Norton L. Travis serves as the Chief Executive Officer of ProHEALTH Dental which has a unique approach to dentistry by affiliating with large, well-established medical practices and healthcare systems to coordinate medical and dental services. Mr. Travis began his career as a corporate lawyer, having founded a firm in 1980 that grew to become the largest dedicated healthcare practice in the metropolitan New York area. Mr. Travis served as the Chairman of the Corporate Department of the firm and specialized in healthcare mergers and acquisitions. Mr. Travis received his B.A. cum laude from The University of Massachusetts and his J.D. with distinction from Hofstra University School of Law where he served as a member of the Law Review.
VIDEO - DUwHF #1505 - Norton Travis
AUDIO - DUwHF #1505 - Norton Travis
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It is just a huge honor for me today to be podcast interviewing Norton Leonard Travis JD he serves as the CEO of pro health dental which has a unique approach to dentistry by affiliating with large well-established medical practices and health care systems to coordinate medical and dental services since its founding five years ago pro-health dental has entered into affiliations with such health care systems as the mount Sinai health system as well as large medical groups pro health care riverside medical group west med medical group and caramount medical that collectively include thousands of physicians that serve over three and a half million patients pro-health dental's model of integrating dental and medical services further its mission of educating the public about the vital importance of good oral health as key to improving overall health and well-being prior to serving as the CEO of pro health dental mr Travis served as the executive vice president and general counsel of the nation's largest cancer care provider where he oversaw all mergers and acquisitions during his tenure the company grew to over a hundred locations including an expansion in Latin America he also serves as the project coordinator and a range of financing for the new York proton center a 350 million dollar specialty cancer care partnership composed of three of the largest health care systems in the metropolitan new York area mr Travis began his career as a corporate lawyer having founded a firm in 1980 that grew to become the largest dedicated health care practice in the metropolitan new York area he served as a chairman of the corporate department of the firm and specialized in health care mergers and acquisitions mr Travis received his ba lauda from the university of massachusetts and his jd was distinction from hofstra university school of law where he served as a member of the law review uh thank you so much for coming on the show um this is the first time it's the first time i've ever talked to a lawyer without being billed 400 an hour so I’m going to I’m going to try to stretch this a long time ago if it was only four hundred dollars really what what have you heard for a high these days I’m sorry what's the highest you've heard for a lawyer billing for an hour yeah gosh triple that or more oh my gosh you know you're in new York i saw the neatest banner ad research you know when you you click for a banner ad how much is the uh the amount of money the highest amount is new York city personal injury attorneys and it's like eleven hundred dollars a click yeah so if you any of my homies out there bored just just uh google uh new York uh um personal injury attorneys just start clicking all the buttons and uh I’m just kidding but um you know i i really wanted to bring you on the show because um dentistry is kind of a weird start um the first dental school in the world was in ohio the first dental university was in Baltimore and it started out um separate than the physicians and were told urban legend that it was because the physicians need the bed and dentists needed a chair and they kind of went two separate ways um but in uh the last 10 or 20 years it looks like they're trying to get back together um the the the you know the mouth um body relationships and so that means to me that the business models are going to be changing and i i noticed when i was lecturing in Israel uh for a week it was the only time in my life where i saw that all the dental dsos were owned by medical groups and affiliated with hospitals and that that's not i haven't seen you know any evidence of that anywhere else in the world so um do you think that dentistry and medicine uh might start dating and courting each other and uh get married again i i think that they should i think that it's going to be an uphill battle the slow process and we're fighting many many years of history of a major chasm between medicine and dentistry that starts back in the medical schools and dental schools where as as I’m frequently being told physicians were basically when the patient said uh to look straight down into the throat and not look into the mouth because that was the domain of dentists so for from our perspective and and what our organization is all about is to take affirmative steps to break down that chasm and therefore while we sort of look like a dso and in some respects we act like a dso we have a very very different model which is really driven by as you were kind enough to point out our mission of integrating medicine and dentistry and really educating the public educating physicians sometimes educating dentists and educating insurance companies about why oral health is such an important element of overall health and how we can really make a difference in not just making people's mouths healthier but making them healthier in an overall sense a holistic sense and bring down the cost of health care and keep people healthier and more productive that's what that's what we're we believe is the imperative for integrating medicine and dentistry i don't think it's going to happen overnight we see it in small pockets currently in some medicaid clinics you'll see it uh where you have a dentist who does provide services under the same roof but as you're probably aware the state laws that govern the practice of medicine and practice dentistry generally create barriers to integration of medicine and dentistry in terms of practicing together and so that's certainly going to be one of the challenges to overcome um one of one of the um interesting things in Israel was um i i actually talked to a couple of dentists to work there and i said well what's different about working in a uh dental dso or clinic that's owned by a um a hospital a group and she said uh she said you know I’m a pediatric dentist and i mean i was working on a kid one time and i thought something is wrong and i was able to get someone else and before the standard appointment for a cleaning exam and x-rays um we'd already diagnosed that uh she probably had leukemia and started started that process and she just says you know every um you know every couple of weeks she just loves to be in the system where she can reach out to other colleagues um you know covering the rest of the body and you're right it's a more holistic approach um can i just point out that's that goes in two directions because what's really important and what we really stress in our model is yes we are doing we are doing various screenings of patients as part of their routine hygiene visit cardiodiagnostic screenings sleep apnea screenings blood pressure screenings and so that does allow us to make sure that patients are tending to any abnormal findings that might that might appear but we also see it go the other way in the sense that if a pediatrician is with a child and probably a parent and sees something that the the child is complaining about something in their mouth that's an opportunity for medicine to reach out to dentistry and really coordinate care and we see that all the time in our models um um to bring this home to my homies um um the reason I’m writing on the show is because uh dr richard r rongo um he just merged his practice with yours and the first thing that caught my eye was a great mindset a lot my phone number for my dental office was 893 care and i love how pro health dental their phone number is uh 855 phd care and i saw that and i thought well um so why would a guy like richard a successful dentist um what would what what is he thinking um when he merges practice with yours um pro held dental what what is the advantage uh for hammond um what was going through his mind to say this this is a good decision um i think actually it's a really good question because it allows me to address both the the medical dental integration model of pro-health dental as well as i suppose our dso component as well so how did that all come about the answer is that richard practices in huntington long island huntington is a community that has a very high density of patients who get their medical care from our clinical affiliate pro-health medical so we knew that we wanted to have a dental office in huntington why because our clinical affiliate has a lot of patients there and our clinical affiliate has a lot of primary care positions there both adult and pediatric and that's where we want to be as that's the the the greatest opportunity to integrate care so we decided that we were going to build an office and our standard office runs between 8 and 14 operatories huntington is a 14 operatory office in a great location and then reach out to the dental community explain our model and see if they want to be part of the organization richard and i i i don't want to put words in his mouth but i think I’m pretty comfortable in saying richard saw both opportunities richard saw the fact that as a solo practitioner it was getting more and more difficult to be on your own this was even pre-coveted and where we're now even more difficult but the opportunity part of a larger organization where we could take care of the things that are very difficult for a solo practitioner to do on on his or her own uh but he also liked our model he knew that by being part of pro health that he could be part of this innovative approach to integrating medicine and dentistry and also the fact that they have a lot of patients in the area that as we as we co-market together we obviously co-brand under the pro-health brand which is what we do with our other affiliates under their names so you mentioned care mount care map when we operate in caramel we're paramount dental we're not pro health dental but richard clearly saw the opportunity to become part of an organization that was doing something different and had the ability to access a large pool of patients that already identified with pro health as their health care provider so i think i can i can fairly say it's a win-win situation join a large office have now professional colleagues provide full-service multi-specialty care to patients of all ages under a large brand new state-of-the-art roof and be able to integrate with his medical colleagues in the community so is the um is the uh reimbursement model um have any differences or innovations is it or the answer is not really uh you know the only reimbursement model that uh that we follow and which is actually some people could say is is unfavorable but we just think it's embedded in the model in the mission is that because we work with the local physicians most of whom accept pretty much all insurances the variable may be medicaid but except most all insurances we are we accept insurances as well at least the reasonable paying insurances so we are an insurance-based model but other than that at least currently that doesn't mean that we get paid any more or any less currently than our competitors in the same in the same markets we do believe and are actively involved with looking at a risk-oriented payment model together with our clinical partners and we believe that if we can incorporate oral health services that will keep people healthier that will actually enhance the ability to have a successful risk model because of course they're all driven by you keep the patient out of the hospital you keep them healthy you reduce their costs and you are rewarded for managing that care so we think we think we're teed up nicely for a risk integrated care model in the future we're not there yet um jay what is it jd power and associates um they had their 2020 u.s dental plan satisfaction report overall customer satisfaction index ranking uh dental dental quest was number one um you scored between one and a thousand they had 801 aetna was number two 791 then humana the industry averages 771 cigna the united healthcare dental metlife dental united concordia guardian access dental i was surprised delta dental wasn't even on the um didn't make that first what's that I’m surprised as well yeah um so i i i i don't want to talk about religion sex politics violence we just had an election all this stuff but i do i do have a a couple um i do have one it's glaringly obvious that the the final business model of the delivery of health health care medical dental is obviously not um done yet i mean it's still uh in the making um this early stages i would say it's early stages yeah and this last election doesn't matter which team you're on um it shows that there's two teams on America i mean there's two groups of people very strongly evenly divided and healthcare is a big part of that issue because it's 17 of the economy i mean what's bigger than that um where do you think it's drifting um to clarify did you say you accept medicaid uh only in one of our offices in queens we participate in the child health plus program so that children can gain access to dental services i want to ask you a question i don't want to put you on the spot but you are a lawyer my only beef why i would never do medicaid ever is because it's just like you're in new York you wouldn't do business with the mob i mean when dentists um mess up and do mistakes with these other insurance companies uh they they talk they work it out they ought to each other that they do that but medicaid you're always going to get kidnapped and put in a cage and i mean you um i i had a friend great guy and his wife screwed up the medicaid billing forever and when it finally got busted the best uh plea deal he could get was seven years in prison so he he fled to mexico and and he just died last thanksgiving but it's like you know um there's all kinds of dentists i know that um you know they end up in jail and i said well you know your your mom told you when you're little you're not supposed to kidnap people put them in cages but it's just do you do you think that the medicaid and the fraud division is just so it's just too heavy-handed i mean i mean gentlemen won't do business with them well i i i said it's a tough question i mean i think the answer is like and this is putting on my old and dusty lawyer hat because i haven't practiced law for uh for a number of years but um i think i've got two answers to one is do i believe that these organizations have quotas and mandates and they're looking for fraud yes unfortunately i think that frequently i don't have to look that that hard or that deep because there are and this is of course not limited to the dental industry it's the medical industry as well whether it's through ignorance or or perhaps being you know more deliberate uh there are there's a lot of misbehavior that goes on in the federal health care systems and we see that with the enormous numbers of recoveries that take place there's also as I’m sure you know there's a whole cottage industry of whistleblower lawsuits that where private citizens usually employees of healthcare organizations can get quite wealthy by being the whistleblower to the government and then sit back and they get a piece of the recovery when the government recovers money back from the provider together with penalties and the likes so yeah i i'd have to say taking federal funds has a significant element of risk and it's something that we thought long and hard about i think there's two reasons why we're doing it one is we really felt like in the community in certain of the communities we serve to not make services available to children was inconsistent with our mission and our model secondly we made awfully sure that we have a very very rigorous compliance program that is monitored by our outside compliance council and our internal compliance team and we make sure we get it right so is there a risk does that you know is there a general sense that whenever the government gives you money that there's a string that at some point they're going to want to pull some back yes do i believe that you can substantially mitigate maybe not totally eliminate but substantially mitigate that risk by doing things correct and understanding that you need the proper documentation and you need to demonstrate necessity and the like and make sure you have that well documented yes so for us it was a balance but i think the answer is it is certainly a major risk for any health care provider medical or dental that participates in government insurance programs i would say medicaid probably even a higher risk than medicare um and this is a um a tough question but um you know in the last 30 years i've lectured in um you know 50 countries uh all uh all around the world and um i just can't figure out why the the issue is of health care is so emotional in the united states i mean you know you always hear you know all the other countries you know the top 20 gps have socialized medicine amer um America does for senior citizens through medicare they have it through the poor state by state in medicaid i thought i thought the obama thing with the affordable healthcare act um was the worst marketing branding position i'd ever seen because every one of my patients who was bad-mouthing and i'd say well on your chart you have access and they go yeah that's not obamacare and I’m like yeah that is that's the affordable health care act but nobody i i still haven't met anybody receiving access for the poor uh that have any idea that it's related to uh um the affordable healthcare act known as obamacare whatever but but why do you think it's so emotional and since we're at a dead heat tie 50 50 where do you see it drifting in the next 10 years i mean you know historically i love that book by paul starr the uh the rise the american health care system and um where they said you know the people who are always saying they wanted four things when they got injured uh they they wanted workers comp and they got that and then when they were too old to work they wanted old age retirement and they got that that's social security and then when they um um unemployment they got laid off i mean when they finished the railroad the railroad companies left 5 000 asian people out in the middle of nevada and when they when they got laid off or quit they wanted unemployment insurance they got that so according to roosevelt the four pillars were um unemployment workers comp old age insurance and health care and they got three out of four for everyone they got one the last one is for over 65 and poverty the middle is the last bastion there it's a huge battle where is it going where do you think it'll go in the next 10 years so i try to stay away from political issues and but the truth is howard this is a purely political issue i mean uh i don't think that anybody no matter which side of the aisle they're on would say that they don't think that people should have access to health care it's a question of how we fund it it's a question of what how major a role the government plays my own personal view is i would be surprised if we move much deeper than obamacare into a a socialized medicine approach i just think that we're too embedded in our private insurance model that many people are and i think that this became clear during the democratic debates i had no idea we were going to go into these kinds of topics but I’m happy to talk about them is you know i think that the majority of you other than perhaps you know the bernie sanders view was that no one wanted to take away private health insurance people are if they're happy with it it was just i think we're just looking at possibly whether or not there is a need to widen the safety net that that obamacare was looking to protect but i would be surprised if we see a medicare for all program or anything of that nature i just think that we're too embedded in our in our current system and i think that you also have to look at realistically healthcare is big business if you start moving into a government-controlled system it's obviously have an impact on pricing the lobbyists are going to have something to say about that and i just think that that i think will narrow the the the the pool of uninsured and make sure the pre-existing conditions are remain remain protected and alike but i'd be surprised if we go much further than that so and and i just said one thing which is I’m a new I’m a newcomer to dentistry i mean i've spent my entire career which is 40 so years in a healthcare services business there's a lawyer or as healthcare on as a healthcare executive entrepreneur dentistry is a new world to me it's only been doing this for five years and i think we all would agree that dental insurance by and large is a completely different animal than medical insurance to a large degree dental insurance as you know for many many people is simply a subsidy against the cost of dentistry kept benefits not really providing comprehensive coverage so that you know when people go visit a physician and they have health insurance they know they have a deductible amount they know they have a coinsurance amount but they think they have insurance that is not true as you know of many if not most dental plans they they contribute towards cost on a limited basis but it's not really insurance and still i can tell you in in our business and i think the majority even if you accept widely accept insurances because of cap benefits uh limitation on coverage services and the like you're still seeing the majority of your revenue coming from the patient themselves either because they have no insurance or because they have to cover what's not covered by their insurance plan so i i think dentistry's got a long ways to go for it to really be considered dental insurance i i think it's um um it's really amazing um um when i was lecturing in china um the the chinese dentist um you you could tell they thought the whole concept of uh dental insurance was moral hazard and they explained to me that you know you drink coca-cola and eat chocolate all day and and have 10 cavities why should your boss or government pay for it you should pay for that and that would change your behavior and um do you think that's a large part i i know the past that i lived through like like when the aids epidemic came out you know a lot of people were like well that that's a behavior problem you know that that's that's not a medical problem and right and uh so do you think that's part of the dental dilemma that a lot of people perceive look all we need to do howard is go to our northern uh a neighbor up into canada which which has you know which i am i am sort of a canadian by my folks who are from canada my wife's a canadian my daughter lives up there so and all of my family's from canada so i I’m pretty familiar with the canadian system especially in ontario the ohip system and essentially you have broad comprehensive coverage you know with all of the pitfalls of socialized medicine but you have broad comprehensive coverage on the medical side and no coverage for dentistry so what does that tell you in terms of social policy in terms of the importance of taking good care of your mouth to me it means that there's a long ways to go for people to understand that good oral health is going to not only have somebody have their mouths look better or feel better but it's actually going to make them healthier from an overall health perspective and and so that that to me is a glaring example of how far we have to go so from the um back to this report from jd power and associates on dental plan satisfaction slightly decreases um what do you think the consumer what do what do you think the uh 1 000 uh surveyed people that have dental insurance from dental quest aetna humana whatever what what do you think they were liking and not liking about their insurance i know on my side um the the thing that bothered me the most about the whole affordable health care act is that you know we were over here screaming saying um look man you got a 30 of our cost is paperwork when someone comes in um we have to have a human the most expensive part you know people time and money we have to have a person call the company and wait on the phone and try to get all this approved it's like why don't they have an app on their smartphone that we scan why don't we i mean and i was screaming that my gosh if he just automated that system i mean he could save 30 of the health care costs without changing anything um but but that's from the provider point of view the paperwork is a mess and you ask anybody in America what do insurance companies do oh they're perfect at um collecting the premium and then they can't make the claim i mean that that's ev everybody assumes that's what they're trying to do and I’m a cynical bastard and i i kind of look at uh these insurance companies like well that's what they're doing they just they they got the claim and they're just delayed delay delay because um it's just annoying to have to have a full-time human sit up there all day long calling insurance companies and every time we try to automate it it doesn't work and for uh it's like the voting the same thing the voting i mean um here i have a smartphone that can recognize my voice it sees me to sign in it's with me at all times this phone it's probably a 99 chance this phone can verify this is howard i go in to vote and i have to pull out my driver's license you know wow high-tech and then um they couldn't um i couldn't vote because i had uh sold my house and put my dental office as my residence and you can't vote uh from a residency of a commercial property so i had to show them my home so i just call my comptroller she takes a picture texts it to me i show it to her on my smartphone and she's oh okay so she approves so i can vote I’m like why didn't i vote on my smartphone because you don't want to make it easy to vote they obviously don't want a democracy there's no doubt about that it's a republic they don't want a democracy and i don't think insurance companies uh want to make it easy to pay their bills but I’m wondering what is the consumer side on this jd power and associate what do you think why do you think some consumers like dentaquest more than aetna or humana or whatever what what are you hearing from the consumer well first of all I’m I’m going to uh stay clear of your concern about voting and because we'll we'll leave this to talk about the dental world and not politics because i can only get myself in trouble there um i think that what what you're seeing likely what you're seeing is that the people who have more comprehensive plans and dentaquest you know which does run a fair number of medicaid plans and like they you've got people who are paying very little or in some cases employer-sponsored dental plans and getting adequate coverage because there aren't enough providers in the network to provide them with services on the other hand as you move down the the continuum to the other end where somebody is either paying the dental premium themselves which as I’m sure you know many employers do not contribute towards the cost of dental insurance or maybe it's a split premium and then they find out when they actually need services how little is actually covered and how much their out-of-pocket exposure is is where you're going to get the less satisfied people because i can tell you i hear this all the time from the folks in in our company is that people show up to a dentist they have their abc dental name the plan they have their card we have i have dental insurance they get presented with a treatment plan and they are basically told that only a small portion or even half maybe of the of the treatment plan is covered either because of coverage limitations or or actually capped benefit and that's when people realize that dental isn't the dental insurance they had maybe wasn't as terrific as they thought they had you know they walk around with the insurance card in their in their wallet and they say have dental insurance i think that the where the rubber meets the road is when you actually need dental services so that's probably where you're seeing this differentiation of between more comprehensive plans and really more like subsidy plans interesting so what um i do believe that the uh what you said the opening remarks that they um group practice um really got a big lift on the pandemic when when the uh when the covert 19 hit um it's kind of nice not to have to go alone and be the the one dentist in your office figuring out ppe and all this stuff like that and um dental town um classified ads has always had a thousand dental offices for sale it immediately went to 2000 for the first time all the old guys said you know this is the last draw and uh and then the 5 000 ads for jobs for dentists shrunk to 1 000 and they were all dsos and um so i've been trying to um podcast interview all the dso kingpins like i just did mb2 the other day because um that's the request I’m getting from all the kids saying no one's hiring they're looking for a job um how um um marco uh economist at the ada um says that um you know it looks like we're going to the industry will be down 38 percent for 2020 and he's projecting he'll be down uh 20 for 2021. how do you see it well um i think that those numbers based upon the original uh what what what marco and the ada had projected to my knowledge leaving aside our own experience which i'll be happy to share with you were painted a grimmer picture than what's actually happening uh i think that at one point it was that you could hopefully get back to 80 percent of pre-covered levels by the end of q2 2021 um i think it really depends on who you are and where you are and what your ability is to recruit staff i i think that recruiting hygienists and assistants and the like are a far greater challenge than being able to hire dentists just because of covert related issues home care issues schools being closed issues that kind of thing or just fear of of infection but i will tell you i think that um for the right models that are not uh um simply looking for what i guess i would refer to as retail dentistry but have more of a mission and model as we do um i mean we're significantly up from our pre-covered levels for a in our exist in in our existing offices and i do think i i i think I’m right and we have done a major what i'll call public service whether you want to call it infomercial stab out really broadcasting on cable television and local newspapers and all like about there's never been a more important time to take care of your mouth because now we know that we see the clinical literature starting to look at correlations between poor oral health and and covid and we as we know there's plenty of literature dealing with other you know chronic and systemic diseases so i i don't think this is a one-size-fits-all situation we absolutely see many many more dental practices up for sale i think that that's going to be the case for some time um and i think you're also going to see some dentists who are on the verge of retirement just literally you know shut the lights and close the door and call it quits whether they sell or not we're seeing that as well um i think that that the other part of this that's going to make the sale of practices more difficult in the short run is and i don't think this is any different than we've had other uh uh recessions uh whether you know in 2008 or otherwise i think that it takes a while before sellers or their advisors or the brokers whomever come to grips with the fact that the world has changed pricing is going to be different uh the the willingness of a buyer to take full risk on a practice that hopefully will recover back from covid is not the same so i i think just the rulebook has changed but i do think that the opportunities exist we're certainly extremely busy with what we would call a lot of tuck-in practices which means local dentists like our friend dr rongo who decide to do this proactively but a lot of local dentists who say being in private practice as a single practitioner or one zero or two z is just too difficult too expensive and here we are nearby with our 12 14 operatory offices and even though we're pretty busy you know there's there's usually capacity there so we see this as that those practices can tuck into our model and make these practitioners lives much much easier we can we can run the practice from that point we also do find that many of them and i think dr rongo would would confirm this as well it's nice being in an office where you have colleagues where you where you can communicate with fellow clinicians about the care of your patients and and we offer that not only within each office but because we have an integrated uh electronic health record for all of our offices we literally have a situation where if there is an expert in one particular service that you want to consult with outside of your office we we facilitate that we facilitate sometimes with the patient via tele-dentistry but you can consult with an expert one of your partners one of your colleagues without having to sit in the same room you can just pull up the record and all that just adds to the team and collegiality approach of being part of a large integrated practice and it's also following uh the long-term trend of retail i mean the uh if we learned anything in the last three centuries from retail starting where you live in new York city the first were the shop houses where you had a shop and you lived upstairs and the next generation said well that was 10 foot by 10 foot let's go 20 foot by 20 foot and every generation just got bigger and the bigger model um extinct a little model until walmart and costco and price club and home depot were all 250 000 square feet and they all claimed they got too big walmart um was the first one to said yeah it's too big um i i came to that conclusion at about a hundred thousand square foot for myself personally i'd rather buy milk at a gas station than go uh go through walmart um it's just too big but my gosh um we look at pediatric dentistry the fastest growing one plus one equals three is when a pediatric pediatric dentist and orthodontist get together because obviously mom's question is always going to be do you think little billy's going to need ortho one day and they have to fill out a form and make a different appointment and it's just you know putting it under one roof and then asia i love i love seeing how uh different people with the exact same problem solve it differently and the only place i've ever ever seen routinely dental hospitals is like cambodia vietnam um my gosh um um you know where you go there and it's a ten-story building and every level is a specialty uh dr park did that in um seoul korea where he's the founder of magen dental implants um but i i never even see the term dental hospital um you know there's not i mean phoenix got a 3.8 million metro why do you think no one in phoenix at 3.8 million ever put the whole dental machine under one roof and called it a dental hospital uh and I’m I’m quite familiar with the asian dental hospitals we've had discussions with one of the major organizations in china you know i think we're just very steeped in solo practice history i think that that you're really talking about moving from the you know you would probably know these statistics much better than i but from what would appear to be a largely single maybe two practitioner model around the country to go from there to a dental hospital is an enormous leap so i and and i think that dentists from what i've seen and again I’m a newcomer to the dental world uh are fiercely independent want to try to be fiercely independent want to be on their own um and so i just think that's a steep uphill climb whereas in in in places like asia you already see those models in other clinical disciplines and it isn't that difficult even look even on the physician side and which is way ahead of dentistry in terms of aggregating into large groups and that's basically our model i mean our our clinical affiliates which you named earlier in in the podcast range from the smallest as 400 physicians and the largest as 1500 physicians so but they're still not the majority of healthcare services in in the regions in the metropolitan new York area so i just think we're we're we're fighting a lot of of old habits and a lot of independence and dentists physicians they don't want to give up their independence it's hard for them to basically be their own boss and now be part of an organization that's going to have rules and regulations and policies and procedures that they will not necessarily always agree with so that's that that's not that's not such an easy thing to sign up for i think that's largely what we're facing here i think culturally it's just way way different than it is in the areas of asia you described yeah and if you're uh still in a quarter of our listeners are still in dental kindergarten school so if that flew over your head i mean if there's one thing we learned in human history it's you need transparency and checks and balances um competition um absolute power corrupts absolutely and you just nailed it dentists don't want to be um part of uh rules and regulation no no human wants rules and regulations but i am to think outside the box that's why i wanted to have you on first i mean um it might have been normal to sit there and think i mean you got some amazing people on your team uh bruce valerie director of prosthodontics chief dental officer i mean he's a board-certified prosthodontist he's a legend and neil kanowski a periodontist um you got some legends uh you know and i i was thinking well i should get them on first but i thought no i want to get the CEO lawyer on to see his vision think outside the box you know because that's what that's what we're up against here is just tradition i mean uh you know you're born into uh what kind of food you like i mean i if i was born in saudi arabia i probably wouldn't crave macaroni and cheese uh craft dinner three times a day so um but what what what um what about you and the system and pro health was able to attract a guy like bruce who's got a resume longer than uh there is and uh neil kranowski i mean these are just legends and prosthodontics and periodontics what do you think um lit their fire what gave them the why why they wanted to join your team instead of being their independent self i i'd like to think that it's the model it's the you know i think that when you have forward-thinking people who lived who have experienced dentistry in i'll just say the current I’m not going to say necessarily old-fashioned because i don't insult anybody but in its current more insular model okay and then you see that i mean just the way we always think about it is this okay if if you were in rochester minnesota as a private practice and dentist and mayo decided to open up mayo dental that would probably be a pretty significant competitive threat uh if if so when we look at here on long island pro health medical pro-ath medical with its thousand physicians 300 locations and 1.5 million patients and they are receptive to integrating medicine and dentistry and working with us and co-branding with us and marketing with us you get guys like bruce and neil and richard rongo and and many others who say that has got to be the model of the future is a and and helping us get there they're they you know it doesn't have make it very clear i mean i i have drunk our kool-aid i love our model okay but it doesn't happen by itself we have to be the ones to as i always tell people it's really easy in integrating medicine and dentistry it's really easy to talk the talk we as the dental organization have to be the ones that actually walk the walk we medicine is not going to do this and come to us we need to go to them and convince them why having in effect an oral health service line an affiliated oral health service line makes sense for their patients and for them as an organization well you know go go ahead go ahead no actually and unfortunately we have the folks like you know bruce and neil and rich rongo and others who get it who see how fundamental it is and really want to be part of a cutting edge organization i should mention to you i don't know if this came up in the materials that you saw you know we're working extensively with harvard school of dental medicine uh you know they they have had a oral health integration initiative for for some time uh we are doing joint research with them we are conducting surveys of oral health literacy with them because i believe we are the only organization even though we're not that big and we're pretty local currently i mean i i do have vision of taking our model to a much larger platform but uh who are really doing the clinical integration and so uh you know it's when you can get folks like the individuals you named and like harvard and others to come and work with us uh you know it's going to be it's definitely going to grease the skates for us and get us on that path hopefully to the to the end zone much quicker well you know i um i've always wondered um you know as all these dsos have taken off that uh um you mentioned rochester earlier and uh i noticed that you know no one really did uh the mayo clinic model i mean it seems like all the big dsos you know they were more convenient they had better hours or what what have you but no one with that um absolute focus on quality which it sounds like that's what you're doing i mean you're trying to do this integrated deal and again to the listeners out there um my gosh these guys he attracted i mean like take bruce i mean um gosh he's a diplomat of the american board of prosthodontics he's past president of the american college of prosthetics i mean these guys are legends it looks like you um you're the first one I’m aware of where you're trying to do this uh you consider yourself a dso right uh well that's that's where the answer is we perform dso functions certainly by supporting all the practices that are part of pro health dental but our model of affiliation with medical practices sort of takes us out of at least the classic dso definition i think that we see ourselves more as this disruptor and innovator and the dso part of it is really the support services that are needed to make that happen you know and and i think the best way to describe that howard is you know with all the uh now as we know many many practices are available for purchase or whatever you know we are we are we are being approached by many many dentists brokers etc and truthfully unless the opportunity sits within our strategic plan which is largely geographic to be to be within the service area of our affiliated medical group where we're not interested in that practice so in that respect we don't really look at how many flags we have on the map we look at having the right flags on the map and having the offices that are strategically going to help serve the relationships that we have with our affiliated medical groups but the uh i mean but the density i i i wish i could show you this picture it showed uh on the eight billion humans um there's about um a bunch of these 50 million human streaks where just like 50 million live in abandon and one of the biggest ones is where you are from boston to uh philly i mean there's just a ton of people so you you could stay in your strategic area i mean that that's that's like two countries um you could stay there a long time um have you um um have you acquired many strategically fit practices has anything changed with the ebitda have they become cheaper since more people are selling or is there anything you've learned from that is it all old guys like me or you know what what's uh well it's it's not young guys like us so put us in the same category here it's it's it you know they some of the major uh transactions we're working on currently involve dentists who have 10 to 20 year runways still to continue to practice but the combination of seeing how the world is changing liking our affiliated model not wanting to necessarily knowing that we're coming to town if you will not wanting to necessarily compete but but work together we're seeing dentists of all ages being attracted by the model and and so in terms of as i said before when it does involve a purchase uh i think that it's just not what it was pre-coveted i mean you know you can't necessarily look at 2019 financials and say that's what I’m going to rely on you know i mean i assume like the rest of the world here in new York we were you know we were shut down from early march until the beginning of june so 2020 financials are a mess for everybody so i think that what it does is it necessitates getting creative to create a mutually fair and beneficial uh approach to acquiring practices and that's what we're doing we always pride ourselves in one thing if somebody you know somebody comes up to us all the time says well what's your model what's your formula okay my answer is always no you got to go first what are you looking for to join us are you if if we're talking to somebody who within six to 12 months wants to have his toes in the sand in boca and just wants to sell the goodwill or any so-called records deal or whatever you want to call it then we have one approach but to me it's really a question of how long does this person want to continue to practice and what's their philosophy then we structure a deal around what will work for them because i mean i've been doing this a very very long time in my in my in my many lives of being of doing healthcare m a and a deal that works for one side but not the other is a bad deal and ultimately will implode we need to look and make sure that the deal works for both sides and if it doesn't we take a pass but it has to work from the standpoint of the seller as well with the only caveat on that being that the easier deals are the i want to retire in the next year deals those are pretty easy to structure the deals and and and we do a handful of those the deals of somebody who says no i really want to approach dentistry differently than what i have in the past i believe in your model i want to join the organization those are the ones that i think are are the most important to us the most creative to us in terms of building value in the company and the ones that we have to be most careful how we structure yeah you have to have a cultural fit and you have to have a financial fit and all those things aren't aren't conducive to any kind of a cookie cutter they're they require a customization approach to make sure that the deal works for both sides so you're talking about both sides you're talking about a dentist selling to um your system and your model and all that what about does why why um does it work for um healthcare like like um like kenneth davis md uh president and CEO of mount Sinai health system why why would he be even interested in dentistry why would he be interested in you what um it seems like we were always the uh the red-headed dentist or the red-headed stepchild uh we were never you know um so why uh and dentistry's never really even been five percent of the industry it's always slightly below so it's like 4.9 4.7 what so why does uh dr kenneth l davis md president of the mount Sinai health system why is dentistry on the radar and with you well i i i don't want to put words in dr davis about the way to tell you what my belief is first of all mount Sinai has a dental residency program so dentistry was already on the radar screen for them to some degree uh and and they do perform oral surgery i would like to think and i do believe that the driving force was a true clinical belief because dr davis after all is a is a position and and the same as our other clinical partners which are all physician controlled that they think that this is an opportunity to enhance their service offerings provide more comprehensive care to their patients and as i said before it's not necessarily a one-way street that they're going to send their medical patients over for dental services they know that our model actually helps to generate medical patients by doing clinical screenings that are generally not done in a dental office so i think there's just a total symbiotic synergistic relationship but ultimately it comes down to i i believe that dr davis as our partners they want to do what's best for our patients they want to provide comprehensive care to the patients and the more that we can do that the more that we can integrate care just like they have done with other service lines under medicine the more they add service lines the more one-stop shopping and comprehensive care they're providing to their patients we just add we augment that by adding another synergistic service line so then um back to uh new York city which uh obviously it's so funny when you go around the world because uh um anytime you're lecturing in uh africa or asian someone's been in the united states i would say oh i they come out and tell you i've been to the united states and I’m like i know what it's going to mean it's mean they went to the greater new York meeting in manhattan and they think that's the united states i grew up in kansas and i still could remember the shock i saw i gave my first dental lecture in new York city because i want to go to new York city it was august 4 1990 and as a little kid from kansas i mean i i'll never forget it i looked out that window i i couldn't believe it but it's also wall street um the big financiers um you know when i got out of school orthodontic centers of America had done an ipo on the new York stock exchange it rose to over a billion valuation or a dozen on nasdaq they all imploded and we've never seen them ever back to wall street again but there's two in australia that are publicly traded uh one three hundred uh dental and um pacific dental there's one in singapore uh q am why does wall street how come when like a um a big dso is it just seems like all the private equity they put money in it they build it up they buy a bunch of practice they merge it then they just sell it to a bigger venture capital then a bigger it's like a hot potato the the the final exit strategy of instant liquidity was always the stock market why have we never why why did that stop and do you ever think you'll be you could do an exit strategy on wall street well um so here's what I’m going to this is again my view here howard is this at some point whether you're looking at a heartland or someone who's just gotten you know there's nobody bigger to sell to if you will wall street's going to have to be considered as an exit because almost all private equity as i think we all know private equity is a you know anywhere from a short to a midterm investor it's not a long-term investor so ultimately they're looking for an exit um i think that that a public exit will have to be considered unless there are other potential suitors that are larger that serve a broader scope of services than just dentistry and whether that's health insurers health systems whatever that's that's always a possibility but i do think that that and i just was having this discussion last night with somebody i do think that we will reach a point where it has gotten too large for private equity uh so that that's certainly a possibility you know as it relates to pro-health dental i think the only honest answer i can give you is we're only five years into this and so exit is not something that we think about uh but now you know do i wake up in the middle of night and think about at some point sure and the answer is i think that our model unlike the typical dsl model gives us a much broader range of potential suitors it could be private equity it could be a large health system it could be a dental plan it could be because we're really when push comes to shove what we're really doing is we're shaping a healthcare services model not really a dsl model and i think that's that opens up different opportunities but it's not something that's that's that's on our current radar stream we're going to continue to build out our model both locally and and and and i believe regionally and nationally in the months and years to come um i can't believe we went over an hour that was the fastest hour in the world it must be a uh brain food candy for me i loved your um your pro health dental um uh video um you put on vimeo yeah that's the video that i was mentioning that i believe has had i know it has from our call center has had enormous response in the current covert era yeah and I’m just curious because uh um why do you put that on vimeo instead of youtube I’m curious when people use vimeo um what what that now you're this is a uh a technical question i i wouldn't know the answer to it i leave that up to our marketing people yeah i always wonder why they do that but um you have a pro-health dental public service announcement i really like it I’m going to insert that in there um but before we say goodbye um um i i can't the final question i gotta ask is um what is your relationship with the harvard uh school of dental medicine we have a we have a research uh affiliation agreement uh where we have agreed to work together to we are we are rolling out actually was supposed to happen just prior to so it's happened on march 15 so that tells you what why we had to uh pivot uh we were rolling out a survey process where in our clinical affiliates primary care offices to test public awareness on the importance of oral health obviously it was all being done by paper so now can't do things by paper anymore we have switched an electronic approach and we're rolling that out the results of that will make their way into what we believe will be a publishable research paper and we will look at other ways to work with harvard to demonstrate the efficacy of an integrated medical dental model which as as you may know you know they're they're just recently retired dean bruce donov was a huge advocate of published heavily on the subject and is still involved to my knowledge so we're staying involved with harvard because our philosophies of integrated care are totally in alignment and i still um it's kind of embarrassing when you're a dentist because dental caries is still the number one most common chronic disease in the world and um i mean um and are oral cancer you know so many of these cancers have improved so much the five-year survival rate of oral cancer hasn't changed since freshman year of dental school for me i mean for 30 years that needle hasn't moved and and then when um and you really need to be on the ground because when you're in the united states uh it might not make sense to you but when you go to other countries like um you know i'd always heard in that africa that doctors recommend that they drink coke and I’m like no they don't that's got to be some crazy you know some crazy joe when i went there it's absolutely true and then i was edumacated that uh well if they go to the well and drink dirty water they might die a color I’m not worried about a dental cavity I’m worried about cholera and uh so um better is uh you know you can't let um better uh or best be the enemy of better and every physician i talk to over there especially in like tanzan um you know a lot of those countries they're like yeah we they love the processing of coca-cola they they love their systems and purification and it's so good that the fact that it's empty calories and causes a tooth rot um it's still um the number one killer is still diarrhea um you know and um they they drink dirty water and they they die of it so dentistry's got a long research road ahead of it i mean god just uh just to cut that five-year survival rate oral cancer or at least get dental caries off the number one can we somehow get it to number two that would be terrific wouldn't it it would and uh and i wanted to start with you uh thinking outside the box and it's just been a great hour but um if you want to send back your uh your two legends uh um bruce and neal um or we could even do it together they could be a different place we can have on uh zoom we can have many but it was just a huge honor to have you come on the show um i i do think that you may be the first mayo clinic business model in dentistry i've been waiting a long time to see a big dso where the number one marketing driving machine like the mayo clinic is quality and the mayo clinic brothers story was ins it was very very interesting because we don't live in those times so you don't have people thought in those times but in those times when your 85 year old grandma was really sick everybody's like well she had a good life and let's just make her comfortable and you know just let her fade away and all the medicines were of course bottles that had the same ingredients opium alcohol morphine coat you know and they just made her come from another diet it was the mayo brother said no no no wait wait wait i know she's 85 but they there's people that just want the very best and mayo clinic is down here in scottsdale and it is an amazing system and dentistry was always um you know cheaper faster more retail more available more affordable which is all great but I’m glad to see that we might have that pro health might be the first i've seen where you're trying to be the mayo clinic of dentistry if you didn't normally thank you thank you i i take that as a great compliment and it was really a pleasure to spend the last hour with you well i i don't know if you'll make the number one above ken norton he's still my favorite norton but uh number two and look i grew up i grew up in brockton massachusetts so i grew up with rocky marciano and marvin hagler so you know that that's now you're talking boxers so uh but i'd be happy offline to have a discussion with you about heavyweight boxing because it was something that i was really a big fan of in my in my earlier years yeah and and just like innovation who saw the i can't believe i went from boxing being number one to ufc i didn't see that innovation coming it's and it's all about innovation um making everything faster better easier cheaper smaller and uh thanks for uh coming on the show norton it was just an honor to podcast interview have a great pleasure thank you pleasure to meet you resume our lives there's never been a better time to focus on good oral health as an essential element of overall health clinical studies show that poor oral health can contribute to serious illnesses such as heart disease stroke alzheimer's and even some cancers at pro health dental we are dedicated to improving oral and overall health through integrated medical dental care with your physician make an appointment today and remember to put your health where your mouth is