- Hi everyone, this is Erica Spicer Mason
with the Becker's Healthcare Podcast series.
Thank you so much for tuning in Today we're joined
by two guests who will talk
to us about resource consolidation, dentist satisfaction,
and DSO growth in 2024.
I'm delighted to be joined by Dan Crawford, the manager
of Enterprise Market at Clear,
and Greg Mahoney, the Senior Manager
of Consulting for Sky Tale Group.
Welcome, Dan and Greg, thank you so much for joining us.
- Thanks for having us. - Thrilled to have you on.
And before we dig into our discussion,
I was hoping you could both just take a moment
to share a little bit more about yourselves,
your background, your role,
whatever you'd like our audience to know about.
Um, Dan, maybe we can start with you.
- Sure. Um, so thanks for having me.
Thrilled to be here as well. Always great
to collaborate with Becker's.
Um, but um, as Erica mentioned, my name is Dan Crawford.
I manage our enterprise market here at Clear, so all
of our groups and DSOs from, uh, uh, from sales
to account management and customer success.
That falls under my team.
Um, I've been with Clear for, gosh,
coming up on five years now, feels like a lot longer,
but, um, really excited to be here today.
Really excited to share some insights
and, uh, we've done a lot of great work
and learned quite a bit from our group
partners over the last few years.
So looking forward to the discussion.
- Fantastic, thanks.
Dan and Greg, tell us a little bit more about yourself.
- I, I've, I've, uh, been a consultant at Sky Tail
for two years and have worked in, uh,
smaller emerging DSOs
and larger DSOs in building their strategic operations
and their infrastructure in order to scale and grow.
And so now I get to do the, that with a portfolio
of clients across the country.
And Sky Tail, uh, not only is a full service, strategic
and financial firm
to pres present those consulting services, but also an m
and a advisory firm to help emerging practices
and large scale practices go to market and help sell.
- Wonderful, thank you so much Greg and Dan.
Sounds like we have a lot of great expertise, uh,
for our session today.
And Greg, I think just based on, you know,
what you were describing with your experience at Sky Tail
and in the DSO space, I did wanna kick off our conversation
with talking a little bit about resource consolidation
as we are seeing this trend toward consolidation in the
dental industry.
So in your view, what are the top challenges
that DSOs face when undergoing resource consolidation?
- I think this really becomes a strategy of looking inward
and performing your own resource base analysis.
What do you have at your disposal to create positive change
and strategic growth?
And that can be difficult for organizations.
They're looking at, well, we don't have as much money
to spend right now,
or the budgets are tighter, so
how do we grow our organization?
The first area they'll look at is service line expansion.
If you've been kind of bread and butter practice
or group, how can you expand services?
So where dentists consider additional CE
or build out a practice within a practice then
and the associated marketing plans that go along
with building that new business, living inside the current,
for instance, uh, building out a an orthodontic section
inside your practice may maybe with clear aligners
of some sort, or maybe it's dental implants and dentures
or sleep apnea and TMJ services, uh,
or expanding in pushing into endodonic
or oral surgery
and building that up as having its own reputation
inside your practice that people are coming forth, uh,
to help, to help grow the other areas.
Where I find DSOs are facing challenges
is then leveraging systems
and employee employee efficiencies together.
When when we start thinking about how in the very beginning
of any business it's trying to bootstrap itself,
it takes a lot of sweat.
And so here we're going back to those roots
and we're building systems
and we're refining protocols to let people
solve human problems and let the systems and SOPs
and policies take care of everything else.
So practically this kind of looks like
assuring job descriptions are accurate
and describe the duties and expectations of employees.
It's probably been a long time since some
of those have been overhauled
and it's not just to have correct documentation there,
but now you can take those that match
what actually people are doing
and then check to be sure that you have SOPs
that follow every one
of those items in the job descriptions.
If you're hiring people
and you need to have them do something, you need
to have those SOPs that support all
of those things you're asking them to do.
That helps set expectations
and then how they're going to do it
and how success will be measured.
And this helps to create, you know,
expectations in the business,
but it also helps keep employees
and team members accountable for what they're expected on.
It provides them tools to achieve success
and feel supported in their work.
And it allows them to fully engage.
When employees come to work with you
now they're saying, well, how do I be successful?
And those that don't know how to be successful,
they disengage and now you have a lot of that
quiet quitting that happens.
That's been such a buzzword around the world recently.
And we want our employees to be engaged, so we need
to provide them all of these tools.
And then lastly, building the SOPs
after we use those to build training materials.
You don't want an employee to start
and then they quit by lunch
because they're like, this is a mess.
I don't know how to be helpful here.
I don't know how to be successful
'cause there's nothing here to train.
And so set a real good first impression
with those new employees using all of those tools there
and now you have a predictable system for bringing people in
and showing them how to be happy
and successful in your practice.
- Hmm, thanks so much Greg.
Really appreciate the insights that you've shared across
a variety of challenges.
You know, we've talked about the workforce, um,
expansion opportunities, SOPs, I know there's a lot to cover
and so I'm thinking
for our listeners it would be really helpful
if you could share any examples maybe of specific obstacles
or wins that you've seen, um, you know,
with partner organizations that your team has kind of helped
to lead through these challenges.
Any examples come to mind?
- Uh, sure. So more recently we've helped here at SkyTel,
a a number of, of clients build out
specialty niches inside their existing businesses.
So in some cases this meant building out A TMJ
and sleep breathing disorder practice,
or this meant adding in dentures and implants
and the creation of the marketing plans and the budgets
and everything else that went around that
the results then turned into where like,
this really matters.
And you know, in a matter of just two
and a half years, creating a niche practice
inside a general practice that on its own does two
and a half million dollars in revenue is fantastic growth.
Uh, or another practice
that was looking at growing their Invisalign business
and seeing that, you know, how do we achieve this?
How do we build this inside our practice?
And, you know, they would do a few cases a month,
but then by looking at how they were identifying candidates
and how they spoke to candidates
and how they followed up on cases
and that that treatment, that case acceptance and
and treatment planning piece, able
to grow from about $12,000 a month to $65,000 a month.
Uh, similarly we've helped
or advised others on, hey, how do I,
how do I create something else for my patients
who are saying like, Hey,
I lost my dental insurance or something like that.
And so then we're, we're recommending them
to employ a membership plan.
And so here to be able to see somebody
and talk through that process with them to grow that to
where they're collecting $25,000 a month in, uh,
membership dues is a fantastic piece.
But I think the real piece where I was talking earlier on
building out SOPs and job descriptions
and how that can affect a practice when working
with a multi-location client where they were thinking, well,
do we add more people here?
And my recommendation was, let's retool
and reequip the people that we have with the tools
that they need to be successful and, and reset.
I think we have all of the people we need right now,
but let's reorganize them in a different way.
This investment led
to a significant expansion in production efficiency and
therefore led to a much higher, uh, level of profitability.
We were able to support patient interactions
and make sure that we created the best experience.
So this wasn't about making patients a number,
but we were there to support
and nurture that patient experience
and provide relationships, uh, with those patients
and with their providers.
But through the building of the systems
and engaging all of those employees
and making them more efficient, we were able
to add over the course of 2023 $800,000 of revenue
really, which meant EBITDA increased from 17%
to 24% and that's a massive change.
And at the scale of this business,
that was fantastic growth.
And I think that's just one example of
what can be achieved when you look inward into your business
and say, alright, let's, let's invest in the people
and the systems we have
and you can truly ring out a lot more
profitability through that process.
- Thanks so much, Greg. What a fantastic example.
And one that leads to increased
efficiency and profitability.
I know that's something that will, um,
certainly interest a lot of our readers,
so thanks again for sharing that.
And I know a big component of growth is of course,
measurement and for more
and more practices nowadays, technology as well.
So I kind of wanted to shift into that territory a bit.
Um, and Dan, I, I know
with your work at Clear you can probably speak pretty well
to this to, um,
and I I wanted to speak specifically to same store sales.
I know this is a really key measure as
practices are growing, so what essential resources
or technology have proven crucial for DSOs
as they reach their same store sales goals?
- Yeah, for sure. And um, Greg, I love, you know, kind
of your anchoring your initial insights there about resource
consolidation to that, you know, the journey
of looking inward and reflecting, right?
Because that, that activity goes hand in hand with looking
to increase your same store sales
and your same store growth.
So just, you know, in terms of defining that,
what exactly are we looking to achieve
with same store sales?
Of course that's in a word expanding off
of what you already have.
We're getting more out of what's already, you know,
existing, that's not the technical term,
but, um, when it comes to dental practices and groups
and DSOs that, you know, we work with a clear,
having the opportunity
or taking the opportunity to look inward at, you know,
what sorts of patients do you have coming into your doors,
how are they behaving
and what's the net benefit for us
as a business at the end of the day, right?
So obviously last year
or you know, last year being 22, it's already,
or 23, excuse me, it's already 24.
Um, certainly challenging, uh,
economically in many respects.
And you know, we had a lot, heard a lot of feedback in
that regard from a lot of our current DSO and DPO customers.
But you know, if you think about same store sales, what kind
of investments are you making to again, elevate
what you're currently doing?
Whether that's process people From our perspective,
a big thing is visibility into that number one asset,
which is of course your patients coming in the door.
So when you think about tech
and you know, what sorts of things do you want to invest in,
you wanna look towards things that are not only going to
increase patients' visiting, right?
It's, it's certainly volume is an important component,
but when we think about the same store sales,
it's also very much about retention, return, visitation,
loyalty, things of that nature.
So what sorts of resources
and technology do you have
that can give you visibility into those insights, not just,
you know, net patient visits, but also obviously the recall
and then what are they accepting
and then how many of them are coming back year,
over year, over year?
So that's of course something you should be
looking at no matter what.
But I think a lot of times groups are now looking
to invest in more technology
to look at perhaps different patient cohorts
inside the practice itself to then try
and capitalize on those metrics.
So for example, what sorts of, you know,
what's the percentage of inactive patients
that you have in your system?
How many patients have come in for a visit in the last year
or two that did not return for that second visit, right?
Is there an opportunity there, you know, is there some sort
of discrepancy in terms of,
or some sort of disproportionate amount of insurance
that's kinda kind of being accepted in the practice?
Is that, you know, contributing to a lot of your revenue
and perhaps there's opportunities for you
to make some changes or some adjustments there.
And then of course, you know,
what about the uninsured patients, right?
So typically we see anywhere from 10 to 30% of patients
that are seeing each year in a practice are without
coverage, many of whom do not return after that initial
or emergency visit, given the fact
that they don't have a dental plan.
So is your group
or your practice prioritizing that patient
as a growth opportunity given that you know,
they're not affiliated
with a potentially low paying insurance?
Or is it something that you're just hoping
that you can get the most from that patient
and then hope that they come back?
So I think the key here, when you think about, you know,
what resources or tech have really proven crucial
to DSOs at this point, it's what's enabling you
to look inward, right?
Kind of, again, going back to Greg's point,
but when you are looking inward,
are you looking at the right things
and finding the right opportunities
that you can then invest into further.
- Thanks Dan, that's really helpful.
And as you were talking about this kind of technology
and these key characteristics, it made me think of some
goals that I think a lot
of healthcare practices have today in regards to technology,
which is ensuring that the tech is interoperable
or it's easily integrated into current systems.
So for DSOs
and dental practices, just digging a little further here,
what do you really recommend that they prioritize?
Um, what are the benefits that they should look for,
you know, either operationally
or even as it re relates to kind of the mental
or cognitive load of dentists as well?
- Mm-Hmm, . Yeah, for sure.
I mean, you know, obviously if we can increase efficiencies,
if we can, you know, uh, lessen the amount
of different systems that are in place
that the front desk teams have to try
and manage just to take care of one task,
that's gonna be good things for everybody, right?
So, um, if one of the primary initiatives that we're looking
to really try and capitalize on this year
and obviously on the go forward is growth,
but really same store sales growth efficiency is really,
of course, really gonna be the name of the game.
So you really wanna look for tech partners
that can integrate either with one another
or obviously of course with your practice management system
to really be that should really unique key focus area.
And then again, of course on top of that, once you take
that step, right, okay, maybe I can integrate with the PMS
or you know, I can integrate with another tech partner,
but what are you looking for?
And then what sorts of processes do you have in place
to take action on
that data once you have identified it, right?
So, you know, if the information that you need
to be a more lean
and effective operation is easily accessible to your teams.
Then going back again to what Greg said,
you can let you know people solve the people problems
and the systems can solve the system problems, right?
Your teams can really just focus on the patients
and cultivating those relationships
and really maintaining that loyalty while you've got systems
underneath that are working in collaboration
with one another, providing easy access to different pieces
of information that again, can be actionable as far
as growth and strategic initiatives.
All those things are critical.
So just for some context on our side, one of the things
that we really try and stress,
or we're starting to stress rather with a lot
of our partners is, you know, when you're looking internal
or you're looking at your systems, you know, what sorts
of areas can you pay more attention to right now
that perhaps you do have a different technology
that can give you different bits of information?
What sort of visibility do you really think you want
in order to be successful?
Is it, you know, how much does one
insurance reimburse you more than another?
What exactly does that mean for your profitability?
Is your uninsured patient base providing an opportunity
that you're really not able to capitalize on
because you don't have the right systems or processes
or really strategic, uh, insight in place to go after it?
These are all kinds of questions that you want
to continually ask yourself.
And when you think about investing in technology
to solve them
or address them, you really wanna make sure that there is
that integration between as many components as possible
so that it is seamless.
And that event kind of gets, uh, segues into how is that
of course gonna obviously mitigate the,
the mental strain for the dentist.
It's very much kind of the same thing, right?
If I as a dental business owner
or if a DSO executive can trust in the fact that my systems
underneath my operational personnel are operating
as they should and giving our teams the visibility
that they need and the right data
and that we have a good plan on top to go ahead
and, you know, take action on it,
then I can sleep soundly at night, right?
And I can focus on other things
and really make sure that I have my foot on the gas
for growth rather than trying to plug holes,
put out fires, things of that nature.
- Yeah, absolutely.
Thanks Dan and Greg, I just wanted to check in with you too.
Is there anything that you'd add to what Dan has shared?
- Yeah, I really, I really like Dan's approach here of,
you know, what is going to help, uh, help that,
that owning doctor sleep at night.
And you want to know that your teams
have all the information available to them that they need,
but at the same time, you need to make sure that they have
a narrow enough priority list that they can achieve
what they need to achieve.
Because there are lots of platforms out there
that can provide dashboards, right?
But, and there's every single metric that you
and KPI that you could ever imagine.
And so it's important to cut through the noise
and focus on your business's priorities
and the metrics that correspond with that.
And then tying a specific metric
to each individual in the business
and making sure that it's connected with
what they do every day.
For instance, you, you have somebody
who is making phone calls on for recall, for instance,
there's emails and there's text messages
and things like that that go out,
but there's still people that need phone calls.
But if you have somebody doing that measure,
how many phone calls should they be making each day?
When should those be completed?
And all of these metrics kind of line up so
that you have the ability to tie actions
to metrics and help push things forward
as in the end, we need to know how to manage those behaviors
because the scoreboard, the metrics that are up there,
the scoreboard doesn't win the game.
It only tells you the results
that were achieved on the field.
And so knowing what to do with the metrics
and how to operationalize them is the act is the key part.
And I think that that's where, uh, Dan's team
and where our team kind of combine
and when, when, when we're out there, we're there
to explain, here's this data, here's how to use it
and make it actionable in your business
to create real results.
- Mm-Hmm. Thanks so much for tying that all together, Greg.
That phrase, um, how does it go, what you can't measure,
you can't manage or the reverse of that, that kept coming
to mind as both you
and Dan were explaining the importance
of these KPIs and these metrics.
So appreciate the explanation
and I know we've covered a lot of ground.
We've covered same store sales, technology,
resource consolidation.
So I think I'd like to wrap up our conversation
by really talking about what success looks like.
Um, and Greg, maybe we can get your perspective on this
first since we have you already.
Um, can you share
with us whether there are any key characteristics
of an office that is acquisition ready?
What does that look like
and how can DSOs best align their business
and resources to attract those opportunities?
- Getting ready for an acquisition or
or transaction as an, as an owner of a, of a business,
a multi-location practice, a single location practice.
As you approach that readiness, you are creating a lot of
hybridized systems with technology and people
and you're, you have perfected a lot of your systems
and you feel comfortable that your practice is running kind
of like a sewing machine.
It's got a rhythm, it's moving pretty quickly.
You understand what the next hurdles are going to be
and you already have an understanding of what
that path will be to, to cross those hurdles.
But, uh, the kind of the avatar of a practice that's ready
to go to market or a multi-location group that's ready to go
to market, you have developed goals
and you have an understanding of what the future holds
and there's certain, a certain mentality you are ready
to hand over the reigns.
In some cases this is a retirement plan.
In other ways it's a recap
and it's the realization of a longer term investment.
But the DSOs that are then looking to acquire
practice individual practices
or multi-location groups, those practices,
those owners are looking for A DSO
who has emerged as a leader
and a trusted advisor to dentists, their families
and the staff who work inside those practices.
Those sellers want to know that
when they are partnering with A DSO,
whether in a partnership model
or a full sale model, that
that DSO has their best interest for the practice
and for the providers who work there every day
for the future, that they're invested in their
success as well.
And so we see that they create a,
these the best case scenario, the best practice is
that there's a value creation plan created
for the practice by that DSO And don't,
don't let it be a buy
and hold scenario where like you just keep on doing
what you're doing great.
Like have them show you here's how we plan
to invest in your business.
Here's how we want to see you grow
and how we'll help you do that.
And that should be in the terms of customized approach
to manage your office.
I have seen excellent examples of DSOs committed to growth
for individual offices.
They buy seven offices at a time.
They create seven individualized customized
value creation plans for how they're going to help
that practice grow.
'cause it means better things for everybody.
But I've also seen situations where
DSOs have purchased something
and then just managed to the middle
and there were excellent offices that were pillaged
for their profitability
and in order to support all
of the lower functioning practices that were inside
that portfolio of that DSO.
And so my advice, you know, when you're looking to go
to market is look at the management style
and systems of that DSO, look at their ask for successes
that they've had since they've purchased locations.
Have them prove their, their management skills
because once these deals are done, they can't be unwound.
They play for keeps and it doesn't matter if you're unhappy
or not at the end, the p that transaction happened.
And so there's a lot of things just make sure
that you're there and everybody is pushing in
the same direction of growth.
- Yeah. Thanks so much Greg.
Sounds like it really has to be a two-way conversation, uh,
between the organizations.
So appreciate you sharing those best practices.
Dan, is there anything that you would add here?
- Yeah, I think think the only thing, the,
or a couple things that I would mention that jump out
to me on that front is, you know, to
what Greg was mentioning is, you know, what's happening
of course in the middle between that group
that is getting acquired
and of course the larger group that that does the purchasing
and, and executes the transaction.
And so much of, obviously what happens in
between is about optimizing
and making sure that your group is as polished
as possible from a financial perspective,
a personnel perspective, a process perspective as it can be
that you are not only an attractive offering
to obviously a larger group,
but the right kind of group as kind of Greg mentioned,
given your values and your mission
and what you want to become, right, as an emerging DSO.
And I think so much of, you know, the work
that we do at Clear with offices is really helping them find
or help groups find, you know, unique ways to, you know,
increase that polish, find ways to find more or, uh, to,
or leverage or uninsured patients, rather,
to create a more sustainable revenue stream,
create a more optimized
and stronger coverage foundation that, you know,
can yield high dividends for you and, uh, long term
and obviously for any DSO that's looking to purchase you.
But again, Greg made a great point about, you know,
scoreboards and metrics and all that stuff is great, right?
You can have an idea of I'm getting X amount more revenue
for my uninsured or, you know,
my one PPO is paying more than another one,
so I'm gonna drop this one.
That's all great. But if you don't have the right partners
with you to help your team to execute,
to help you put those right SOPs in process so
that you can be as optimized
and proficient as possible prior to that, uh, transaction,
but the right DSO, then all those numbers
and such don't really matter.
And I'll just speak for Greg.
I know with Greg and this group, they're
so unique because, you know, Greg has kind
of been in the trenches, right?
In offices and tell me if I'm wrong here, Greg,
but Greg's worked in dental practices, he's seen it,
he's done it, he knows what works and what doesn't.
So same thing on the clear side.
We work with so many different dental practices
and have so many different levels of expertise
that you really wanna find the right partners
to help you get to that point so that when it does come
to execution time and that transaction does occur,
you're not worrying about unwinding it after the fact
because you're so confident going into it.
- Uh, it's, it's great to work with Dan
and partner with Clear here because Sky Tale
and Clear both have the same mindset of how can you develop
and be the best version of yourself before you go to market.
And, you know, as we're looking inward in order
to create a lot of value right now and,
and push forward, I don't, I think that
that should have been the mindset forever.
There was a lot of mindset of, well,
from the DSO perspective, you go out
and you buy profitability, you package it,
and then you sell it five years later.
And now there's this focus of wait, we really have
to buckle down and become absolutely awesome .
And so this is kind of like, what I'm thinking
of is like the beginning of the, the golden age
of dental management
because there's a refocus on here's what's important.
This is about growing what you have instead
of just adding more pieces, more pieces to the puzzle.
And so it's, it's great to see this
and now I have the opportunity to work with a lot
of practices who are considering going to market
and we do a valuation for them
and they're like, you know, I would really like to see more,
uh, you know, before we go
and we try to be conservative about
what the market might bring.
And so then we settle back into, you know,
a consulting engagement where we're pushing then like,
all right, well let's, let's round off
some of the edges here.
Let's retool some things in order to add some profitability.
And that's where you see things really come together
because they're like, oh, I didn't even know this
was possible anymore.
And so where we get to where we get
to involve our partners in this
and work together in order to show this piece now practices,
dentists, group executives are looking at like, wow,
you know, I thought we were doing a fantastic job,
but now with all of these tools, the practices,
the business is so much more profitable now we're really
ready to go to market.
And that's the fantastic part of what I get to do every day.
- Well, Greg and Dan, thank you so much
for the great discussion and all of your insights today.
It's been fantastic to hear about your partnership,
how you're working together, and of course some
of those experiences in the trenches really invaluable to,
to our discussion and of course our listeners.
So thank you both again for joining today,
- You for having me.
Thank you, RA. Thanks Greg. Appreciate everyone. Thanks Dan.
- This podcast is sponsored
by Clear Clear's Cloud-based software
and World-class support team.
Remove all of the complexities, hassles,
and costs of dealing with insurance,
improving patient access to care, increasing patient visits
and treatment acceptance,
and providing the foundation for dental practice success.
To learn more@visitclear.com.