbersome process. It can be something that starts in June and that you don’t finish still in December. So every organization I’ve worked with, when they think about planning their goals for next year, even if it’s just coming top-down, I would say set some targets for growth year over year that align, obviously, with what expectations of your board or if you are working with a PE. Set some common targets that they’re comfortable with. But consider the differences in your practices and maybe take your non-de novas, your organic growth that’s happening in your same store, and set a target for that. As well as maybe a different target for a practice that’s one to three years old because that should be growing at a much faster rate than a practice who’s been open 10 years.

Melissa Marquez:

The way the practices grow though might be different because some may have that specialty opportunity we talked about. Some may have an opportunity to add a hygienist. And so when it comes to budgeting and planning, just your basic production goals, maybe try and take that approach and categorize your practices into those areas. And then set targets that way with a plan that you can measure all year long.

Bill Neumann:

This is great. This is a lot of information. It’s super so if I’m listening or watching this and I’m interested in finding out more about Jarvis, first off, how do they … Do they reach out to you? What’s your email address so people can reach out?

Melissa Marquez:

They’re always welcome to email me. My email’s easy to remember. It’s melissa@jarvisanalytics.com. But you can also go to our website and that’s what I would recommend. Jarvisanalytics.com has some amazing resources. So it’s got a way that you can request a demo. That’s immediately going to go to one of our team members that can help you all the way through the process from a free demo and to understanding how pricing works and what your organization’s needs are. That’s really the best way to do it. And we also have a few other resources out there if you’re just wanting to learn a little bit more including some white papers and some additional content that’ll help you learn as you’re considering this decision.

Bill Neumann:

Okay. So we’ll drop the link to the website, jarvisanalytics.com. And you can schedule a demo and there’s chock full of really good information on the website. So let’s say, go through the demo, talk to your sales people, and love it. What’s the onboarding process look like? There probably is a learning curve. So tell me a little bit about that.

Melissa Marquez:

There is a learning curve but in a good way. So we have a customer success team that handles our implementation and onboarding. And they’re going to be experts in your type of practice. So we’ve split our team to where some work with our private practices, some work with our small groups, and others work with our larger, more national DSOs. So they really can meet you where you’re at and where you need to be. But the first thing that’ll happen for our enterprise product is a kickoff call. So your sales team member will do a really warm handoff to our customer success team. Sharing with them what they’ve learned about you along the way so you don’t have to be too repetitive in what your needs are. And then that team members will work to gather more information about your practice, about each of your locations, and then we’ll connect to your data. So it just depends how many practice management systems you utilize and how many locations you have. But we get that done pretty quickly because that’s really the first step in turning your platform over to you.

Melissa Marquez:

Once we’ve connected to the data, whether it’s an on-premise server or through the cloud, we’ll then run a quality assurance. And during that time, while we’re connecting, your customer success manager is giving you our list of definitions, helping you understand how we measure things in Jarvis, and seeing if you’d like to make any tweaks or adjustments to that. Once that QA is done, we turn the keys over to you of your very own Jarvis platform. But we hold your hand through the configuration and training process. So our first call with you once you have access to your platform is to go through how to set your platform up for success so that your data’s accurate. And then we talk to you about what you want training to look like. If you’re a really large organization, that’s obviously going to entail more live training sessions. If you’re smaller, we’ll plan those training sessions out with the key team members. And then we’ll also equip you with things like videos and tutorials and we’ll be doing monthly webinar trainings. So there’s always someone there to help. We also have a support team and a live chat if you bump into any issues along the way.

Bill Neumann:

That’s great. All right. So remember, jarvisanalytics.com. We’ll have the link in the show notes and you can find out all you need to find out, get a demo. And again, just some really great information about the KPIs that you should be taking a look at. And also, just really great insights as you bring specialty in which you should really, when you’re starting out, what to look at.

Bill Neumann:

So with that, I’m going to finish things off here. Thank you again, Melissa. I’m sure we’ll see you at an upcoming show but this is Bill Neumann from Group Dentistry Now and until next time, we appreciate everybody listening in and watching. Thanks.