Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1132 Dr. Bill Jackson DDS, COO at Virtual Dental Care, Inc. : Dentistry Uncensored with Howard Farran

1132 Dr. Bill Jackson DDS, COO at Virtual Dental Care, Inc. : Dentistry Uncensored with Howard Farran

1/30/2019 9:33:19 AM   |   Comments: 0   |   Views: 137

Bill practiced clinical dentistry for 10 years, while founding a small dental insurance company in Los Angeles. He left clinical practice to work with Prudential Healthcare (later acquired by Aetna), where he ultimately became President of the Dental Division headquartered in New Jersey.

VIDEO - DUwHF #1132 - Bill Jackson

AUDIO - DUwHF #1132 - Bill Jackson

Later, he was hired by Wellpoint Healthcare (now Anthem) as General Manager, the senior executive over the dental division and returned to California. During the dot-com boom in 1998, Bill left Wellpoint and founded Dental Connect, a real-time dental EDI company which later merged with Dentalxchange. After the sale of Dentalxchange in 2003, Bill helped in the founding of Planet DDS the developer of Denticon, the cloud-based practice management software, as SVP of Business Development. After its sale in 2016, Bill and his business partner at both Dentalxchange and Planet DDS, Richard Lee, started a quest to address the issues of the dental underserved through the use of innovative technology. The result was the founding of Virtual Dental Care, Inc., where Bill is the COO.

Howard: It's just a huge honor for me today to be podcast interviewing Dr. Bill Jackson DDS he's the COO at Virtua dental care. I have been a fan of this guy for so long. I mean walking through his career I mean he's in the dental insurance company he was the founder of Dental Dorrect and Dental Exchange, Planet DDS, California Dental Connect and now he's starting Virtual Dental Care. Man you could walk these Millennials through 30 years of amazing high-tech dentistry. Bill practiced clinical dentistry for 10 years while founding a small dental insurance company in Los Angeles he left clinical practice to work with prudential healthcare later acquired by Aetna where he ultimately became president of the dental division headquartered in New Jersey. Later he was hired by WellPoint health care now Anthem as general manager the senior executive over the dental division and returned to California. During the dot-com boom in 1998 Bill left WallPoint and founded Dental Connect a real-time dental EDI company which later merged with Dental Exchange. After the sale of Dental Exchange in 2003 Bill helped in the founding of Planet DDS the developer denta con the cloud based practice manager software as SVP of business development. After its sale in 2016 Bill and his business partner about dental exchange in Planet DDS, Richard Lee started a quest to address the issue of dental underserved through the use of innovative technology the result was founding a Virtual Dental Care Inc. with Bill as the CEO. My god what an exciting career.

Bill: It's been eclectic.

Howard: Oh my gosh and I was starting Dentaltown. I decided to start Dentaltown in 98 when you were starting Dental Exchange that was the biggest dog in the dental internet space for Wall Street wasn't it?

Bill: It was, it got the most funding of anybody in the dental arena. It was supposed to be a in fact those were back in the days as you probably recall when searched didn't exist, you know portals were gonna be the the way that people got on the end and so whatever portal somebody went in to that's where everybody was gonna get they were gonna buy all their stuff and so on and so forth in those days. So we were going to be the dental portal doing everything that any dentist could want it was really one of those mile-wide inch-deep strategies that's it's a it's a Google buried when they came out with search.

Howard: Oh my gosh yes and that was Time Warner's biggest mistake they paid everything they had for AOL. Remember that, what year was that merger?

Bill: Yeah at the same time just before the boom

 Howard: Was that the biggest financial mistake Time Warner ever made in their life? 

Bill: It's pretty hard to find anything in history that was a bigger mistake financially.

Howard: I want to start back early in your career because I've always thought dentists time well it's very obvious that dentist and insurance key and companies don't really play together. I mean like when I podcast interviewed the the head economist the ADA. I mean you know economists they let it take big massive data banks and run algorithms through it and try to find order, they don't even have access to Delta Dental’s hundreds of millions and billions of insurance claims. it seems like like you know the sheep and the lion can't really lay down and sleep together the insurance companies, the dentist they want to get paid you know ten thousand dollars for a crown and do one every Monday and the insurance company they can't sell insurance premiums to free enterprise that high and you know they was so they're structurally and competitive towards each other and they've got to act that way. I mean it's really hard for me to get insurance director to come on here because he kind of feels like he's walking in a room of a bunch of dentist who kind of act like a trade union. What was your experience like in dental insurance and what perspective from the dental insurance from back in the day could you provide the young Millennials that you know, what was your view?

Bill: Well you know generally I would say and you know I'm a ways away from it at this point but generally I would say I wouldn't view them necessarily as the enemy and at the end of the day there's only so many dollars in the system that are gonna be paid out and those dollars are determined typically by what employers are willing to put in and employers don't necessarily want to pay you know open their pocketbook without some knowledge of how much is going to be spent and and they're gonna put a top end on it too. So their is not an infinite amount of dollars in the system so how those dollars gets put out is really the question. You know I had always felt and I'm not sure it's possible but I had always felt that there was a way to bridge that gap so that if if the industry could really understand what it is that employers are doing when they're putting dollars into this system and everybody could figure out how to do it the right way that there would be a way to do it and I certainly experimented with that and not to get into that today but but there should be a way that that it isn't necessarily insurance company wins dentists lose or dentist wins insurance company loses as everybody anticipates that just doesn't it isn't the way it works and if there was a way that everybody could share in those dollars in a fair way and I think they're probably potentially are but I don't know that anybody's founded and I don't think we're any closer today than we were 30 years ago.

Howard: Do you agree that the insurance companies and the dentists have kind of an adversarial relationship?

Bill: Well they absolutely do and it's, it's unfortunate I you know from the insurance standpoint it's only adversarial from the standpoint that they don't want the dentist's picking their pockets or actually picking the pockets of their customers is the way they would say it. From the dentist's standpoint it's the insurance company's trying to hoard all be a gold in their pots does not let anybody get and it's not that way. Employer groups aren't going to let the insurance companies make any more money than the insurance companies can possibly make. So really it again that it's this balance that I don't think people understand and and if that education ever got across and there was the kind of mechanisms that would allow it to work the right way. I do think it's changing by the way and that's is part of the topic of teledentistry that this medical dental integration stuff is going to change financing in somewhat the foreseeable future at least it's going to begin inching in as as people begin to accelerate this dynamic of medical and dental working together. People understanding that if you can't have a healthy body if you don't have a healthy mouth.

Howard: So what, first of all do you remember Eddie Judd from back in the day?

Bill: Oh yeah

Howard: He was from Missouri and then he came out to Arizona and I when I opened up my dental office in 87 first thing I did is called him up and asked him to go to lunch and he just thought that was so bizarre behavior. I mean he just I said you know I'm so grateful that you're sending me all this money and insurance things,  my insurance claims all my patients everything I just want to buy you lunch and he just he could not figure that out. The only thing he could figure out was he was from Missouri and I was from Kansas and he thought maybe there was something different in the water there but man I I used to send him a Christmas card every year and say my god last year you gave me 400 grand; thank you so much can I take you to dinner you know, what do you want for christmas and it was just bizarre how dentist just thought of their own self and it's like they don't go into intel and sell a company dental insurance for tens of thousands of employees they have no idea what's on the other side and it seems like every other industry everybody works their value chain. Like my dad owned sonic drive-ins, man he went to dinner with the man selling meat and bread and buns and other restaurants. Like he was good friends with all the fast food restaurants across the street from him. I mean you know they all work together and it's just yeah I'm almost embarrassed that's a way dentist get along with insurance companies like I'm like you can go to the CDA meeting and here's California Dental Association Delta Dental selling a billion dollars of insurance a year you think that guy would be the keynote speaker and yet you look up the hall and they have some speaker saying Delta or the devil and saying are you out of your mind Delta or the devil these guys sell a billion dollars with nine zeros and oh my god it's just embarrassing. So what made you could have gone into anything, I mean you've been in dental insurance, you could be DSO, you dental exchange all these things what made you pick Virtual Dental Care and tell us what you're doing?

Bill: Well virtual dental care what's really something again Richard Lee who's the CEO, I'm the COO oh you know we with the sale of planet DDS really before the sale of planet DDS, we began talking about you know where can dental technology take the industry next. You know everything's going to begin catching up all the all the dreams the people who are tech not technologically oriented have been have been seeing or finally coming to fruition use of the cloud use of better data use of data in a better way use of of technology to run your practices better letting dentists become the CEO etc. That's all catching on and it still it's still got a ways to go but it's gonna catch on and and be part of the industry as time goes on but we said you know what is the next thing and what's the biggest challenge out there the technology could potentially take on and and certainly looking at the underserved this is a huge issue and everybody is beginning to notice it in a way that I don't even think ten years ago people noticed it what are we gonna do with this 150 million people that don't seek routine dental care and how does that affect their overall health. So we began looking at it we've started working with Paul Glassman at University Pacific Dugoni School of Dentistry, who was doing Studies on teledentistry and we had modified dentacon the company's software to help him because you know cloud-based software for his model of teledentistry is a minimum requirement. So we modified it and worked with him so we knew about teledensity we knew about Paul and we began thinking in those terms how potentially could what we've done with Paul be leveraged into something else. We started working with a not-for-profit in Orange County which it was called health, is called Healthy Smiles for kids for Orange County. Which is the largest not-for-profit that delivers dental care to on a non-profit not-for-profit basis to kids and and we began working with them and looking at it and they were at the time sending vans out schools that was under there community outreach and we said you know let's take a look at teledentistry. It's gonna be cheaper it's gonna be easier and this is Paul's model, Paul Glassman's model of teledentistry. Let's go out and and and take hygienists out into the schools as opposed to vans let's give them the equipment that's necessary let's gather the records let's let the hygienists do what a hygienists can do but also let's gather diagnostic records and have the pediatric dentists do the diagnosis remotely. So we started that program with them and it really became somewhat of a lab for us and the first thing we noticed was the technology was really all wrong and dental office software is good for running dental offices at least the good stuff is. Dental office software cannot run a teledentistry practice. Number one and doesn't even give you the tools to do teledentistry number two. So we've spent the last couple of years developing technology dedicated to supporting teledentistry, not to replace the practice management system but to fill that huge gap that it's between a practice management software in office practice management software no matter how good it is and what's what the needs of teledentistry is. So then we began looking at it really with with an eye towards the underserved but realized soon that it was much broader than just the dealing with the underserved. At some point if you're looking at this stuff you're gonna realize you know in some point in the future every dentist is gonna have to be doing some level of teledentistry maybe it's only five minutes a month but but FaceTime on Apple is not going to on your Apple phone is not going to work for for what's considered teledentistry if it's just nothing more than conferencing with a patient. You need to be in your patient record you need to be viewing what it is that you need to view whether that's health history whether it's radiographs whether it's a neuro photographs you should be looking at that and you should be you should be noting down that the conversation that you're having so at a minimum every dentist is gonna have that and as we begin to develop oh we saw dentists coming to us which we again we hadn't even anticipated coming to us and saying; hey not a bad way to market my practice. You know I can put it on my website, I can put it on my facebook site that's, I have the secure teledentistry component they're all there they're used to it with medical at this point and it's getting more and more. So why not add that as a component to make my dental practice and maybe give me a slight competitive advantage and in my community that if somebody's looking for a dentist and then hey let's take it the next step we got another group come and say can I just send this to all of my patients that says they can get ahold of me online if they need to if their child falls and cracks a tooth maybe they just call me up on my cell phone where I can look at it and again within the patient record take a look at what's going on with that so patient and and advise accordingly. We had another group from emergency rooms come to us and say you know something somewhere around the neighborhood of 2% 2 to 3 percent of all emergency room procedures are our dental related. They treat the emergency room people have no idea when somebody comes in with it with a dental problem so so the ability for them to just flip up a laptop and bring a dentist in to advise or do a diagnosis or at least a consultation remotely would be a huge win for them. So they began asking us how we can we use teledentistry and then in come the medical groups who said you know we recognized that the cost of chronic disease from diabetes the cost associated with hypertension the cost associated with Alzheimer's when people don't have good oral health. You know potentially there's a way to use the technology you've developed and potentially bring that into healthcare facilities whether that's Medical Group's whether it's hospitals and then we even had one medical insurance payer come to us and say could you work with us with our Alzheimer's patients and potentially cut down the the overall health risk associated with periodontal disease. so all of these things are emerging from something that we thought was just going to be primarily focused on dealing with the underserved which it still is but there's this whole new world that's evolving from that.

Howard: Yeah we did a podcast, number 758 on Planet DDS with Eric daisuki CEO founder and chairman planet DDS, Blake Rice and Noris Bauer DMD are these your partners?

Bill: No  they purchased the company and they're doing a really good job with it they have taken it we thought we did a really good job and while Richard Lee is still involved with the company I'm not, but they've taken it to a whole new level and they've done a great job with what they're doing.

Howard: So they bought Planet DDS

Bill: Yes correct

Howard: So now is your software does it work best through Planet DDS, I mean is that your main cloud-based computing software for the virtual dentist, the virtual dental care?

Bill: Well again what we built was to fill the gap between the practice management application. I mean if we learn nothing else at Planet DDS we learned that dentists are not going to replace their practice management software easily and like painting with a broad brush but that is all sectors all segments of the industry that would rather stay with what they've got for reasons that we could talk about for hours but we recognize that's, you know coming up with a full-blown practice management system devoted to teledentistry was not going to take off very quickly but also totally unnecessary but we did build it with with the anticipation that we would need to interface with other applications and we also built it with with recognition that it didn't have to be just within the dental industry. Again if we're if a dental office is sending hygienists into a hospital or into a are working with a medical group the hygienists that potentially is going to be on site and that group needs to be able to communicate with everybody in that facility. When you're talking about medical dental integration not just the dental practice management system back at the bricks and mortar office. So we developed it with the we used to call it open architecture but the ability to interface with a number of different applications of billing systems. So we didn't want to limit it and it's not just limited to Dentacon and anybody that has the API is to integrate with at this point. We will and are probably in the of beginning that now other entities. Again we're totally open and will interface accordingly.

Howard: I think Open Dental is the fastest new player because of this because it's open. I think Dentrix and Eaglesoft you're right they're the two biggest Tigers in the market. I mean probably half the dentist in America have either Dentrix or Eaglesoft but it seems like it those are closed systems and it seems like the new lovechild impression on your software is Open Dental. Have you reached out to them?

BIll: No but again I mean there's a reason it's called Open Dental. I like the fact that they're open source, allows us to be able to get into it without  too much difficulty we're pretty familiar with Open Dental, Dentrix does have an API you can't get into Dentrix not so Eaglesoft. Planet DDS is developing api's too so these types of interface opportunities are getting more and more all the time and I think anybody who's going to play big in that industry is gonna have to realizes this you know, the folks from Shine or Dentrix recognize that even Ascend is gonna have to open up to that too.

Howard: So you know these kids you know when I got here 30 years ago Arizona dynamic dental school now there's two private schools Mesa and Glendale, it's a hundred thousand dollars a year to go. These kids are walking out four hundred thousand dollars in student loan debts. They're listening this right now and they're saying is this a business model. I mean what what are you telling dental graduates four hundred thousand dollars in student loans who are interested in and teledentistry can, is that a business model that can help them pay back their student loans and be profitable?

Bill: We've seen it and in fact we're in the process of contracting with dental offices now just with that thought in mind or at least the thought of increasing their footprint. So we've actually developed in California the equivalent of a DSO for hygienists. So the hygienists work for a professional corporation that's that we manage and we'll send those hygienists out into community locations. Again this was anticipated that they were primarily going to be going out to to the underserved but it doesn't have to be that and in fact we've already talking to businesses that's want the convenience of hygienists coming into their locations. So that they don't lose their employees all day long and these aren't huge businesses, these are you know relatively small ones and this is a way that the hygienists can actually work with I won't say for but work with the dentist. A local dentist is going to be the hub of our the receptor of so what's the hygienist doing out there; the hygienist is doing what a hygienist can do legally State on a state-by-state basis in California. You know mostly that means cleanings a little bit more but generally speaking they'll do the hygiene, the preventative stuff and then they'll gather the diagnostic information. So they're carrying handheld x-ray equipment whether that's no matter or something else on the market they're carrying digital sensors they have we give them cameras, intraoral camera. So they're gathering the diagnostic information that goes into our software the dentist then is notified that there's data awaiting and they sign into the application they can do the treatment plan right in the electronic dental record there and the patient gets notified. So the dentist then is able to expand his or her practice by doing the diagnosis and treatment planning locally or you know they could do it at home if they want to but also a further treatment is needed which is you know depending on the demographic maybe as much as half the people need further treatment and that's a referral source into their office. So by working with this if you will outsource network of hygienists, dentists can in fact build a referral source that's channeling into their office. They could do it on their own or they could work with us but one way or the other it is a way to expand the footprint and patient base of their practice and probably the value of their practice.

Howard: and what's the dental hygienist DSO. What's that called?

Bill: You know we're just working and you know we didn't brand it intentionally, we're just working with a dentist who owns the PC.

Howard: Do you see that the hygienists and you have these Smile Mobiles, our two chair dental facilities on wheels. Who makes those for you and is that a big part of this plan?

Bill: Well you know it's mobile to the extent that hygienist is rolling it in like on a suitcase. So this is this is totally easy to deal with.

Howard: The wheels are on the suitcase, it's not like an RV or anything

Bill: No, no those are too expensive.

Howard: Where you buying these two wheel Smile Mobile's that a dentist carries in on wheels, who’s making that for you?

Bill: We've worked with a medical mobile cart company called Kore three that we've been working with. Although there's others that do too and we're looking around ,we're trying to find the best possible. Not only for ourselves but for our partners too who want to get into this.

Howard: but Kore three at medical mobile cart said those are the best ones for you now.

Bill: Yeah they they work with us and develop specifically to our requirements there's a couple different models you know if you're gonna be in an emergency room in a hospital and a medical facility you're gonna want something that's kind of substantial and you can roll around if it's going to be a hygienist going into a school if it's gonna be a hygienist going into a business that's gonna be something that the hygienist is going to need to be able to carry him or herself and that's needs to be a little bit smaller a little bit more compact. They all need internet access because we've got real-time capabilities of if you want to dial up and bring the dentist into it you can. If you want to bring a specialist into the conversation you can, everybody's looking at the same record that way.

Howard: For the hygienist you said they're doing cleanings and x-rays with digital x-rays and the nomad handheld x-ray care or they do a lot of SDS Silver Diamine Fluoride?

Bill: You know that is up to the dentist to do the diagnosis, we don't get involved in the clinical treatment. If the dentist who is doing the diagnosis recommends that then yes the hygienist can go ahead and do that. Now I need to emphasize too, this is a state-by-state regulatory climate around what the hygienist can do and right now there's only seven states that would allow the model I just described. All the other stuff that doesn't preclude all the other stuff. The dentist doing you know marketing for his or her office it doesn't preclude the ability to go out to an emergency room and market yourself and say hey call me in the middle of the night if you want to or you know for the younger dentist that's trying to build a practice. So that's not precluded anywhere in the country but if you're going to work with hygienist out in the field that is definitely a state-by-state issue.

Howard: and what are the seven states?

Bill: Oh you know I'm gonna get them wrong if I say off the top my head. I know of course obviously California can do its Oregon to some degree Hawaii to some degree Wisconsin, Colorado and see I'm already missing two

Howard: California, Oregon, Hawaii, Wisconsin, Colorado

Bill: Yeah their's gonna be more. Their's a lot of pressure right now because of the fact that all of these issues are coming up the cost of the healthcare system not just the dental side but the cost of the healthcare system to not bringing the underserved not giving care, routine care to the underserved big issue. So every state is looking at it on some level as to you know and generically it's called mid-level therapists MLT's or dental therapists DT's type of legislation and and conversations are going on all over the country.

Howard: and this is highly I'm emotional to the dentist I mean you say dental therapists and I'd say 80% of the dentists will blow a fuse and when something like this historically whenever you have something come into an industry and is disruptive there's big opportunities in front of you and like I've lectured in states that have dental therapists and most of them tell me they love them because these have a couple of hygienist doing all the cleanings that they didn't want to do. So they could do root canals and crowns whatever and now they have dental therapists doing the operative dentistry and they say my god it's great the first two rooms are cleanings and then in room 3 and for a dental therapist goes in there and numbs off does the whole filling. So again it's just building a team, it's leverage, it's like why would you want to do an MOD filling when you could be doing a molar root canal. So don't you think dental therapists touch some type of button with our dental homies and make some blow a gasket?

Bill: Oh yeah I think you're underestimating when you say 80% but I think it's more than that and but I would say but I would say you're absolutely right you know and I'm not even going to discuss the scope of what activities they could do. I mean let's just even leave it at preventive services let's not even say they go into the operative world but it doesn't matter whatever the spectrum is gonna be. I would say you know doctor get ahead of it, it's gonna happen so why not get ahead of it why not be able to as you say there's going to be opportunities, so why not take advantage of it while those opportunities are emerging. I mean you know putting in your heels and hoping, digging in your heels not trying to stop it and hoping it goes away as probably doesn't make much sense in this arena since it's such a big issue politically.

Howard: We had another teledentistry podcast episode 1078 the future teledentistry with Dr. Maria Constanta are you familiar with her?

Bill: No I'm not I've heard the name but I don't think so.

Howard: Yeah and I feel sorry for her because she's from Kansas City, so last night she watched her Chiefs lose in the last few seconds to the Patriots. So she's probably given up all over the future of teledentistry it probably took a step backward I can't say, but she's got a big group In teledentistry. I mean their's gonna be something here and Dentistry you know one of the my beefs with dentistry all along is that it seems like it's always been more focused towards the all-on-four than the all-or-none and a lot of them do it for business reasons because they think there's more money in Ruth's Chris Steakhouse and there is McDonald's and I'm there to tell you that the bottom half of the market probably has more business opportunities and more needs and less competition. Aspen Dental is one of the only DSOs who actually I think has a plan where they have a focused market I mean Aspen dentistry is always rolling out where they ain't they go to the underserved they go to where it's Medicaid and for some reason you know you go to these big dental conventions they want to have all these prosthodontists talking about these big $25,000 in arch all on four but no one wants to talk about teledentistry Medicaid treating the poor. Do you think there's just as much business opportunity in all on none verses all on four and teledentistry for nursing homes and Medicaid as their is in setting up the cosmetic practice in Beverly Hills?

Bill: Well think about it this way and you know how many people have approached you with business plans as they have me that's you know what what is the first thing I look at when I'm looking at a business plan is is what is the demand. I mean if on one end of the spectrum if you have to create the demand you know forget about it I'm not even gonna talk to you. You know you're gonna be scraping on the hillside for you know two years before your fingers find a place to hold on to. On the other side if you can find something that is that it's already in demand and the demand hasn't been met my gosh you are gonna take off and that's exactly what's going on in in dentistry with the underserved I mean you got dentists who are focusing on the 55 or 65 60 percent certainly no more than 60% of the people who can actually pay or have somebody pay for them and they're totally ignoring 40% of the market. That's one hundred and forty five million people in this country and the 145 million people not all of them don't have dollars associated with them. So if there is a way to monetize that 140 million people first of all our system isn't big enough to the capacity in the system isn't big enough to take it on but even if they if it could take it on my gosh just look at the opportunity for somebody that can figure out how to make it work and it's in an area where the demand is not only there it's huge and their's a lot of people seeking the solution so yes absolutely there's opportunity there.

Howard: That was really profound what you just said but why create demand when you can just fill demand. I mean that is just profound so many dentists are indeed trying to sell these big cases and you're saying why create the demand when you can just fill the demand right?

Bill: Yeah, absolutely

Howard: I mean that is very profound. So what are my homies gonna find when they go to your website What are they gonna find, what action should you give them, what should they do?

Bill: Well what they're gonna find now is that we're right in the middle of changing our website and in a month it's gonna look different and it's gonna say a lot of different things but they can still find us and there is a form that they can get in touch with us and again what I would do is invite anybody again we, you know we're limited from a regulatory standpoint to talk about the hygienist going out and expanding the footprint of the dental office although in those states where that's doable you know we welcome the discussion with anybody but anybody who wants to begin to get in get their feet wet with using teledentistry as marketing. We've learned a lot about that we've seen some ways that potentially insurance companies both medical and dental are gonna want to interact with them. So learning about and again what I would say is it's even learning about it at this point is important because if they can stay ahead of this everybody's going to be doing it. I don't know if that's ten years I don't know if it's five years but at some point everybody's going to be touching teledentistry because the patients are gonna demand it and potentially insurers are going to demand it. So I think that learning as much about it as they can early on, it would be great and for us talking about it is what we're doing right now. I mean we're gearing up we're getting funded we are gonna go big at some point once we feel comfortable that the industry is ready for it and we're not gonna be the only ones, so there's gonna be a lot of talk about this.

Howard: So their's a lot of private equity flow I mean KKR just bought what 56%of Heartland dental. Do you see the private equity appetite for dentistry still growing?

Bill: Well certainly in the DSO market and you know the technology market is heating back up again. Their have been any number of reports, I'm getting calls from private equity people about revenue cycle management I'm not really sure why but obviously people are exploring it again just the whole cloud-based you know dental practice management industry as you know again I don't know whether there have been any reports that have gone out the reports that have gone out about it but again I'm getting calls at a much more frenzied level than I have been for the last couple of years. So I think their's a lot of money floating around, their's a huge amount of money floating around in telemedicine. So you know every now and again will peak so people say teledentistry what's that and they'll call us and talk to it. So I think their's gonna be some money around technology and down flow going forward quite a bit.

Howard: Talk about a teledensity program takes oral care outside it all started with Dr. Paul Glassman DDS MBA The University of Pacific this is the virtual concept that a doctor Lisa Mazzetti dental director VGMH was talking about and talk about a Paul Glassman and what his thoughts are on all this, is he a friend of yours ?

Bill: He's one of our advisors but Paul was one of you know I mean he's the pioneer. If anybody if you ask somebody who's the pioneer of tele-dentistry they would say Paul Glassman and again his initial approach was how do we send people out into the community to help deal with the underserved and you know their were a million questions when he first started you know. Now you as dentist me as dentists we might say hey look it I can take a look at some x-rays and some images some photos remotely and you know do a pretty good job of creating a diagnosis and certainly in the insurance world. We had you know numerous dental consultants looking at x-rays and making some sort of remote diagnosis, so that's been going on for years but Paul needed to prove it so Paul actually from an academic standpoint was the first one to put together that in fact a dentist could make a reasonable diagnosis and treatment plan based on x-rays and images and so he proved that and that took a lot of the bite out of people who would go to regulators and say that this is dangerous.You know if what how does anybody know that it's going to be the same diagnosis remotely that it would be in the office. So he took the bite out of that, he personally went to a lot of regulators and it still does talking about the value of teledentistry potentially to the underserved. So his model again in this it's not overly unique anymore but his model was send hygienist out, let hygienists do what they do and let them including in California by the way interim therapeutic restorations. So they can actually scoop out decay and put in some sort of fluoride temporary and you know, in kids that may be permanent as far as that restoration goes but that helps a lot out in the community too, in dealing with caries but any rate that's that was what he studied and then he's put together numerous programs statewide and he's a national lecturer, international lecture for that matter on this type of a delivery system.

Howard:  Another point on teledentistry is Dr. Dorota Kulicka-Sobocinsk DDS MPH. I'm sure I butchered that name I'm sure it's a hundred percent chances polish, Dr. Dorota Kulicka-Sobocinsk  University of Rochester, who says that the missing piece and telemedicine is dentistry are you familiar with her?

Bill: Again the name not the person

Howard: Yeah I mean it's all over the place and I think that dentistry, whenever there's a disruption you really need to look out and see what's going on. I also think a lot of this telemedicine I think some of the 4000 pound gorillas in the room or the the 4000 pound elephant that no one talks about is four and a half percent of Americans will finish out their life at a nursing home and the data is coming in from nursing home that they're getting about one root surface cavity per month. So once grandma's been in there for a year she has 12 root surface cavities which just grow crazy and there's a big market for that. I've gone to several nursing homes in Arizona and just follow them around for a shift you got to get the right nurse that you know it is open to it but I mean it is just appalling when what I saw in my own eyes is this these nurses they seem to be small people to begin with and they have an entire wing and they've got a bathe and feed and eat and give medicine in this entire wing and when it comes down to the tooth brushing thing all I saw with my own eyes was a toothbrush a little pee of toothpaste back and forth on the front six teeth, spit in a Dixie cup and that was there, that was their oral care regimen and to have someone going in there teledentistry and doing a thorough cleaning however often that is or putting some SDL silver diamine fluoride on those root surface cavities would be amazing and the other 4000 pound elephant that people don't want to talk about is the sedation that when these kids these hundred and forty million people you talk about that aren't really in the dental system. When that two-year-old needs eight pulpotomy x' and chrome steel crowns and a board-certified pediatric dentists and a board-certified anesthesiologist put that take that kid to the or and put them under and that oftentimes doesn't turn out right I mean it's a you know when you do an IV sedation you want to only do people between like 16 and 60 that are healthy you sure as heck don't want to be doing two-year-olds. I mean even the three publicly-traded dental office companies around the world - in australia 1in300 Smiles, Pacific General Smiles, there's one in singapore Q&M. They're lawyers when they did their DSO and went public in asia their lawyers said you're not even allowed to do this. I mean they just x it out there Bismol there's no IV sedation by anyone under 16 over 60. So what you're talking about really fulfills a huge black eye in dentistry and that's underserved for nursing homes and also in those nursing homes if grandma and grandpa if they're not in there for dementia or Alzheimer's or whatever they got rheumatoid arthritis their I mean they're there in a home for a reason and brushing and flossing all your teeth. What percent of people in nursing homes do you think don't even have the ability to properly brush and floss their teeth every morning and night?

Bill: Well it's anecdotal but it's you know I've seen an alzheimer patient that has forgotten how to hold a toothbrush. You know and what you're talking about is quality of life issues that I you know I think anybody that's involved in dentistry is aware of and it is a quality of life issue and who wants our family members to have poor quality of life if they don't have to but it's also a real dollars and cents issue to the healthcare system. We've got a contract with a Medicare Advantage insurance company that has hired our hygienist network to go into Alzheimer homes to periodically clean the teeth and they're not doing it out of the kindness of their heart although that's part of it they're good people but at the same time the quality of life issue is a side event. It's the dollars that are in the health care system that they're trying to manage as best they possibly can.

Howard: Yeah their's a very neat thread on teledentistry on dental town and a lot of these people are saying it works because Medicaid. Their's many ways you know when you go into these in nursing homes an encounter is an exam a pro fee a denture adjustment a post-op check and their's just people, one guy says when their's money available for Medicaid. There'll never be a shortage of dentist figuring out how to utilize this and their business plan. So looks like this is gonna take off, do you see in anything in the near future that's gonna 10x it? I mean they always talk about Wall Street like you know, you look at a bunch of companies that go into a new technology and you just watch them then all of a sudden one will have a 10x outbreak and then historically that is usually the company that got there got it right. Do you see anything that's around the corner that could 10x tella dentistry?

Bill: Well you know we'd like to think we are but that's you know I think that the component that's missing and you're not going to find it in your thread because we've seen it and that is the whole technology piece of it. I mean as an industry dentists have done a really good job of working poor technology right. I mean what determines what it would a dentist calls success its clinical outcomes right, whether that is financial clinical outcomes or the quality of their work they're not too concerned about the quality of their data, they're not too concerned about the quality of their business analytic tools. So as an industry I can prank paint with a broad brush and say that it's an industry that is used to working around poor technology and or using technology poorly and working around that. So I think we've already seen the beginnings of that in teledentistry of where somebody thinks they can utilize some existing application that's out there in dental and use a for teledentistry they're not going to be able to what you're reading for the most part is you're going through that is I wouldn't even call it teledentistry. What you're reading for the most part is either a hygienist or a dentist going into one of these facilities and doing care. Tele-dentistry to me means that a hygienist and again I'll use the dirty word dental therapist goes into these facilities as potentially a lower-cost alternative to sending in the dentist and then communicating with the dentist who then becomes almost like a specialist if further treatment is needed and then further treatment is arranged for but the dentist then becomes almost like a specialist and but you need special technology to do that and that doesn't exist. That's why we saw a great opportunity to coming out with technology that just that could fill this gap of where you can in fact we communicate. Our technology allows you to communicate real-time so in a secure setting, in a way that I can bring up the x-rays, you and I can both be looking at it in fact we can bring in the patient we can bring in the hygienist we can bring in an endodontist, everybody could be on the same screen looking at the same record at the same time, that's teledentistry, not just going in there with a record and maybe writing something down and calling somebody on the phone or showing somebody on FaceTime in an illegal and unsecure it arrangement but so the major piece that's missing that we think we bring to the table and that's what potentially gives us first mover advantage in this industry is the technology and this unique delivery system of a DSO hygienist that's not out there. If a dentist tries to do this on his or her own it's doable and with our technology. It's potentially doable it's just much more difficult they don't have that expertise, they don't know how to hire a field force and manage a field force the they don't know what technology to choose from a software standpoint from an equipment standpoint. They can investigate all of that and they can bring people in and they can hire consultants or they can hire an outsource Network which is going to probably make more money in the long run. So these are pretty unique things that we bring to the table related to it's a so-called teledentistry.

Howard: You know it's so interesting I mean you're like one of the biggest high-tech guys that ever lived in dentistry I mean really, I mean your dentist for ten years yeah your DDS the University of Southern California when the insurance companies, Dental Connect, Dental Exchange, Planet DDS. I mean really you have been at the forefront and I have to say that most dentists have no idea they've spent their whole career working around poor technology. I mean I was saying 30 years ago my claim to fame was that my dad's cashier as sonic drive-in had more practice management data than I had you know, 20 years later running a dental office and just the fact that their practice manager software isn't hooked to a peach tree or quicken or Microsoft Great Plains accounting, I mean they don't know their number and then when you look at that they're all the dentists are all upset this weekend .Their's just thread blowing up on a Dentaltown called Root Cause did you see that root cause that documentary on Netflix, anyway root cause is it's a very successful movie that's on Netflix talking about how what do 98% of all cancer patients have in common, they had a root canal and they're interviewing all these a holistic dentist saying that you know those teeth got to be extracted and you got to course spend all this money get all this stuff out of there and the dentists are just blowing up that you know that these holistic dentist they weren't showing research they didn't interview anybody who is in you know epidemiologist or you know just just a sensational movie but I was looking at root cause of why this movie Root Cause can exist and again I said it at the beginning the show I mean Delta Dental what would percent of all the insurance claims since World War two do you think Delta Dental has done? A quarter?

Bill: Well yeah I mean there's Delta Dental you know they're state-by-state all the rights that's changed somewhat recently well that's probably pretty high but yeah you can go that high.

Howard: Okay so if they have a quarter of all the claims for the last half century I mean that data could prove whether community water fluoridation works or doesn't work. That information could tell you in a minute if people had root canals had a higher increase again. I mean cancer or whatever I mean dentist they think they're very high-tech because they have a CB/CT x-ray machine they got an intraoral camera, they got an iPad. They have all these little toys but as far as any utilization of the macroeconomics of the dental industry a hundred and ten billion dollar U.S. industry they don't have a clue to that and their own accounting and it's really funny how they think they are so high-tech and you and I both know they've spent their entire career in low-tech and don't even know it.

Bill: Well yeah you know the high-tech to them like you say is the is the ITaro or something like that which is actually pretty is high-tech I've got to give them credit for this stuff that's come out for from clinical usage but as far as information technology usage that's right and by the way I got to throw in here thanks for the kudos on me in technology but I was very fortunate 20 years ago to meet Richard Lee who is who was the you know the founder of Dental Exchange that my company merged with and the founder of Planet DDS and I've been working with. Without that relationship you probably wouldn't be talking about me and technology at the same time so let me throw that in.

Howard: Well let's get him on the show does he want to come on the show?

Bill:He probably would

Howard: Well have him come on the show. He wasn't on that app planet DDS one was he?

Bill: No I doubt it

Howard: So but again like you said earlier though that the dentist chief I mean a fire look at the fire department, man if I just retired from being the chief of the fire department for 50 years and I said well when I started you know there were two fires a year and last year half the town burned down. You would say the fire department in a bad job, the fire department has outcomes it's how many fires are their, how many do they prevent and in the 30 years, I practice in Phoenix, in Ahwatukee. I've only seen one house burned down every decade and when I talked to firemen they come in my office they say they're basically ambulance drivers 90% of all their calls or health care but dentists have to look at outcomes and again but that data they are trying to build a business and pay back their student loans but the purpose of a dentist is the lower the disease missing and filled teeth of a region and I think that the amalgams that we were doing in the 80s probably lasts twice as long minimum as the composites we're doing today. Doing preventative dentistry in a town without community water fluoridation and the dentist doesn't provide access or Medicaid or Medicare. I mean it needs more macroeconomic data so did that so the country can decide are these two hundred eleven thousand Americans who have an active license to practice dentistry are they doing a good job. We gave them a hundred and ten billion are they reducing disease, cavities, caries. Are they making an impact and that doesn't seem to be where the focuses. Seems like the focus anymore is just got completely taken to the cleaners by all these private dental schools. I'm $400,000 in debt how am I going to pay back all these student loans when they're out there on the front lines supposed to be treating disease missing and filled teeth. What are your thoughts on that?

Bill: Well and I take it the step farther and that is let's include medical into that because that there is this continuum but that needs to be focused on and the outcomes measurements between dental and medical need to be better too - you know what can you say we're health care professionals that's the you know, who went into dental school saying I want to make a lot of money. People went into dental school because they wanted to help people they wanted to help health outcomes but you're right he could put behind, you could put behind the eight-ball with all the debt. You know they need that four hundred thousand probably doesn't even include their undergraduate and you know talking at a consultants get together with some dentists a couple of weeks ago they said it was the brothers who said why would we be happy to have only four hundred thousand and different stuff. So yeah these poor kids are stuck with with trying to figure out how to get enough money to pay the stuff off and live a reasonable lifestyle at any rate.

Howard: So for action so are mostly are you looking for people to join your team right now, today talking to the ones in California?

Bill: Well California is where we're starting. We could, our technology can go anywhere of course because it's simply technology. The people that we're working with right now it's all very workable but any dental technology and the technology really but any dental technology has to mature. So we recognize that we've got a few more months of maturing and we're really looking at this point to work with beta testers that were probably not even going to charge any money to for a while just to get this stuff off the ground. You know your 10x analogy that you were talking about before, comes with knowing that what we've got works knowing with what we've got is good knowing with it's solid and that's that it produces the outcomes we want it to produce. So we're probably going to be looking for the next six months to find the right kind of partners. We want to make sure that dentists who use it for marketing purposes actually do get patients coming in because of it, they are able to retain existing patients because of the fact that they've got cutting-edge technology that somebody else maybe in their neighborhood doesn't. You know we're looking for people that are forward-looking that's as regulatory restrictions ease that they can expand the footprint of their other practices by taking it beyond the wall, by taking the care that they offer beyond the walls of their practice through the use of hygienists in some form or dental therapists. So at this point we're looking for to use the words my business partner Richard Lee, their's a funny-shaped door that we've got and we're looking for people that can fit through that funny shaped door and these are going to be the early adopters, these are gonna people the people that will end up being advocates of what we're doing in a positive way.

Howard: So are you in Irvine California right now?

Bill: All right, well you know we're a remote company I live up in Ventura County but we we're headquartered down in Irvine yes.

Howard: Yeah and do you think do you think I'm some DSO will be ,what's your exit strategy if you build this up and you get private equity or whatever. Do you think a private equity would want to merge this into a DSO or what do you see your exit strategy?

Bill: Well the exit strategy could come from a lot of different directions you know this I could spend a long time talking about the payer world won't bore you with it, but well you know that the reality is as payment for health care continues to change as financing for health care continues to change if the straight line had happened with the Affordable Care Act it didn't, but it's crooked but it hasn't ended yet but standalone dental companies are gonna be a little bit in trouble.How does a standalone dental company sell? Well I've got a marketing and sales crew on one hand and I've got a an administrative staff who over simplifying this but it basically pays claims and manages the payment of those claims on the other hand. Their isn't a whole lot of difference between the good guys between the administration of claims and the payment of those claims. So a lot of the difference is on the front end of who does a better job of marketing and selling what they have you know and of course their marketing and selling their ability to do the back end. So I'm not separating the two but the point is if you take away that front end that marketing and sales components from a standalone dental company and you merge in medical and dental in some way that the financing mechanism pays for both. So now we've got a coverage that is both medical and dental in some way, which is where the ACA was moving things. Now all of a sudden that the medic the dental company the standalone dental company is at the at the mercy of the medical company so that medical company but can potentially go around and bid each one of those medic dental companies down. You know and I'm really looking far ahead here but they could go to a Delta Dental and say you know I want to pay X for this and then they can go to a United Concordia and say I've already got a bid on X can I go X - I think we can then go to a MetLife and say etc etc. So that puts them in a bind as to what it is that that they have to offer and so inevitably in my mind this is one person but inevitably in my mind that's exactly why Guardian is going around buying up the delivery system potentially and others are going to have to - they need to become the delivery system not just the administrators of the delivery system. So if I've got a network of dentists that it Delta's maybe a little bit bigger than the Guardian that's maybe a little bit smaller than United Concordia, who knows but if that's my only differentiator I don't have a whole lot of differences but if I own that network and I can offer that medical company something more than just claims administration that's important. So if we've got a network of dentists that are doing teledentistry that have the ability to do second opinions, that have the ability to work with hygienist a DSO hygienists out in the field that have different means of offering services to - you know if you got a hygienist network potentially you could be taking impressions out in the field you know all sorts of other opportunities, so this is a very easy network for a payer to potentially to get involved in.So that's one exit strategy, the medical world you know again if Medical Group's dental could be a very big component of what they're offering, so whether that's I mean Kaiser is doing something on their own but their's it guys are successful with dental others are gonna begin to looking how do I get into this business and what does that mean. So their's a lot of potential exits and we're not worried about that where right now, we're worried about making this thing succeed.

Howard: Is it strange when you're trying to do business ventures in the dental world have such one of the largest players Delta Dental being a non-profit. I mean there's not really I mean are there even any pure-play dental insurance companies I mean Guardian and United Concordia you know dentistry's, I'm just a small portion of what they do correct. I mean dentistry is only 5% of the total healthcare budget. Are there any total pure-play dental insurance companies publicly traded or that just do dental insurance for a profit and are not a non-profit?

Bill: Well you know again yeah their are only a small part of the country when you're talking about a MetLife but at the same time if you were talking to the executives in the dental they would have probably a different opinion about how important it is within the company and how to make it succeed. So I mean they would call themselves pure-play. Guardian would call itself pure-play the dental site of the thing United Concordia obviously and then you know their's other players that are pure-play that's their's something like a Liberty Dental in California that is you know, they got three million members mostly Medicaid but all they do is dental and you could go around the country. Centene is similar, Detalquest. So their's players out there that certainly I would call themselves pure play dental.

Howard: Well I'm so you think  Richard Lee would be a good follow up for you, do you think he'd bring a lot more do you think you covered the whole thing?

Bill: Well he would go over it, Richard is a little bit more reticent to talk than I am so he's a lot smarter than I am but he's a little bit more reticent to talk

Howard: Yeah it's funny on when you podcast I was very surprised at how many of my friends that were like big famous speakers but when they speak they're standing behind a podium reading their slides but just like a free-for-all on a podcast. So is there anything I wasn't smart enough to ask you about or their I can't believe we've already been here an hour. Is there anything I didn't cover that you wish I would have talked about.

Bill: No I think we covered the gamut here

Howard: All right so for the action plan it looks like you're looking for people from California, hygienists and dentists to contact you if they want to learn more about this?

BIll: Well and I would say nationally anybody that's interested in learning about teledentistry especially from the technology standpoint. You know this live consultation stuff the appointment you know we allow patients to actually get online and schedule a remote conference with the dentist, so they could if a patient is interviewing for a new dentist, if a patient has an emergency they want to talk to somebody about in a secure setting. So again anybody can do that nationally, we don't limit that to California.

Howard: and how do they contact you?

Bill: So anybody that's interested in telephones and dentistry go to the website, we've got a forum on our website.

Howard: So well hey thank you so much I mean you're the busiest man I know in this space, thank you so much for finding an hour to come on my show and talk to my homies. I thought this is very informative thanks so much hope the rest your day is a rockin hot day

Bill: Thanks you too Howard

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