Absolute Dental DSO Embraces “Next Generation” Technology.

Welcome to another episode of the Dental Software Advisor podcast. As we all know, the world's been changing dramatically. I mean, Amazon really started it, didn't they? And patients really expect more from their providers in their dental groups. They expect all kinds of services, all kinds of engagement, real-time interaction. So the world has changed, and DSOs and groups are really starting to lead the way in this patient engagement. And what are they doing? They're using technology to help support this. So I'm real excited today on an episode of Dental Software Advisor to welcome Dave Gierasiewicz, who's the CEO of Absolute Dental. And we'll be discussing how Absolute Dental, as a large dental group based in Nevada, actually uses technology in unique ways to engage and help their patient care. And as an anecdote, you know, knowing I'm a techie and I'm a geek, I have to mention that Dave is one of the first CEOs I mentioned that actually has an IT background.

So he's very qualified, and I'm real excited to talk to him.

So, uh, Welcome to the podcast today, Dave.

Awesome. Thanks for having me, Mike. Appreciate it.

So Dave, can you talk a little bit about Absolute so folks get to know a little about your organization?

Sure. So Absolute Dental is the largest branded DSO in the state of Nevada, approximately 30 locations. Uh, we are probably the largest Medicaid provider in the state of Nevada, spans about 100 providers, um, both in Reno, Carson City, in Northern Nevada, as well as most of the Las Vegas market. All dentistry in one place, oral surgery, endos, perio, pedo, general hygiene, you name it, we cater to the patient.

That's really interesting to have all those specialties. Just as an anecdote, I've been talking a lot the last couple years about internal referrals, and so we can get into that later or not, but obviously you have a need to use technology to really kind of support a lot of your internal referrals, I would assume, because you have so many different disciplines.

Yeah, we do, because the specialty groups travel from practice to practice, so making sure that that's coordinated properly and keeping those referrals in-house. Ultimately, you want the patient to not have to leave so they feel comfortable. So there's, there's definitely some work behind all that.

Great, great. So based on the last conversation we've had— actually, we've talked quite a few times— and, uh, just the 10,000-foot view of how your group, just the philosophy of how you use technology to engage patients, and then we can get a little more into the weeds on actual features. So just a couple of minutes on, on how you look technology in this whole patient engagement experience and how the world really is changing for dental groups?

Sure.

So I've probably said it more times than my, my team and I would want to admit. Amazon has changed our world. You know, if you would have thought, you know, even, even a couple years ago that you get on an application that you're in your bed at night at midnight and within 2 or 3 clicks you spend $100 and then a box shows up at your house sometimes the next day or within 48 hours, certainly that, that's magical, purely magical. And it has really changed the way we have expectations as consumers. And I think that the patients also expect that. So my team has heard me say many a times, whether it be one-on-one or as a group, listen, patients expect the Amazon experience. They expect to be able to schedule online. They expect to not talk to anyone while they do that. They expect to do that on their time. They expect to walk into a dental practice with no surprises. They expect to check in online. They expect to, in some cases, be seen by a dentist remotely. They expect to check out, hopefully contactless and seamlessly. And then they expect to, if they don't like it, press a refund button and then get, get their money back. Because that's the way Amazon has trained us, right? But certainly we're doing anything we can and everything we can to try to meet the patient or the consumer ultimately where they expect us to be.

You know, the other thing that's interesting, Dave, is, you know, we hear this kind of myth, I guess, when you think about large groups and DSOs, this whole corporate dentistry tag. And there's a lot of folks that look at large groups and say, well, it's not as personal, can't be as good as, you know, a smaller, more personal type of practice. But what I found both in my years in medical software technology and dental is that really technology can actually help improve patient care, as your point of engagement. So I want you to talk a little bit about kind of this myth about corporate dentistry and the fact that, at least in Absolute's case, you're actually using technology to become better at helping, at doing patient care, right?

Yeah, I think, I think the corporate, quote-unquote, dentistry gets a bad rap. In fact, we banned the word corporate, you know, about 5 years ago. Because I, it just has negative connotation. The reality of it is I feel that larger groups have the resources to do R&D. They have the resources. They, they know that it's ultimately about the patient experience because frankly, larger groups, whether they're branded or not, they, they have larger headline risk. Uh, that's part of it for sure. But certainly we always want to do the right thing. So we have, whether it's a skunkwork project, whether it's R&D dollars towards some sort of technology budget, whether it's patient focus groups, we're always looking at items that can help us improve that patient experience.

Right. And you know, it's interesting you mentioned Skunk Works. Again, as an ex-software development IT manager myself, our conversations, it's really interesting about your group, and I assume other groups have IT resources as well, but you know, nobody's going to take, no large group is going to be able to take a piece of off-the-shelf software and just plug it in and works exactly like their organization, right? So talk a little bit about how not in the weeds, but just in detail, how you modify software, how you work with the vendor to actually customize their software. You know, many times 80% of it might work for you, but the other 20% is your organization, right? So talk to our viewers a little bit about how you as an IT organization work with a vendor to actually help kind of customize and make the software work for you.

Sure. Every group I speak with, every other CIO I've spoken with in the last 15 years being in this industry, there's never anything off the shelf, you know, because there's always a special need. And, and interestingly enough, Mike, as I, as I migrated from the CIO position and seat to the CEO position and seat, my view has changed a little bit on that because I don't necessarily need all the things that I thought I needed. They were more so wants, because the technology certainly is a means to an end at times because it's again about patient care. But there are always items that you need to bolt on outside of that system that you have or develop yourself outside of that system. And as you know, probably even better than me, you know, being in this marketplace and what you do, the reality of it is there's just been a plethora of technology companies that have cropped up in the last 7, 10 years of bolt-ons here and there. Automated confirmation services, review, patient reviews, um, you have text messaging services, you have Analytics software. There is all types of bolt-ons that are available out there for these out-of-the-box packages.

The good news is, you know, large, larger groups have the resources to research.

We have the network to go and talk to peers and figure out what's working and what isn't working, and so that we can work with the vendors to improve. We just recently went through an improvement project with, with our practice management system vendor. And they came to the table and actually put some really cool features in for us that really helped us manage our revenue cycle management platform and product on the backend at a much more granular level, as opposed to the level it was on out of the box. So I do think if you work with your partners, they will come to the table, but again, sometimes it's not in their roadmap perhaps. So you might want to have to go out of the box and find a bolt-on or someone to do customization.

Great. Well, I want to segue a little bit into the fun stuff, right? The actual features and functionality you've you put in for patient engagement. And I guess I can digress a little and talk about how I met you. And I met you as we talked about back in April. A lot of my DSO and group customers started saying, hey, Mike, we're kind of dead in the water, but we heard about this thing called teledentistry, right? Can you look into it? So, so for the last, gosh, 7 or 8 months, I've read, I've talked to every vendor possible, and ran across you as a DSO embracing teledentistry. And, and not just in the way of, you know, people think about teledentistry as, oh, We can have a video visit. It's much more than that. It's workflows. And the thing that's unique that I found, and I don't wanna talk too much about it, I wanna let you talk about it, but I found unique about how you use teledentistry is that you actually have virtual dentists, your dentists, that could connect for emergencies or any other type of care within your organization. They're trained for it. But also in a case where, let's say it's the middle of the night, you don't have one of your dentists available, there's then an outside network that almost like an Uber concept that it fails over to. So again, talk to me a little bit, 'cause that's, you know, everybody's real excited, people don't understand tele-dentistry. Tell me how you're embracing it at Absolute.

Yeah, so from a patient-facing perspective, everything you just talked about, they don't understand or know, or frankly don't even want to know that. They just know that they're in pain and they wanna get someone to help them. Right? And so what teledentistry and Absolute, you know, worked together to really improve upon was this idea of the Uberization, like you had mentioned. And that is while we have, you know, 40 or 50 general providers that are able to take these teledentistry calls from patients that are in pain, not all of them are always available to take the calls, whether it be at night or during their shift or wherever they might be. So the way the technology works is if a patient comes in and they're in pain and they need to see somebody, The call center works with them and gets them, gets her profile set up. And then, you know, the call center presses a button. And then effectively what happens is all of the providers that are in Absolute on this program are notified at the same time. And then if none of them answer, one of them answers, the patient, you know, gets seen. If none of them answers, then it fails over, if you will, to teledentistry. And then they have, again, a number of doctors that are able to see that virtual visit as well. So from patient perspective, they see a doctor. From backend perspective, certainly we're getting much more complex in the ability to really cater and meet the patient where they want to be.

That's great. That, that's really exciting. And again, it leads to a just-in-time approach where patients are more demanding and patients do shop, unfortunately, for healthcare services too. So the ability that you're able to connect with them because of this teledentistry workflow incorporated is great. The other thing that's kind of exciting for me that we've talked about is, you know, you were talking about online appointment scheduling, and from my experience in 20 years in healthcare IT, you know, to me, online appointment scheduling meant online appointment requests, right? And then it has to go, and then it's a manual process. What's really exciting is you've actually integrated your online appointments with your practice management system, so therefore If I, as a patient, wanna make, I actually have all the templates there so I can actually make an appointment, right? Can you talk a little bit about that? 'Cause that's kind of exciting and that's fairly new, I think, to the industry.

Sure, and you and I have, I had to change my mindset on this because you and I have the same point of view on this. Back when I got in this industry, it was more about the online page, online schedule request, the appointment request, because there was a fear of, well, What if the doctor's on vacation or the template's not right, or, you know, the practice isn't there, or we have someone who's gonna put a bunch of, you know, fake patients in the schedule. Listen, that mindset in my opinion has to be changed. And I changed it with myself in order to implement this online scheduling concept because it truly is online scheduling. So what we did, so our current partner did not offer out-of-the-box online scheduling. We did go to them and we said, hey, we're interested in online scheduling. And they said, well, it's not currently available, but we have some behind-the-scenes store procedures that we could— that are already available in your, in your version. Here's the documentation on them. I'm happy to support you however we, we could. And so we took those, those APIs behind the box and worked with another software vendor, a marketing company, and another software vendor, and voilà, we now have the ability for patients to go online, type in their profile information at their leisure, whether it's on their phone or their computer, select a practice that's convenient for them, and then based on the appointment type— denture consult, ortho consult, adult visit, child visit, etc.— we actually in live form access the practice management system, serve up appointments that are readily available for the next, call it, 10 business days, give them the option to pick. They press the button, And then automagically that shows up in the template, in the system.

And everything else happens from there.

You're music to my ears because as a software guy, I'm always looking to do something right to somebody else's software.

And actually what's fun about this, Dave, is you're the first CEO I've talked to who actually has talked about APIs, right?

We won't get into the technical weeds, but maybe we'll talk about another podcast what that is. So thanks for that.

You're making me smile and blush, but definitely fun.

Yeah, yeah, there you go.

You know, uh, the other thing, I guess the last feature— you have a number of features you've implemented, but as we've talked, I'm thinking about the teledentistry, the appointments, and then finally, um, recalls and reminders. You're kind of taking a little different look at that and how you use your technology to engage with patients on that. Can you talk a little about those features that you modified your software to support?

Sure, so as an operator, you know, we say it's Groundhog Day, right? Because as an operator, we're expected to do the same things every day. And we're expecting our front desk staff, treatment coordinators, office managers to be, you know, at their best game every single day when we talk to patients and make phone calls. And that's challenging because you're often spending time in front of the patient as opposed to on the phone. So we had to stop thinking about it from an operator perspective as far as how do we get calls to happen, It was more about where does the patient expect us to be. And just like you, Mike, I'm sure, and me for sure, I text message multiple times a day, probably touch 20 people in 20 different companies and states. And frankly, again, the Amazon approach, people don't want to talk to anybody because the technology facilitates that they don't have to. So we've, we've looked at it from the perspective of what does the patient want? Well, the patient wants to be reminded and they want a simple way of getting their hygiene recall appointment scheduled. So what we did was we went out and found a product that was already available, a website. We used the practice management system data, created some scripts that go back and look at when, you know, overdue or upcoming patient recall lists, if you will. We identified when the next 3 hygiene appointments would be available in their practice, their preferred practice, and we picked an AM, a PM, and we spread it out over a week, right? And then we effectively text message thousands of patients that say, listen, the doctor says that it's time for your recall appointment. It's very important. You know, below are 3 options, 1, 2, or 3. Press 1, 2, or 3, or press 4 if you want to be connected to somebody that— because one of these times don't work. Patient gets the text message, they look at it, they select the time that works for them, 1, 2, or 3. That comes back. Again, automagically, we get that into our practice management system.

No human involved.

Higher quality, lower operating costs. But more importantly, the patient gets what they need right there.

You know, Dave, as I listen here, I listen to your excitement about technology, I wonder sometimes it must be hard being CEO running the whole organization to not want to kind of go over to the IT side, just, just like develop and do things right. Because I know that's my bent, right?

Whenever, whenever we talk to vendor product groups And even though I don't do software development anymore, I just get excited.

So I'm sure that happens to you as well.

It does.

What I'd like to do is kind of ask you for our viewers now, just kind of on closing, is there any messages in terms of using— you know, we're probably having people from DSOs, from groups, and also, you know, just people, our normal viewers out there, dentists, hygienists. That are listening to this, what would be kind of a takeaway and a message of this conversation about using technology in your group or DSO? Something to think about.

I would say two things. Number one, mindset. You really gotta, just like I had to, open up your mindset as far as what the patient wants. Where do they want you to be? And maybe it's not about the patient either. Maybe it's about your team members. Where do your team members and your patients want you or need you to be so you can interact with them to be more successful and create that fluidity within the organization as opposed to the same old way that all of us have been trained to operate. So open-mindedness, and when you're on Amazon or you're on an app that you like and enjoy, just imagine it's branded with your company name and what you could be doing with your customers, patients, or employees. And I think, secondly, it's more about just acceptance. When you think about the idea that change is always happening, acceptance of change, you're either growing or you're dying. So if you're not adapting to this technology world, then you're gonna be left behind and that's where you're gonna struggle 'cause your customers and employees are frankly gonna leave you.

You know, that's so true, the whole change thing, whether it's dental, medical, or another industry, change using technology for change is really important. You know, as we talk, the message I think about is, A long time ago, I started looking at surveys of how patients look at dental groups and DSOs and practices. And one of the things that struck me, I don't remember where the survey was done, but there is a perception by a lot of patients that groups and DSOs and practices that use technology and use newer technology, well, maybe they're actually doing better dentistry as well. In other words, if they're using old technology and keeping their head in the sand, not keeping up with what's going on, then maybe they're not. Now, whether that's true or not, we can debate, but the perception is there, right? Of that using technology might be a better place, right? In terms of patient care.

So I think it's implied. I think it's implied when you go to a service company, regardless of what it's for, if you feel you're being interacted with efficiently and effectively, it implies their service is better.

Well, Dave, this is, uh, I'd love to talk to you every day about this stuff.

And, and we will, because obviously you're a little bit of a tip ahead of the curve with some of your technology you're using.

And I do want to have you back on to kind of talk about, as a gut check, see what you folks are doing.

Because I think it'll help DSOs and groups and practices as well to kind of think like you do. So anyway, I'd like to thank you for your time today. And I wanted to tell our viewers that today we have the CEO of Absolute Dental, Dave Gierasiewicz. And Absolute Dental is really the biggest group in Nevada, dental group in Nevada. And They're using technology to improve their patient engagement and their patient care. So thanks again, Dave. I really— I know you're a busy guy. I really appreciate your time.

Appreciate the time, Mike. Always enjoy talking tech.