This Is Like Pulling Teeth

Chris Miladinovich: Hello and welcome to ProspHire’s Soaring to New Health Podcast. This episode is This is like Pulling Teeth. I’m Chris Miladinovich, co-founder and Chief Operating Officer of ProspHire, and I’m joined by Daniel Crogan, principal and Senior Vice President of Consulting. Hi Dan.

Dan Crogan: Hey Chris, we’re really excited to have Paul Rita and Armanda Lester with us today from North American Dental Group. Paul is the CEO and Armanda is the VP of Operations. NADG is a dental services organization that provides non-clinical administrative services to more than 240 affiliated dental practices across 15 states. You are pioneering a new culture of dentistry. What does that mean and what does the vision look like for the future?

Paul Reda: The way North American Dental Group looks at this is we want to be available to our patients, right? We want to be available when our patients want to see us. And that’s a bit of a change coming out of COVID. Previously, it had been a, we’re open this time, our patients are going to come see us. And we’re shifting that mindset. We want to be available for when our patients want to see us. We want to be able to serve our patients the way they want to be served. We want to be able to provide the best patient care, every visit, every patient.

Chris Miladinovich: NADG is huge. Talk to us about how you guys got so big and what your secret sauce to growth was?

Armanda Lester: We started early in 2010, and as the company started to evolve, they started looking at more of group dentistry. So, when the mergers and acquisitions were in question, they looked at group dentistry practices. Pretty much, you know, the type of brand that has streamlined their brand, and then they also were aligned with the vision of growing into a larger group and adding their great best practices into the organization.

Paul Reda: Yeah, North American Dental Group has grown as a brand of brands. We have 80 different brands across our 15 states. You’ll never actually see a North American Dental Group branded practice, but what you will see is professionals, people who care about their patients, the best in class providers, the latest technology in dental, and really an ability to really take care of our patients in a way that they want to be taken care of in the way they deserve to be taken care of.

Chris Miladinovich: How do you get that information? So, when you sign up for the commitment to take care of the patient, and that is the most admirable goal and something that needs to be at the forefront of every healthcare industry, every sector, how do you get the voice of the customer? How do you find out what the customers are asking for in your, in your line of business?

Paul Reda: Chris, that’s a great question. We focus on listening to our patients and providing the best technology. One of those things that we’ve recently implemented across the entire platform is something called AskNicely. And this is a platform where, after your visit is completed, you’ll receive a text message. It’s very user-friendly on your iPhone or your Android device. And you’ll be able to answer a few quick questions on, hey, how was your experience? What can we do better? And we take those, and if we get a response that’s below a nine, it’s on a one to ten scale, our company policy is to respond to that individual within 24 hours. Because we really want to know, what can we do better? We’re here as your friend, your partner, and we want to make sure that, every patient is getting the best care they can every patient every visit.

Armanda Lester: I would say it’s also a team sport. So when the patients are responding to the AskNicely text messages, it is something that we review every day during a huddle. It’s what are our patients saying about us? How can we show up for them better? And then also how can we recognize our team members that did such an exceptional job for the patient? And then mimic that for the future.

Chris Miladinovich: Wow, that sounds like a great differentiator our other companies in the industry doing the same thing. Is this something that you guys feel sets you apart?

Paul Reda: AskNicely is a relatively new technology, it is also being currently used by our sister company in Europe, Coliseum Dental Group, which is 650 practices in Europe, so the entire platform is using it. But it really has just been tremendous in being able to improve our patient experience, how we take care of our patients. And one thing that’s interesting is over 350 of our providers have downloaded the AskNicely app on their phones so they can understand what patients are saying about their practice and then they can improve, which I think is tremendous. That means you’re getting adoption. We can have all the technology we want, but if nobody’s using it, it’s ineffective. Here, 350 of our providers are actually using this every day, which is fantastic. And it’s fantastic for our patients.

Dan Crogan: It’s apparent your focus is the high quality, so your members, your dentists that’s your number one priority. With the rapid growth, how have you been able to keep that number one not only across the organization but with the new acquisitions and the growth across the firm?

Paul Reda: Well, I think you always need to be moving along, innovating, and trying, hey, is this good for our patients? When I look at a decision for this organization as a whole, the first question I ask, is this good for our patients? And then I ask, is this good for our teams? If it doesn’t pass those two questions. It doesn’t get past anything. That is the ultimate, should we do this or not? And once you do that, we want to provide the best technology. People value technology. For example, Google Maps, right? Everyone looks at Google Maps and says they follow the blue line right where they’re going. We have artificial intelligence now in our practices and we’re rolling out across the entire platform. We have digital scanners, right? We are trying to provide the best technology. We provide training for our providers so that they can provide the latest dental procedures and give every patient the best care possible. Patients first, everything else second.

Chris Miladinovich: Let’s talk about artificial intelligence a little bit. What a cool thing, all the things going on with chat GPT and all the AI products coming out there. What are you guys doing with that? Are you doing anything cool? Anything leading edge?

Armanda Lester: So we started a pilot with Overjet, it’s an AI platform for dental and we began that in January and we quickly realized that so many people were reaching out outside of the pilot, very interested in how they can implement that into their like daily exam with their patients, also learning materials for the team and patients, and so on. Really quickly, we realized that it was working well, and we saw a different type of data come out from what we had historically. And so we scratched the pilot 60 days sooner than possible, and now we’re rolling it out organizationally. And so we’re going four regions per month, and we’re making it fun, first and foremost. But also an opportunity for our patients to understand their healthcare from a different lens, which I think is like the most innovative thing we can do because when you’re sitting in front of a black and white screen, looking at, you know, dental anatomy, it’s hard for you to understand what a doctor just said specifically when they’re using some type of like technical term, but really when it takes like a color-coded approach and when it comes on, you can instantly go, wow, what’s going on there?

Chris Miladinovich: Yeah. So break that down for me. So I’m a patient, I come in, I get a procedure done, like, talk me through, what does that look like for the patient?

Armanda Lester: So, you come in, before you get a procedure done, you’ll have your x-rays and images taken, and then there’s an overlay, so you have your standard x-rays, and then we apply the overlay and then it comes across with like a color-coded map of your teeth, and it shows, like, based on the color, what type of treatment the AI is thinking. And then the doctor also like, you know, from like, look, touch and, and his education or her education will go in and say, like, they agree with AI. And most of the time it’s spot on. But the coolest thing about the technology is that we talk back and forth to the technology. So it’s always evolving.

Chris Miladinovich: Wow. That’s incredible.

Paul Reda: Chris, I think there’s actually an important point here. When we talked about what the patient experience was, and we talked about AskNicely, and one of the most common themes of AskNicely is patients want to have better communication. They want to understand from the provider, what treatment are you prescribing to me? What do you recommend? They want to build that trust, right? So that, keeping that in mind, you look at Overjet, you see your x-rays on a big screen TV in front of every patient, here’s your mouth, here’s the different color codes for decay or a treatment that you may need. This allows us to build trust. It allows a patient to feel comfortable. It really facilitates that communication that patients are craving. It really is a whole ecosystem that we’re trying to build here with technology, with people, right? Treating people as people, not as objects. And that’s what really makes Overjet AskNicely and what we’re trying to do at NADG so great. We are focused on our patients in the communication giving them the best treatment possible and providing those tools such as overjet as Armanda mentioned It really is a winning combination.

Chris Miladinovich: So let me ask you this as a follow-up. Adoption is probably the hardest thing in any transformational activity. I mean, I’m talking to two people here that know nothing more than how difficult transformation is as you guys have grown over the years. You got two facets of this. You’ve got the patient adoption of AI. Are they open to it? I mean, you guys are growing like crazy. 450 dentists that they can’t all believe that this could work. How are you guys getting them to adopt? Both the patients and the dentist side.

Armanda Lester: I think the greatest thing about the technology is that back to like my comment originally. It’s a team sport, so the assistants are involved, the hygienists are involved, the doctor is involved the admin team is involved and it offers a different workflow for each type of position which is even better. And furthermore it is also now utilized by a lot of the I think top eight major insurance companies adjudicating their claims with this specific platform. So in the ecosystem of how we get paid, how we diagnose, how we educate our teams it’s full circle.

Paul Reda:  I think it’s just people want to have the latest technology, right? We go back to the Google Maps analogy, people believe in, they trust technology and here this is a way to bring technology into healthcare. It’s an easy way for people to comprehend. It’s easy for our providers to say hey Chris, this is the care you need as you can see by these images, right? It makes it more accessible, more digestible. And that’s really what we want. And candidly, our providers are craving for it. The providers love it. And I think patients aren’t even aware it’s out there fully. We’re going to be fully implemented with artificial intelligence across a platform before the end of 2023. Other major DSOs are not there yet. They’re piloting, they’re considering it. We’re all in. We’re all in on this. And this is, and this is the way of the future. Alright, you said chat GPT and all that, and I get that. The AI is here. I think it needs to be used in a controlled method, of course. Our providers here, it forces them to look at the tooth and forces them to communicate with our patients. That’s what we want. We want to build communication and trust with our patients. We have their best interests at heart. And that’s what we’re, and this is just helping us to show that.

Chris Miladinovich: So Paul, you lead a large company, you know, 3,700 and growing employee base. And your perspective on artificial intelligence is very important. How would you characterize where AI is, where it’s going, and how we can apply corporate responsibility to using AI correctly, especially in healthcare?

Paul Reda: So I think AI is definitely in its infancy, right? We’re starting to see it more in the New York Times and the news, etc. But I do think we need to use it responsibly. It is not a replacement for human beings. It is not a replacement for a doctor. People want to feel comfortable talking to people. They want to be treated as people. And that’s the core to the values of North American Dental Group, is treating people as people, not as objects. So you want to have that balance. Now here, it’s a nice way to augment with a patient. Here’s this thing. This is what the AI is showing. I have confirmed this as your provider. This is what we think we should do. So it’s building trust, but not completely relying on it, right? We get on a plane and Chris, I know you’re a pilot, right? You’ll enjoy flying and planes have autopilot, but you’re not getting people in the cabin with no pilots in the cockpit.

Chris Miladinovich: I have a hundred percent delivery rate.

Armanda Lester: I think furthermore from like from the AI perspective that the feedback I’ve been given from a lot of our providers that are really excited about it is that you know we’ve all seen like what is it the Trident commercial 9 out of 10 dentists agree? Well, there is interpretation on dental diagnosis. And so within like the AI It’s showing what the AI believes and then the doctor is confirming and or giving feedback back. But what I’ve noticed is that it has built confidence amongst the team and doctors.

Chris Miladinovich: That’s incredible. So let’s, let’s change gears a little bit. So there’s a lot of consolidation going on in the dental industry. Talk to us a little bit about what’s going on in the industry and where you see it going in the next five years, because a lot of the other sectors are following the paradigm of consolidation, efficiencies of scale reducing costs, et cetera. What’s going on in dental?

Paul Reda: So I do believe in roll-ups and I do believe in getting economies of scale and dental has been a prime example of that over the last couple of years. You’ve seen massive DSOs grow and they’ve acquired practices ourselves included. However, the economy has shifted and we’ve seen an inflation rise. We’ve seen interest rates significantly increase and what this is doing. This is putting a lot of pressure on DSOs who acquired with every ever increasingly expensive debt, right? A lot of companies in the organization in the industry, many of our competitors can no longer support their debt load. So I think that is going to put a slowdown on acquisitions and mergers and acquisitions as well. I think multiples will come down in terms of the amount of turns or times EBITDA companies are willing to pay for both platforms and individual practices. So I think that has to be careful. I think growth is important. I know at North American Dental Group, we are getting a lot of growth, but it’s organic growth. We are growing by expanding access to care. We are being available to our patients when our patients want to come in, not when our patients need to come see us on our schedule, right? We’re trying to reverse that paradigm. So our goal is to be by the end of 2024, open from 7 a.m to 7 p.m. Monday through Friday and have Saturday hours at all of our practices, right? We want to have every practice have multiple doctors that is organic growth. And then what we do is we find doctors and we’ll talk about how do we grow? A lot of doctors want to grow their careers, we’re opening JVs, or new de novo practices, in partnership with our providers, where they have an ownership percentage at the local level. Right, that is how we are going to grow in the short term. The goal is to grow between 15 and 20 practices a year for the next five years. That’s building them ourselves, that’ll put us around 350, and then we’ll be opportunistic in the mergers and acquisition market. I expect in 2024 there to be a lot of availability in the market due to the interest rate pressures that I talked about earlier. So we’re being strategic and smart and we’re going to do what’s best for our team and our patients.

Armanda Lester: We’ve done a lot of adapting I think that’s the one thing as Paul has come in as COO and then furthermore CEO. We’ve like adaptability has been really good, probably our motto, and then pivoting like quickly. So we’ve done a lot of that. It’s how can we meet the patient demand? But then also take care of our team, which I think is the most important thing that Paul talks about mostly. So as we talk about expanding our hours, it’s really expanding the access to care. We do serve a lot of rural communities where you know, we might be their only dentist and also, one of the primary sources of income for the community for work. So we’re trying to make it easy for everybody as they come into our organization, whether it be a patient or a team member.

Chris Miladinovich: So I have two questions about that. First of all, how do you address the social disparities? Is there anything you guys are doing to help the less fortunate, the vulnerable populations? And then my second question is, are you applying innovations from other healthcare sectors? For example, do you guys have concierge dentistry?

Armanda Lester: Social disparity. We do. So one of the greatest things about our organization is that we actually encourage community service. It’s part of our culture and our core values. And as a matter of fact, at the end of every year, Paul gets to go and reward somebody from our organization with a big event. So it is encouraged. It’s promoted in most of the communities there is like a Give Kids a Smile event or we have our team members going out to local schools and doing like a volunteer of like teaching kids how to brush their teeth or what oral health looks like and you know, just making sure that they’re out there talking about it.

Chris Miladinovich: Innovation. I know you guys have a lot of cool innovation, a lot of great ideas going on you know, I don’t know if concierge dentistry is an innovative topic.

Armanda Lester: Maybe like not necessarily concierge dentistry, but we have talked a lot specifically when the pandemic came through, we did a lot of teledentistry. And as a matter of fact, we did a lot of that at no cost to the patient, which I think is incredible because we were very concerned about how we made sure that people were getting, you know, taken care of during the pandemic. It’s something we’re still talking about and we still have it piloted in specific areas where there is a demand. And then furthermore, we have like other opportunities where we’re showing up to different patients for the types of services that we do supply in their areas. So it’s not necessarily concierge yet.

Paul Reda: We’re expanding our teledentistry. We think there’s a market for it. We want to be able to provide that access that our patients need in terms of are we serving underprivileged communities? We have many of our practices serve state-funded patients. Granted, there are lower reimbursement rates, but we do feel that it’s our obligation and it’s our responsibility to those communities to provide care to them and access to care to them. And so we’re increasing our access to care in those communities. Armanda alluded to that we value community service. So at the end of each year, we have several team members, actually, I think it’s three this year, that we will acknowledge and we’ll award them something called the Chairman’s Award. And so, the family that owns North American Dental Group, Jakob’s Holding, is based out of Zurich, Switzerland. And we have our sister company I mentioned, Coliseum Dental Group, in Europe. We each bring three of our team members who are very involved in the community and we bring them to Zerks, which lend them and their spouse and they get to meet the chairman, which is Patrick de Manciniere and then chairman of Jacobs Holding, which is Philip Jacobs. And that is the, how we reward them is just, hey, we really appreciate what you’re doing in the community. So we have that in a year. So, and I am fortunate, I do get to participate. I get to give the award. So it was kind of fun and satisfying.

Dan Crogan: We talked a lot about the voice of the customer. You’re hearing what they need and what they want and transitioning the company to serve those needs. The ownership responsibility for dentists. It’s exciting for them to be part of the growth. Obviously all of you as well. And you’re staying way ahead of the market trends with innovation AI as well as, you know, what inflation that debt’s gonna impact. How do you make time for not only the massive growth, keeping the patients number one priority, but also making sure that you’re, you’re innovating and, and making time for all of this? It, as you mentioned, it’s a team approach. It takes an army. Can you talk a little bit about how that’s transcended all the way through your growth journey? Profile these past few years.

Armanda Lester: We’re a doctor-led organization and so the doctors are really the ones that are providing the feedback and the demand for what we’re doing. And I think that’s really really great that like we’re hearing their voices and we’re encouraging you know more feedback and continuing to evolve based on what they’re asking for.

Paul Reda: Yeah, our purpose is to really support them in providing the best care to every patient every visit, right? We support our patients. We support our providers and that’s what the team at North American Dental Group has been able to do and that’s what’s just super exciting. It’s just a lot of fun.

Armanda Lester: And at every level we have a clinical partner which I think is even more magnificent because you can’t muddy the waters with Operations or clinical we’re all responsible to each other and then we’re threaded together. So I think that’s really unique as well.

Paul Reda: We’re a team. You do it for the person next to you. And what we’ve kind of transformed into is this culture of performance. We reward performance, culture of accountability. We know that we need to do it for each other. And it doesn’t have to be me saying, hey, Armanda, do this, because there’s three other people who are going to say, hey, Armanda, we need to do this for our patients, we need to do this for our team. And ultimately, what you get out of that is a stronger organization focused on patient care and providing care. The best in class patient care, every patient, every visit.

Dan Crogan: Tell us a little bit about why do dental practices partner with NADG? And what do you all look for whenever you partner with strategic partners for growth?

Paul Reda: Well, Dan, I want to take the second part of that question first, and I’m going to let Armada take the first part. When we’re looking for strategic partners at North American Dental Group, the first thing that comes to mind is what relationship do I have with them? Right? We need to have a strong relationship built on trust, candor, being able to have these open conversations. And then you want a partner that can deliver the results. For example building relationships. I know with ProspHire, I have a very close relationship with two of the managing directors at ProspHire. And that kind of brought me here. But that’s not what keeps ProspHire here, right? The amount of results, the work that the team is doing. For example, you talked about growth. There’s been a lot of growth in the dental space acquisitions. What happens when you acquire is you’re acquiring technology and systems, right? That may not be what you want or it may not be your current system in place. So ProspHire has been helping us with over the last five months and will continue to do so in integrating all of our practices onto one platform 1 system standardized processes and that to us is an invaluable service and a great partnership. Because once you have that one standard platform, then you can start making informed business decisions. You become more nimble and you’re really able to differentiate yourself from other DSOs in the industry who are just gobbling things up, putting them together, and hoping to sell it at a higher multiple, right? That’s not what we’re focused on. And we’re focused on building a sustainable platform that’s scalable. That it puts patients first and ProspHire is helping us get there.

Chris Miladinovich: Well, thank you. We’re, we’re honored to be partners with you and, and help you achieve your vision and, and execute on that. And we’re just honored.

Armanda Lester: We’ve also integrated as a team. So ProspHire and North American Dental Group, we have integrated, you know, the partners that we’re working with through ProspHire and North American Dental Group. It’s one big family now.

Chris Miladinovich: Yeah, we really try and, and make sure that you can’t tell what jersey you’re wearing. And because that’s what makes a good team, right? You don’t care about the jersey you’re wearing. You have a goal. You have a vision. You have a mission. And, you get it done, and you get it done well. And, good work leads to more work.

Armanda Lester: I do think that the most important piece of why we do get and attract so many different types of partners is that we don’t pretend like we wrote the book on dentistry or the organizational industry standards. We are constantly evolving and what is most important is surrounding ourselves with different types of opinions and ideas, providers, people, and as we’ve done that, we’ve been able to adapt and pivot quickly throughout each type of event that we’ve had. For example, we’ve gone through a couple capital reinvestments or most recently a huge pandemic once-in-a-lifetime event. And had we not had those different types of opinions and ideas, I think that we could have it could have gone very differently for us. And what I think is most important is that we do create safety in dialogue. So when people are coming with ideas, opinions, or expressing concerns, it’s received and we do take it very very seriously and we change from that.

Paul Reda: Yeah, I think one of the reasons that dentists want to partner with North American Dental Group is we listen to understand. Right, we listen to help them grow, we want to support them, we want to build them up, we want to lift them up. We want to increase their confidence, not just of them, but of their teams. We want to give them that opportunity. And we do want to take away some of those burdens that not all dentists want. Revenue cycle, credentialing, our call center, which we’ve heavily invested in, our technology such as online scheduling that we’re using NexHealth, going back to how are we innovating, we have a great online patient engagement experience with NexHealth. We’re providing those services, that feedback was asked nicely. New technology, CBCT machines for imaging, AI, right? We can provide them that technology and that support, but really we just want to hear them and we want to give them, we want to put them in a position to be successful and to be their best selves.

Armanda Lester: We’re constantly investing too in our education platform, so we’re building out different types of CE’s for the different types of providers. We are now, you know, a fully integrated dental service organization where we offer every type of specialty or general dentistry. And so we haven’t taken it from a broad perspective. We’ve really like gone to a minimal approach where we look at ortho or endo or oral surgery, perio, pedo, and how can we serve those doctors in our organization? And then general as well. And I think that’s really, really important to any type of doctor, regardless of their tenure in the business, they’re constantly looking to evolve their skill or it’s required by the state for their license.

Paul Reda: I mean, it goes back to, it’s real simple in North America. You do the right thing, no matter what, doing the right thing is not easy. It’s not cheap sometimes, but no matter what you do the right thing. And that’s how we run this business. And that’s how we want to interact with our patients. We want to interact with our providers and our team just do the right thing.

Dan Crogan: Well, Paul, Armanda, we can’t thank you enough for joining us today on the podcast. It’s been a really insightful conversation. Thank you for being part of “This is Like Pulling Teeth.” I don’t think this was anything like pulling teeth. We had a wonderful time and we thank you so much. If you have any questions about today’s topic or for our guests, please reach out via our contact us form on our website, ProspHire. com and until next time, keep soaring to new health.