145: Patient Behavior and Practice Performance Across PPO, Fee for Service, & Membership Plans

Welcome to DSO Secrets. I know what it's like to be an entrepreneur in the dental industry. I've had my ups and downs, just like you. There's so much opportunity to be excited about, but so few resources to get answers. From here on DSO Secrets, we get you those answers so you can change the lives you're meant to bless and achieve your personal success.

When I was working as an associate right out of school, I never imagined I could own these many practices with this amount of support.

So thank you.

You have helped build my marketing mind

to a whole new level. You have this natural talent, this unique ability. Hello, everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott, and today I'm excited to talk with Dave Monahan, the CEO and founder of Clear. And by the way, Dave, before we got on here, I went to your website. So just so everyone knows, I'll plug that right at the beginning here. K l e r.com and it's just a beautiful website. So if you're looking for, like, website design. I know that's not the purpose of this conversation, but I just thought it was really well done on how the information is provided. But, you know, I think the bigger conversation all of us are grappling with is we've got inflation that's hitting us hard. It's probably been hitting us for a while. We've got maybe a recession that's coming, though. Dentistry tends to do pretty well in those things. One thing that I'm seeing too is we just continue to see. I call it customer entitlement. Some people call it customer expectations. But the Amazon effect, the fact that I can click, click, click and everything's simple and easy, and whether it's scheduling or getting things for a good price, etc. So anyway, I'm excited to have you on because the innovations that you're doing with Clear, I think, ties into the reality that dentistry just needs to continue to innovate. So I'd love to know just a little bit of your background, how long you've been with Clear and what kind of got you in this.

Cool. Yeah. So thanks for having me on. I appreciate it. So what got me into it? So, my background. My background. First, I'm a tech guy and I actually worked for Northrop Grumman for a while. We designed avionics systems for fighter aircraft and drones. And then I moved over to Microsoft. Spent about 8 years Microsoft running a number of their businesses. Then I branched out and it was just. The company was getting. Just getting Started, I took it over and we were building wearable devices and it was like for health and fitness applications. So you can put them on your body, take just like the little devices that are out there now. But we were doing this back like in 2006, 2007 and supplying it to healthcare providers and then high end fitness providers. And one of our claims of fame was we built the Nike plus system if you've ever saw that.

But oh yeah.

So we are the technology behind all that. We worked with Nike and Apple to put it into the marketplace. We were never allowed to say that we did that until years and years after. They were incredibly protective of their brands, but we were the tech behind that. And then I ended up selling that company to a medical diagnostics company in 2016 and was looking for the next thing to do. Ran into actually somebody who owned six dental practices. And the net was he started explaining to me what dental care really was about. So I grew up thinking everybody went every six months and got the care they needed. And he explained the reality of about 50% of people didn't go to the dentist and how hard it was to deal with insurers. So I got intrigued and I spent about six months, I hired a market research firm to dig in and I started Clear from that. We launched clear in 2018.

Wow. And so tech into dental, what would be the thing that you weren't expecting that getting into this, you're like, wow, that's going to be a lot more complicated than I was giving credit to because I mean, you've done some amazing things. And you know, I was an entrepreneur in a lot of different industries. I don't think dental's given enough credit on how complicated it is.

Yeah, I agree. So I think that for me, a couple things were sort of that really stood out. One was patient behavior. And like people not getting and understanding sometimes the value of seeing the dentist and the value of that to their overall health. And it seems like it's gotten better over the years, but still not where it needs to be. So I just assumed everybody would understand. Keep your mouth healthy is important to your overall health. But obviously that's not the net is it's behavior. It's sort of patient or consumer behavior. And there's things that are pretty complicated. And then the other side of it is just I couldn't believe the level of hatred between dentists and insurers. So I came from a world where, and we weren't clear this way, where you create partnerships, right. The people you're in business with, you create partnerships with and you try to help each other. And the wall there between the insurers and the dentist was just amazing to me. And the complexity that was created based on that wall was just amazing to me. And then learning things like about 40% of all payments made into insurance never get the care, like all that, I just. It made no sense to me because it wasn't insurance and it was incredibly complex and it was. There's a lot of hatred and it was just like, what happened? I'd like to go back and set a track, what really happened there and how it got to where it is today.

How do you think about it now? I mean, you're definitely in the middle of it. Some would say any kind of discount plan, et cetera, is an alternative to insurance. So do you feel like you're bridging that gap or trying to move that needle forward to create a more cohesive type experience between a payer, or I guess the patient, the payer and the provider?

Yes. I came to the conclusion, why do you need a payer? What's the value? So there's a theory in engineering around first principles. Try to take everything back to first principle, right? First principle means what's the baseline? Why does something exist? Or what problem are you trying to solve? And so you go back and you look at insurance and you're like, what problem was it trying to solve? You go back to the history of insurance and you can say, well, it was a way to whatever, provide benefits to employees and all that stuff. But then it was something that maybe was needed in the past because we didn't have the systems we currently have. But the conclusion I've come to is that you don't need it anymore. I mean, you think about the direct models that are out in the world right now, right? And you name any industry, they have direct models. Why do you need something between the person consuming the product or service and the person providing it? Well, the only reason you need it is if you've got a lot of regulatory issues or sort of whatever, you've got a pool of risk or there's gotta be a reason, right? For a third party, the net is dental has none of that. Dental does not have risk. I mean, talk about dental insurance. Dental insurance does not carry risk. There is no risk to manage, right? It's just an intermediary, third party managing payments and setting rules. And it makes no sense to have it sort of the end of the day, given all the technology we have out there in the world that can, you know, basically make it much more

efficient for everybody, would you say? Ultimately? I mean, because you're looking at it from a financial perspective. And for those who maybe haven't thought through this, and I think most have, when you look at health insurance, that's a true insurance because you and I could have something catastrophic, right. That our $500, our thousand dollars a month would never cover when it's multimillion dollar brain cancer or something like that. So in typical insurance world, there's something catastrophic that could happen. The reason you're paying into an insurance is you actually hope to never use it. It's like life insurance, right? It's like, did I use my life insurance today? Well, no. Okay, well that's good, you know. But you're paying in for that peace of mind. I think what you're saying at a financial level is dental insurance you're paying in. But really, it's like one person once explained, it's like having insurance for a haircut. Like you're, you know, whether you decide to get one or not probably benefits the insurer, but you probably need it. Right. On a consistent basis. And so it doesn't have the same kind of actuarial intensity that you would have in normal insurance. So do you think that a lot of the reason why it's there is simply people are used to health insurance. It was kind of at the HR benefits package, people were saying, wouldn't it be, you know, people not knowing, kind of the financial piece would say, oh, it'd be nice if I got a discount. And so they ended up calling it insurance. But really it's a sophisticated discount plan.

That's exactly what it is. Yeah, it's the best way to put it. Yeah, there is. I mean, think about it. Not only does it not cover catastrophic, it caps itself. Right. It caps itself at $1000 of 1500. Right. It's not only non catastrophic, it's also whatever. It's got caps to it that keep you from actually utilizing.

That's fascinating. I never thought. It's almost. It's the opposite of a high deductible plan where you pay in first and then it's unlimited. It's actually, you know, you might not pay. It's limited. Right. You only get so much. So do you think it's more patient marketing that's really happening? Like for me, when I think about a PPO or HMO or any other kind of insurance plan, what I'm really getting is maybe some marketing help. Right. Is that really What I'm getting out of insurance.

So you are. So. But it's got to take a look at what the data actually shows for insurance. So 94% of all insurance plans are sponsored by an employer. So no consumer, almost no consumer, goes out and buys dental insurance on their own. Right, Right. So what you are asking sort of, why does insurance insurance exist? Well, it was packaged as insurance to employers. That's what, that's why it exists. Right. And the employers really have no other option and they feel obligated, Right. To provide that. They've always provided it and they always probably will until something comes along that's better. And so that's why it sort of has the life it has. So I think that's the issue is that it became ingrained and it hasn't improved itself. It just sort of. It's a classic five companies control the market and there is no incentive to improve or innovate. So just.

Well, and that's been the. I think you said, where does the animosity start to come in? I think typically in a partnership, both sides are looking for opportunities for improvement. And from the little bit that I've dug in on the payer side, you're just not seeing innovation. Right. You're not seeing an investment, you're not seeing adjudication being, you know, keeping up with the technology capabilities today. Right.

So, yeah, it's. The fundamental model never changes. Right. It is what it is. And reimbursements basically stay flat or go down every year. So there's no innovation there. There's no innovation on how patients utilize it or the technology behind it or cutting costs associated with it. Right. It just sort of keeps doing what it's always done. It just doesn't change.

So I'm probably like you as an entrepreneur. I don't like to complain long. I'd like to be like, okay, if that's the issue, then I'm going to go solve it. I mean, somebody's got to solve it, but I definitely don't want to be sitting in a corner crying about it all the time. So part of the way you solve it is you say, well, there's a bunch of people who don't have a solution around this. They could use a discount plan and kind of bringing it back to you. Dave. I think more and more people are open to direct consumption. They're kind of eliminating the middleman. They feel comfortable with technology. In fact, for the most part, I jokingly say, I really want to know you. I just never want to talk to you, you know, I just. How can we communicate in a way that's using my cell phone that's, you know, keeping things clean and smooth. So tell me how you think of clear kind of solving the problem, if you will, for this relationship.

Yeah. And just, you know, as we go into that, to your point, I'm not a complainer. I'm not, you know, the insurers did something that, you know, got him established and made them successful and made them large companies. So kudos for them for whatever that was. Right, right. But it doesn' not a better way to do it in the future. So to your point. Yeah. So consumers, we did a lot of research on consumer behavior and also, by the way, employer behavior, employee, what employers want. But on the consumer side, consumers are 100% behind direct models. They value direct models. When you position your membership plan as a direct care model, it actually provides value to the consumer. So they're used to direct models. Mean I'm not dealing with an intermediary. There's less administration work. If there's something goes wrong, the people who provide the service or product are right there. Right. I don't have to go through a middleman to deal with it. So, yeah, direct. They also associate direct with more affordable and better, actually better service. So, yeah, so that's the, the key here is that, you know, consumers are enabled with phones, right. Smartphones. And they can do a lot on those smartphones. They like to do a lot on those smartphones. And the same thing on the practice side. Right. They have technology now that, you know, can bring them into where they have a direct relationship with the patient. There's no reason not to have a direct relationship with the patient. And at the end of the day, it's funny, it's. Although you have all that tech and that's all great, and that's a way to get people signed up easily and sort of get them off and going on subscription. What is really the driver behind a coverage plan is that there's peace of mind that I have coverage, and that can be clear. Anything else? What we really learned was back to that patient behavior thing. Why don't patients come in? It's because they're afraid of cost. And when you dig into that further, by the way, is it's not that I'm afraid of just cost. I'm afraid of not knowing. The cost is a way to put.

It's the unknown, unpredictable component. Hey, I'll go buy a Suburban for $90,000, but I know it's not going to be $4 million when I come. Right. I like, I have some perspective on where this cost is going to come in.

Exactly. So if you look at just talking about like fee for service patients or uninsured patients, they typically stay away from the dental practice because of that fear. So there's a. We think, we talked about ins and this can be a replacement for insurance, but just as important, it can give your fee for service patients or cash patients the reason to come in more often. Right. And get the treatment that they need.

So you're saying that within a discount plan. A couple of things I think is fascinating. Number one, and I hadn't thought about this, but as a consumer, which we all are, I assume that if you have a direct model, your technology is better. I just thought of that. Right. It's like, oh, you're like more modern. Right. And you're not reliant on some of this archaic, you know, information. I hadn't thought about. You're right. It also means administratively, things just got simpler. You know, it's kind of like, okay, so it's just you and me. I'm just thinking about how many things I buy online. And part of it is it's a direct relationship. The other thing is with that technology being better, more transparency. So I think that feeds into something I hadn't thought about, which is not just transparency on like how much my insurance costs, but it's true. Like if someone walked in from some payer and I said, hey, just pull up on your phone, like what your benefits are.

Good luck. Yeah.

I mean, how many hours does it take my team to figure out what your benefits are? Right. So, but then you're taking it a step further and saying, no, no, no, this isn't just like what your benefits are, but like how that translates into what the cost of care is going to be. And really you're creating then. And I'm just assuming, I haven't looked at all the technology, but you're, you're creating like a transparent menu for the patient.

So in our, we did a lot of consumer research prior to starting clear, like six months of it with a third party. And we interviewed uninsured patients, insured patients, we do focus groups. We did a national sur and there was three things they wanted from a plan, a dental plan. One was it had to be simple. So I can understand it like that. Right. So think about the dental plans out there right now. They're 20 pages long with you know how many caveats? I don't know how many. But you know, say, 100 caveats. And then second thing is, it had to be affordable. And so the way they. And a lot of people say, well, does that mean it has to be cheap? And the answer is no. Actually, affordability to patients was anywhere between 30 and $50 a month, which is plenty of range. Right. For your hygiene visits. And you can fit in plans that solve the care need and also are profitable for your practice. And then the third was just what you said was transparent. And what was transparency? What does transparency mean? Right. It's funny, because we provide inside the membership plans, we provide access to all the pricing. If they want to go look at it, they can. But you know, how many people actually go look?

Pretty much it's low. Huh. So transparency is. I could if I wanted to.

It's trust. That's what it is. Yep. So transparency means trust. And so you think about some of the other dental plans out there, Whether it be PPOs or discount plans, are really complicated and they're very hard to understand. And so there's no trust. And I think that's one of the reasons consumers don't buy them is they can't understand them and they don't trust them. So if you. When you do a membership plan, like, we obviously help you design it and price and all that good stuff. But there's typically underneath your membership plan, you might have, you know, we have a list of things to know. Right. So as a patient, when I'm signing up, there's like five of them, Right? There's like five things to know. That's all you need to know. And everything else is really simple and understandable. And it's funny, we get the comment all the time. Is, is this for real? Like, is this real? Like, what's the catch? What's the caveat? Because they're so used to, like, all kinds of craziness. Right, Right. Simple, transparent, affordable. You do that and your patients, anywhere between 50 and 75% of your patients are going to be interested.

Yeah. So what you're doing now is you're getting so much more than, okay, great, a patient who's going to have the pricing discounted so they can accept care. What you're saying is it's doing a multilevel kind of psychological buying approach here is, oh, so my dentist or this practice is one of those guys that wants to have, like, a real relationship with the consumer. Right. So. And they're eliminated the shell games. And they're, you know, now this is getting old, but they're more millennial. You know, they're more current and modern on what this relationship needs to be.

Yeah. And it's funny, you mentioned a lot of things. I would see if I can sort of break them down. So what it's funny, the millennial thing is interesting. So we get that comment all the time, like, is this a millennial product? And actually you want to believe how happy the seniors are about this.

Totally.

Yeah. They're very tech enabled. It's amazing. The other thing is with the seniors is if you give them an option to pay monthly or upfront, they pay upfront. So they love clearing the deck, Right. And not having anything sort of overhang. So they'll pay the whole annual subscription up front and they're very happy to do that. And then going back to psychological things. So I don't know if you've ever seen these books, the membership economy and things like that. There's books out there. What happens psychologically to somebody when they become part of a subscription or a membership program and what the net is, the average across all industries is they buy twice as much from whoever's providing that subscription or membership. And by the way, all of us

with Sam's Clubs and Costco memberships know this, right? Yeah, yeah.

And I always challenge people, I say Amazon. So you go up on Amazon, go find a product that you buy, right? And see what the price is on Amazon. Now go outside Amazon and figure out what the price is. Right. I guarantee you, I guarantee you can find it cheaper outside of Amazon. But they're committed to Amazon for a variety of reasons. Simple, it's trustworthy, right? You can get returns, right. Very easily. It's amazing how easy returns are right now. And it's direct and you have this relationship, right? And that's exactly what occurs with the membership plan.

And I paid a membership for my free shipping and I got to use that. Free.

Yeah. Well, that gets it as well. So let me give you the analogy on membership plan. So I paid for my hygiene, right? So what am I going to do? I'm going to come in for my hygiene. So membership plan patients come in about three times more often than fee for service patients. And what. And then the next question I always have, and we have all this data and shows all this, but what happens when you're in for hygiene, right? Well, you accept treatment. So treatment's three times as high, right. For membership plan patients, the combination I just have. You have more whatever, you know, at bats, right. As a dentist, they're coming in two to three times more often. You have more swings to. For the patient to accept treatment. And then since they're part of the membership, they're getting some discounts, right? They feel closer to the practice. They just accept it at a higher rate.

So, I mean, it's the speed of trust too, right? That's happening. So you've got the, the membership component that's driving almost like, yeah, I got to use this thing. I'm paying for it. Which is fascinating because you're right, because of some of the opaqueness of it, you don't get that as much on the fee for service, I'm sorry, or on the PPO side, even as you would get on a discount plan. So when I said one of the benefits of insurance is marketing, you're saying yes, and it could be even better if you enhance the product.

So we have all the data on how does a membership plan patient behave relative to a fee for service patient and a, and a PPO patient. So I'll just break it down a real high level relative to, sorry, a fee for service patient. A membership plan patient comes in a little over two times more often, accepts about two to three times more treatment, and drives about three times the production in your.

Wow.

And so that's fee for service versus membership plan. And then versus PPOs. They come in slightly more. Membership plan patients come in slightly more than PPO patients. And people have asked me why and I quite get the pulse. I'm not sure why, but they do. And I have one theory which is a lot of these patients been uninsured for a long time and now they have a membership plan patient or they have a membership plan, they just come in more often versus a, you know, PPO patient who may have a PPO for a long time. I don't know, but that's my theory. Now here's the difference though, between those two. It's a slight advantage to membership plan. They accept close to the amount of same procedures. The membership plan is typically a little higher, let's say 20% higher. Here's the kicker, though. The collections are anywhere between 50 and 75% more. And it's because of all the discounts and all the refused whatever payment from insurers on the PPO side. So you'll typically collect anywhere between 85 and 90% of all your fees under a membership plan. And obviously under a ppo, it can range a lot, right? But it can be 50 to 70%, you know, depending on what PPO you're talking about.

So you're talking about against like UCR, whatnot and how much the contract. And then you got these caps and everything else. And with discount you're actually able to. I mean, there's really not a cap, is there?

There's. Okay, that's the other thing. Yeah. So one of the reasons I might accept more treatment is just because there is no cap, there's nothing to worry about. You can accept as much treatment as you need.

Right. There's not a transitional mentality of like, hey, my PPO is covering now. It's not, it's like, all right, I already got it kind of upfront in the discount now. How much treatment and care do I think is valuable to me? And by the way, there's a bunch of transparency associated with it.

Exactly. And I trust my dentist more. Right. And I'm going to accept more. And I don't have to go through all this stuff in the background to figure it out. It's very simple. Yeah. So there's a lot of benefits there.

Can you walk me through kind of a case study? I mean, it's probably. Some of this data is from that. But let's say that I was, you know, I was getting clear in a discount plan and for the first time, is there kind of the ideal customer for you? Are there certain behavior, certain mindsets that kind of creates, man, these guys will hit it out of the park. And maybe you want to talk about the non ideal customer where it's like, yeah, we can do it, but it's not going to work, you know, and it's not because the product's bad and it's not necessarily because you're bad, but there's certain behaviors you got to do.

Absolutely. So I think there's two key behaviors at the end of the day. The first behavior is that you care about your patients and you really want them to get access to treatment. So, you know, you're. We've had some practice. On the flip side, some practices will say, well, I'm only going to offer to certain patients. Right. I'm going to look and figure it out. And that person will pay full fee. That person won't. And I'm going to pick and choose. And that is you miss the opportunity to raise the whole, you know, your whole practice up. And so what we've seen is when you try to pick and choose, one is you just don't get the spread of the plan that you should. And two, you just don't get the effect because you're only affecting a small percentage of your patients. And even the ones that would pay full. You're actually going to get them to accept more treatment under the membership plan. So one is, I don't know how

you drive that culturally too with your team. That's got to not feel. I mean, yeah. What would be the right way to even say to your team, hey, we're going to pick and choose who gets this? You know, so a little crazy.

Yeah, it gets crazy. And then we've actually had some practices that tried to do that and some patients got pissed off because they're like, why don't you offer. I heard you talk to the other patient about this. Why didn't you offer that? But we can show anybody the data you want. The whole boat's going to rise. You want to offer it across the board because the whole thing rises. So that's one. And the other is you got to market it, you got to talk about it. So just feeling comfortable having a conversation with the patients. And it's funny, it's this idea, the selling. You hear this all the time. I don't want to sell to my patients. You're like, no, you're providing value to your patients. Right. This is a valuable program for your patients and the patients get the value of it. So feel very good about it when you're talking to your patients.

It's an extension of treatment coordination. I mean, at the end of the day, if they don't have that momentum going into it, the treatment coordinator is a lot more flat footed than someone who's bought into a discount plan. And now, you know, it's the difference between maybe just like walking into a store versus having a Costco membership. Right. You just have a lot more coordination of care that's going to happen.

Absolutely. Yeah. So just being committed one to patient care and then to marketing are the two key aspects we see and practices

are successful on the technology front, you know, when a patient comes in and so forth, like, how do I think about this? You know, I'm used to, on a ppo, I've got to go figure out, you know, what their, what their care is and benefits and all of those things. How does that work with Clear?

So, you know, they talk a little bit about the patient experience and then the practice experience. So just, just going back one step where the patient's signing up so the patient could sign up on with a QR code. We provide brochures with the QR code and they can have at the front desk or, you know, whatever they can send them back. We have practices send them to home to Sign up. And then you also have the option when some patient walks in to sign them up on the clear portal. So it's really simple. It's like a three step process. Sign them up just like a modern, any kind of sign up for a service.

Again sending that signal that this is like a technology based practice.

Right, Exactly. Yeah. People love the QR code. It's funny because we did the QR code back in 2018, before the COVID you know.

Yeah. Menus and stuff now are all QR code.

Yeah. Now everything's QR code.

Yeah.

It was funny when we first did it, we had to explain some of it and it was like at that point, QR codes are getting a little old. In 2018, 2019 now everybody loves it.

They think now it's super bowl commercial. It's just a QR code. Right, Exactly.

It's crazy what happened there. But anyway, so, you know, they can sign up very easily or the practice can sign them up at the front desk if they're not, you know, comfortable signing up on their phone. And then once they sign up, they basically are. The patient gets access to a portal where they can see all their benefits and then the practice has access to the portal as well. It's obviously we have one that's, you know, practice focus, the one portal that's patient focused and it coordinates all the benefits and the knowledge of what the benefits are. And they're usually pretty simple. Right. To clean these exams, X rays, things like that. And so the net is. We just try to track that and just make sure everybody knows what's going on across the different portals.

I would think there would be a lot of anxiety if I was like a fee for service or I hadn't done a ppo. I mean, sorry, I hadn't done discount plan before, just coming up with like what the right rates could be because I don't want to cannibalize some of that fee for service stuff. Right. I look at some of our practices, you know, for us we have to be careful because we take Medicaid. And I think even those who do PPO need to be careful about just providing discounts without a clear plan. Because if they looked at their contracts that could be an issue. I just used clear plan. That was a good play on words there.

So.

But sitting down at doing that discount, is that something that your team helps with or just like hand me the software, Good luck.

Oh no, we, we designed it so we have a consultation with whoever is going to be lead on your. And it could be the. Typically it's a dentist and the office manager or somebody, whatever treatment coordinator can be there as well. But the net is. We have an hour consultation. Prior to that consultation, we will actually take a look at your patient demographics. You'll send us your fee schedule. We actually have an algorithm. Our CTO has a PhD in machine learning. He actually created an algorithm for pricing a membership plan. And it's pretty funny. So what we typically have is practices providing their pricing is too low, they typically want to go too low. And what we've learned over here.

Fascinating.

Yeah. What we learned through this algorithm in the years of working with practices is you price it low, you're going to get the wrong patient. So you're going to get a patient that just wants to use it and get out. Right. And maybe they get a little treatment and they get off the plan after a year or whatever. And so your cancels and your renewals aren't good. If you price it at the right point, which is not too high, not too low, you actually create value through pricing. And anybody who knows marketing is pricing is value. And so if it's cheap, people think it's cheap. If it's not and it's well priced, people think value. And so we actually run this algorithm for practice based on a fee schedule to come up with what the subscription should be. And then we give you a range. We'll say, let's say between 300 and $350. And then you have local knowledge to know what competitors down the road, what other things are going on, what's demographic. In my practice, maybe I go high, maybe I go low, maybe I go in between. But there's a work, the consult, you work through that and decide on price. We also in that consult, talk about your patient demographics. Are they older, are they younger, are they millennials, are they seniors? How many do you have a pedo practice? And if you do sort of what does that look like? And, and so we.

There's a ton of value just in having this conversation. Just, I mean, I would think just kind of understanding your market better. Right. And getting access to some of the talent that you have to like, dig in deeper.

Absolutely. Yeah. And what comes out of that is we. You can put unlimited care plans on, clear your membership plan if you want. Typically you end up with three to five care plans. So some will, if you, if you do have PETA, you might have two or three for kids, you'll have one for a standard adult, one for a perio patient. And then One for, let's say a senior. And again, it'll depend on your demographics. But anywhere between three and five care plans based on those demographics.

Oh, wow. I hadn't thought about that. I was just thinking like one plan, everybody.

People love seeing the plan that was made for them. So like a parent seeing a plan that was made for an infant. Right. Or a toddler or, you know, a teen, a senior seeing a plan was made for them. We had a practice, this is a really cool case study who had a lot of senior patients who didn't come in all that often, who lost coverage right when they retired. And so they provided a seniors plan. And the seniors plan was a little cheaper than sort of the standard adult plan. But they put a stipulation in it, which is the seniors had to come into the office between 1 o' clock and 3 o' clock in the afternoon. The visits, treatment acceptance and production for the senior patients tripled and they took care of their dead time of their practice.

Right? Exactly. Yeah, that's powerful. So with discount plans, yeah, you can get really specific. I hadn't thought about like customer avatar targeting with that, but you're right. I mean, they say like the whole review things with Amazon, what was so powerful is we were able to find ourselves in the review, right. It's like, oh yeah, that's the problem I'm trying to solve with this product, et cetera. I hadn't thought about discount plans that. It's like, hey, Emmett, this is you, right? This is what you're looking for. And by the way, here's the right time. If you want it a little cheaper, you have to come in at this time. Or if you want to, you know, premium anytime at the gym type service, then boom, it's here. And yeah, that is, that's really awesome.

Another thing that works is you add special offers inside those plans. So you might offer a whitening service, right. To adult patients. You might want to offer, you know, Invisalign to adult patients or like an Invisalign special. You get $200 off, right. Your Invisalign treatment. Or for teens, you add, you know, orthodontics, Orthodontics special. You get $500,000 off your orthodontics, like things like that. You can really customize these things based on the types of demographics you have in your practice.

Oh, cool.

So they have these kickers on them that are unique benefits. So someone could be like, oh yeah, I went to XYZ Smiles and I got their discount plan. Oh, which discount plan? Did you get the one? You know, so now it's a. It's a real talking point. Right. Of benefit. Well, and it makes it to your point. It makes it way more unique and special than. Yeah, I got the same insurance as the other 5,000 people at my, you know, at work.

You know, Emmett, one of our most popular care plans is the Perio plan. And so it's by far the most expensive. Right. You would assume that. And it's the one that the perio patients really gravitate to. They love to see. This plan was made for me. It's got, you know, the cleanings I know I need. It has, you know, some will do three visits, some will do four visits. Right. Depending on the practice. It's like they just love it that somebody's thought through their care and is offering something specifically to them. And it is the most.

Would this be something like after they've been diagnosed with perio issues and so forth? And you'd say, hey, listen, we actually have a discount plan. Before you go out and pay for all of this. We actually have a discount plan. Look, here's our five. Notice this one. Perio. Notice all the things we just talked about.

Exactly.

Boom. Buy this and it's cheaper.

Yeah, exactly. Yeah. And they just appreciate that you thought through this for them because, you know, it could be a little bit of a shock, right, for a period of patient and trying to understand the cost of that. So it gets them moved over to Perio Care, you know, very smoothly.

What's interesting too, that I've really taken away from this is your point on, like, we think of discount plans really about the discount. You could almost say they're more transparency plans. You know, I mean, you're getting more benefit on the transparency it's providing than you are really on the price break that you're trying to get to.

Yeah. Taking that like building off of that is. It's a trust and relationship plan. Right. That's what it is. It's about creating a relationship with these patients and making sure they understand that you can be trusted and also that you care for them. And. And the pricing, to your point, is not that big of a deal. I know people think get stuck on pricing. It's like it is not. Our average subscription on our platform is $360 a year. And so. And that goes straight to the dentist, right? That is, you know, and so you think about that is $360 sounds like, hey, would a lot of patients sign up for that? They do a lot. Sign up and it's. So think about their alternatives. They either don't know, right, and they are blind to what they're going to pay, or they buy a ppo. That is incredibly complicated. By the way, the average cost, right, for a PPO is $550 a year. Plus you have deductibles, right. And you have a cap. So they hate buying those things. That's why consumers don't buy them. So they're stuck between a rock and a hard place, right? I either buy a PPO or I go without. This fits right in between and it feels great for them.

Do you like the word like a coverage plan versus a discount plan or do you think discount plan still the right term because consumers want to get. Or do you like membership plan better or is there like regulatory components where you have to say it a certain way?

So actually I would say don't use discount. People assume discount with cheap. So there's two words I would use maybe.

Yeah. Because if I had a Costco discount plan, that would really ruin my Costco membership.

You remember, right, when you walk in that door, you're a member. So one is we like member because it just connotes the. It makes you feel like you're part of something, right. And that you're, you know, become part a member of this, of this practice. And by the way, on that front, practices will give little gifts to their members when they sign up or when they come in, like, and you just make them feel special. So that's one word. You could use the other word, if you're going to go down, you know, what, you know, direct sort of what exactly what, you know, potentially is to some patients, savings. I'd use the word savings instead of discount. It's just a little bit of more friendly word. And then the other one is, you know, patients have become more and more accustomed to subscription. So subscription dentistry is another way to think about it. And that's a way for them to get their mind around. It's a monthly thing that I'm committing to. So. But my favorite of the three is membership.

Yeah, I could see that. I mean, really, you'd almost want to lead with membership and then say, by the way, with membership plans, you're going to notice with each one it's got some unique savings and benefits associated with it.

Right? That's exactly where we position it. We say you get savings at the membership, and to your point, you get benefits that a patient without coverage does not get.

Pivot a little bit. I've heard Rumors about clear intelligence, but I don't know anything about it, so I'm not intelligent about clear intelligence. So do you want to tell me a little bit about what that is? Is that something that's coming or something you currently have?

It's coming in July. And so what we've done is we've integrated with practice management systems and so we now can take the data both from clear and from practice management systems and do a lot of great things with it. So, so there's probably three high level categories that we can add value to a practice. One is just around automation. So when you think about signing up patients and you got to post payments from the membership plan over to your practice management system and things like that, once we have connection to the practice management system, we can automatically post payments in your practice management system. When a patient comes up to the front desk to sign up, we can pull all their data from your practice management system and autofill the information that joined clear things like that. There's a bunch of things like that where you can automate. That's one category. Second category is around growing your membership. So we are developing ways that you can now market your membership plans, for example, to your dormant patients. So why do dormant patients not come in? A lot of times it's because they don't have coverage or they're afraid of costs. It's that typical behavior thing. Right. And so we've looked at the data and then it's. I don't know if people know this data or not, but on a typical practice, one dentist practice has about 2500 dormant patients that have not come in 12 months. 2500, right. Just sitting there. And there's typically some on and off marketing to that patient base. But what we're going to do is do a standard sort of cadence into that dormant patient base and signaling around, hey, this can be affordable, right? This can provide you the transparency you want, you have care you need and all that good stuff. So, and there's a bunch of. So under growth, there's a bunch of initiatives like that, including reaching out to small businesses near you who can sponsor their employees into your practice. And then the third area is around what we call performance. And so performance is how do patients behave based on the coverage they have. So I talked a lot today about these different behaviors, but trying to measure that in your practice management system right now, I'd say good luck. Right? How are these different patients behaving? Whether it be PPO or fee for service or a membership plan. And Underneath ppo, we've looked at this as well. We've done this analysis for practices. Each PPO behaves a bit differently and they have a different reimbursement schedule. Right. And so trying to understand that, I know a lot of practices will bring a consultant in like every five years, take a look at it and try to figure it out. But that's not real data, like real time data. That's just data that sort of gets pulled. To summarize a little bit, we can do it real time, day in and day out and look at how each One of these PPOs are performing for your practice, including are they profitable or not. So it's got clear intelligence, has a lot to it, that's going to be rolled out over time. It's not like we're going to flip a switch and all that capabilities there. But we see this big opportunity to help practices understand how coverage impacts patient behavior and practice performance. And two, how you can do something about it.

Dave, you're definitely not a complainer, man. You are a solve the problem guy. And I think this is a big one to solve. When I look at inflation that's happening, I just look at what patients want as far as patient expectations and so forth. Like this is, these are the type of things that if we can solve them, really moves the industry forward. I don't want to attend another event where we just say, you know, oh, I hate this payer, I hate that payer. Like, okay, great, let's go solve it. And you got me really excited about like just membership plans in general, like it's application. I feel like I'm a pretty innovative person. But I admit I hadn't thought about the depth of possibility within dental and psychologically how much that needle has moved for me that you're right. I want to be part of a community. I want to have a direct relationship. I want it to be technology based. Yeah. I want the simplicity of that and if you can do that too. For the other thing I'm seeing in this is one of the ways you handle inflation is decrease the amount of activity that your current team has to do. Right. So you're not needing as many team members as you scale and grow. You can use those team members to cover more areas and, you know, more people I have on discount plans, the less people I'm trying to call and figure out what their benefit is, et cetera. So anyway, I'm fascinated by the team you have too. It sounds like a huge benefit for any practice to be able to just Do a deep dive and really look at some of their pricing mentality.

Yeah. By the way, in that pricing of review, a lot of times we'll reset their UCR as needed. So a lot of them haven't even looked at it in a long time and we'll discover that it's actually too low. So set that first and then set your membership plan pricing off of that benefit there. And yeah, to your point about what is this? For me, it's transformative. There's so much opportunity inside a dental practice. Just right here and now. You can get your uninsured patients to come in more often, accept more treatment. Right. You have dormant patients that we need to reactivate. Right. And get them to come in. You have new patients who walk in the door. The reappointment rate on new patients is about 45%. That's about the average. Right. If you get them on a membership plan that's 100%, I guarantee you they're coming back. I guarantee it. And so you get your new patients coming back. Right. It's all there. It's all in front of the practice. It's all in their data and the understanding of their data. And it's just a matter of sort of activating that.

Yeah. It's now us having the mentality and realizing really that we just need to extend this from treatment care and say, all right, now here's a new tool that we have for treatment coordination. Exactly.

Yep. Great way to put it.

Yeah. Hey, Dave, anything else before we go?

No, I think you covered a lot here. This is great. I enjoyed our conversation. I appreciate you having me on.

Yeah. I appreciate you being on and just continuing to move this industry forward. For anyone who's listening, if you have further questions for Dave, what's the best way to get ahold of you or your team?

If you want to get a hold of me, you can go straight to daveclear.com. so it's pretty simple. It's K, L, E, E, R. Or if you want to, just like we have consults, we'll set up online. If you go up to clear.com you can set one of those up. It's really simple to set one up and talk to somebody, live.

Like I said, check out their website. It is beautiful. Maybe steal some ideas for your crappy website that we often have in dental that we're constantly needing to upgrade. So, anyway, thank you again, Dave, for being on. For those also who just want to talk a little bit more about this, membership plans, not discount plans, but membership plans. Come over to our Facebook page at DSO Secrets. And until next time, keep smiling.

Thank you for listening to DSO Secrets. Join our community on Facebook @DSO Secrets and get answers and resources to some of your most challenging questions. If you want to get a copy of the seven secrets of any DSO, go to our website at dsosecrets.com and we will get that emailed to you. Remember, don't go at this alone. Let us be your team while you build your team.