173: Clear Aligners: Maximizing Patient Value without Excessive Demands on Staff

Whether it's an individual practice or a scaled up dso, how do we unlock current patient value? I think that the question is always relevant. How do we find new patients?

Hi, I'm Emmett Scott, and just like you, I've had my ups and downs in the dental industry, but times are changing. The DEO has built a map of how to succeed in one of the most challenging industries to navigate. On this show, we talk to dental industry leaders, solve problems, and get you the answers you need to face these challenging times and thrive. Welcome to DEO's Growth Secret podcast for dental organizations. Now let's get started. Hello everyone, and welcome to another episode of DEO Grow Secrets. I'm your fearless host, Emmett Scott and I have David Rodriguez here of of Smile Direct Club. And what I really want to go into that I thought would be interesting is as we're all trying to simplify, you know, what's going to be the role of aligners in the go forward. You know, I've talked a lot about how specialists have an advantage over general dentists in this marketplace and I think there's a couple reasons, but one of them is that they have a singular focus. They, their staffing, training and so forth is simpler. And as general dentists, we've gotten our fingers into a lot of different pies and we've got to start thinking about how we're going to simplify that down, make life as simple as possible for our staff, but also continue to provide as much value that our customers are looking at. And I love that other companies are innovating to try to solve this for us. So anytime I see that, I'm like, this is the discussion to have. Now, Whether you use SmileDirectClub or want to use SmileDirectClub, I think the principles that we're going to be talking through are ones that you're going to want to bring into your practice no matter what. So anyway, with that, David, great to have you on here. I appreciate your time and maybe you can give just like a short background. I mean, you've been in dentistry for a couple of years now.

30 something. Yes. I hate to admit that, but my hair line probably gives me away a little bit as well. Yes. On mainly always in sales and marketing roles, but restorative companies, management companies shine, those types of things. The last ten years with Invisalign. So I'd love to have this conversation about clear aligners, because I've certainly seen it from that innovation perspective while I was with Align. It certainly has developed in terms of being a clear aligners, I should say being a relevant opportunity for general dentists. And I'm happy to discuss that. There's so many, so much innovation and choice in the space now. It's, it's worth, worth some talking through.

Yeah, I mean before the show we were kind of talking about this and I love that you admit it. Like we've got lots of choices out there now, right? I mean it used to be maybe 1, 2, 3, I don't know, maybe it's a list of 10 and each one is kind of innovating in a different way. So I mean if we wanted to jump right in. Tell us a little bit about how Smile Direct Club is thinking about this space. Of course they came in as kind of a direct to consumer company but now have really involved the dentists in the process and I know some larger DSOs and mid size have had some success with you all. Tell us a little bit about what that's evolved to and where it's at now.

Yeah, thanks. You know, I think there's a couple of guiding questions that maybe should allow us to get into a deeper discussion. The first thing is, you know, from an organization standpoint, whether it's an individual practice or you know, a scaled up dso, how do we unlock current patient value? I think that, you know, the question is always relevant, how do we find new patients? And that's great. Let's put that aside for a second. You know, we've got big books of patients in these organizations and how do we really unlock the value I would say is certainly, you know, I'll be kind to myself, a middle aged man that might be thinking about some life events and my smile and I might be interested in a straighter, wider smile. You know, how do I go and when I, when I approach that question in a practice, what are those options in that practice and why? Why are they available? And can that practice really tell me how I get from A to that smile or B, you know, quickly, easy, you know, fast and reasonably priced. I think the other is certainly capacity and, or workflow and throughput in practices coming out of COVID I speak to so many practices, Emmett, that just can't find the staff that they used to have and so scaling their business. The challenge is really people first before technology or before modalities or treatments. So those two questions, how do we unlock current patient value and how maybe digital can address some of these capacity issues. I think that puts us in a good place for a chat.

I like the unlocking the value you know, I think the first place a lot of us are going is renegotiating fees with insurance companies. Right. Just on our most frequent procedures. But to your point, when you step back, you've paid for the marketing, you've got them in the door, somebody answered the phone, someone got them on the schedule. You know, you have staff there available for them. Are you really maximizing their experience there? You know, and not in some way that, you know, you're taking advantage of them, but like real value that they want. And frankly, they don't want to go to three different places, they've already walked in your door. And so, you know, as great as SmileDirectClub is, maybe for an online purchase, they'd actually rather just, if they're in your house, they'd rather you take care of all that for them and be part of that journey for them. Right. So just driving that convenience as much as possible to increase that revenue. Because we often talk about how in dentistry, for the most part, unless you're fee for service only, you can't really move that price up against the insurance side. But the way you said it, you can increase the amount of dollars you're getting from patients if you're increasing the value you're bringing them.

Absolutely. And I think that most patients, myself included, you know, I, I married into my dental relationship, so to speak. My dentist is my best friend's wife. So, you know, as I'm talking to Dr. Hale about these things, you know, she's asking me and doing a great job, quite frankly, em, about, you know, where I am, anything coming up, I'm happy with my smile. Have I thought about, you know, addressing any of the things that she's pointed out? And I'm list listening. I'm listening to Pam the hygienist. I'm listening to Dr. Hale. We're having a conversation and she may or may not know I've got a graduation coming up and, and I'm ready to act on that. She may have had the clear aligner conversation with me two or three years ago when I wasn't ready then. So I, I think having sort of this arrow in the quiver around an easier solution, a predictable talk track, being able to address the patients where they are and when they are is. Is pretty important. And going back to that notion of choice, if we rewind the clock 10 years, it was Invisalign and, and may player or two. And now today it's, you know, 10 plus relevant choices that can, you know, deliver clear aligners in different ways. But let's think about where patients are today and the segmentation of patients, especially these younger patients, who are learning everything from YouTube and are interacting with influencers and are maybe making decisions about care from information sources that I'm certainly not that familiar with. You know, I have a teenage son, and he's telling me, he goes here and there in the next place. And it's interesting to me because as a marketing professional, I'm feeding that back in. But Emmett, going back to those patients and unlocking value, if I can really speak to their needs and have some choices. Let's imagine, for the sake of this discussion, that a clear aligner is a clear aligner, that we trust that aligner. If there's compliance to get the teeth where they're supposed to go, we'll call that table stakes. Now, how is it that I want to really maximize the opportunity for revenue first and second, for efficiency in that practice? I certainly want to capture those fees and create a happy patient, but I'd like to do it as efficiently as possible. And I keep coming back to maybe a chair time discussion. How much chair time is involved with a traditional clear aligner? Over a period of two years, it's certainly several hours. It could be up to 10 hours, just depending on, you know, the, the type of case. And could any of that really be put online? Could a check in be put online? Could a reminder be put online? Can we order another aligner online? And as we think about that young demographic, they're used to jumping onto an app and doing almost everything, 100%, yeah. So if you think about technology, and you're starting to see that from a lot of the, I would say the better known aligner companies ourselves included a smile makeup platform where they can check in that. That literally this scan from your camera is just aligning with the treatment plan. And okay, am I tracking? And if not, I have two choices. Emmett. I can click the button that says take me to the dental team because I'd like to talk to a dentist, or I can click the button with this new Care plus and make an appointment at Dr. Emmett, and I can go back in and see him because he is my dentist and that's my relationship. So convenience really driving compliance, compliance driving successful outcomes and efficiency. If you really think about it, you know, it doesn't have to be AI and this, all of this fancy technology we're talking about, it's technology we have in our laps today that's, you know, based off of everybody's phone. And I really like how that's developing.

What I love about what you said too, is, you know, early on, especially if we had any ideas around this, we as dental companies were having to develop this out. You know, it's like I'm going to develop out a software to do X, Y and Z. And I think you, as sponsors, as vendors, as partners, have started to innovate and bridge that gap for us. So, you know, with what you just said, I, in essence, am handing my patient an app that gives them everything that they want with the ability to reconnect with me. And I had zero development costs in that. So that's number one, which is really interesting and worth kind of pressure testing with some of these other partnerships that might be out there. Number two is I can come up with a lot of ideas that could increase value for the patient. They have to be executed by a team who's trained to do that.

Yes.

And to the extent that I can offload that from my team, to the extent that I can bring value but not have to train someone beyond, you know, some administrative tasks, man, huge leverage, huge operating leverage, to the extent that I have to put a whole team in that I've got to put a whole lab in those kind of things. It's not that. That's not, quote, unquote, worth doing. It's just going to be a ton of effort, and my ROI is going to be much farther out because I've got to overcome now that overhead cost that's in place. So part of what I'm hearing from you is that with some of the technology and the partnerships that you're creating is you can get fast leverage to be able to provide value to the patient without redoing your entire office system.

Yeah, I would agree with that. And I think it might be helpful for your audience to just think a little bit into the past and let's bring it back through a couple of examples. I'm old enough to remember the innovation of inner oral cameras. Literally, just taking a photograph and showing the patient, you know, where they were, what condition they were presenting in. You know, seeing is believing. Right?

Right.

And we start to go to digital diagnostics. I'm also old enough to remember offices I'm visiting, dipping X rays. Right. Well, now we've got incredible diagnostics in seconds. You know, things that just we couldn't even imagine 20 or 30 years ago. And also being able to use or have those illustrate where the patient is in terms of their need for care and some decisions that they can make about that. I REM being with SHINE at the time where cone beam was first coming into practice for specialists in particular, you know, the machines were as big as an operatory and the cost, half a million dollars. And I was kicked out of a fair number of practices saying, you know, get that out of here. I'm never going to need anything like that. But as implantology really came to the fore and you know, that information about how much space was available, angulation, et cetera, to create successful outcomes, to really treat patients the best way possible, technology becomes easier and easier to, I think, understand how it's going to positive impact and benefits. Now I'll go back to this conversation and an oral scanner, something like an Itero, for example, or a three shape, pick the one that you like. But seeing is believing, right, Emmett? All of a sudden the patient can see hard and soft tissue. They can see via time lapse the progression of disease, if that's the case. And it really helps them understand that if I start to make decisions with my health care provider, in this case, Dr. Emmett, I can understand how this investment in my health is benefits. And they might be cosmetic, they might be functional, they might be both. But I really like what you said because now these apps and the fact that you can take a picture or a scan from your phone on the smile maker platform and put this into this larger decision making opportunity for the patient and simultaneously create that leverage for the practice, this is great because now in a general dentistry practice where you might not have a treatment coordinator, you know, the luxury of an ortho office is a really highly trained, very highly paid treatment coordinator. And that's, you know, pitching this and okay, great. And in a dental practice, a general dental practice, you may not have that. So can the technology put this general dentistry practice on somewhat equal footing? And can we create that throughput, that positive momentum? Because as we know, practices will learn, iterate and get better as they start to hear yes and no. So when we hear yes, why did we hear yes? And what can we do to put the patient in a place where they have all of that information to help them make the right decision and we just sort of facilitate that conversation.

Yeah. And if I, if I zoom out on a macroeconomic level, we've been in kind of this boom market for so long that there was excess margin and capital for people to say, you know what, I'm going to build some of this on my own, I want to keep this in house, I want to do it myself, I'm going to, you know, and the Entrepreneur in us thought it was cool too. And frankly, there wasn't a lot of options where we're sitting today. I don't have the capital. I can't go out and R and D new ideas. I need every piece of dollar and margin that I'm getting. But to your point, I still need to innovate. I still need to be bringing additional value to the customer. And there's lots of options, too. And there's individuals like SmileDirectClub that are making massive investments into this specialty area that frankly, if I tried to do it, it'd be really hard because I'd just be doing it as a side hustle and you all are doing it as a core business. So the patient experience is going to be 10x what I could pull off. Right. It's just a bigger investment, a bigger focus.

Yeah, you know, that's a great spot maybe to spend an extra minute or two. And the reason I suggest that is one of the challenges I had at a previous employer. Also in clear aligners, most everyone would know their name if we said it here. So is, you know, the, the notion of clear aligners, especially as a differentiation, an operative operational opportunity, excuse me, to differentiate their practice in, let's call it 2012, 2014, 2016. All I had to do was hang this little flower on my, on my window and, and, you know, wait for the TV commercials to drive people to my door. And that was great. Those are solid days. But that really doesn't exist, I think, at least in the same way, any longer. But let's say that we were starting a new practice together and we thought, wow, clear aligners are the way that we're going to really build some, some revenue here, some production, get some people in the door, and we're going to have a clear liner day, set it up, we advertise it. We partner with this company or any company, and we get 20 people to come. 10 people say yes to practice. And we're pretty excited because we can do the math. At $5,000 a case, that's a fair number. And wow, we did, you know, we did well today. But then we get a lab bill and we get that lab bill within 30 days and we don't really have the cash flow that's going to help us at the time do that lab bill. And that's a little bit of a.

Because we patient financed it all. And so they're paying us x hundred dollars a month.

Month, yep. $25,000 bill, net 30. And we're thinking this Math doesn't work. So if you think about options, efficiency and tools, which is where I think I picked up your question. You know, one of the tools might be are there partners out that, that allow you to sort of get through that same push or, or specialty or focus on clear aligners but do it in a way that doesn't negatively impact your books? Yeah. And our particular model around you can

literally crush your practice by being successful in the model.

You just isn't. It's counterintuitive and 100% true. You think you're doing the right thing. It sounds and feels like the right thing. And then you get a lab bill, but you've collected $800 that month and you're thinking this isn't going to work. So if we think about other ways, whether that's the financing that SEC traditionally offers to patients or something like that, even third party financing, I'll focus on the impact to the practice. There is a revenue in our model to the practice upfront for being our partner, I. E. Partner network, which is really what attracted me here. Building a network of partner practices for two reasons. And this is one. Right. We're going to be able to assist, allow partner with the practice to really build that book of business around clear aligners. And that might be pre restorative orthodontics. And it. Right. It might be in preparation for restorative work. There's partnership that's possible there and it could be a cosmetic outcome that the patient wants. But everybody is winning here. But if you take those same 10 patients and put them through our model, there is a significant revenue impact to the practice in the first 30 days, not a bill. And then as we go through, we manage at sdc, just for the sake of argument, all of the billing and financing and blah, blah, blah, there's just absolutely zero impact to the team at the practice around this. So it frees up that time or gives them back that time. And I think that's great as well. Yeah.

Because the biggest fear is I get this going, I've got this long commitment, it doesn't quite play out. And then I don't have the staff to really support it anymore. I can't afford the staff. Right. So in this situation, maybe we should get into the tactical because I think a lot of people are like, I already know how this works. And the reality is we probably don't because you guys have been evolving. So I'd love to just kind of level set us. Can you just walk me through, play by play, how a Relationship works with you all?

Sure. And, you know, I think it'd be good to start with a number we get at SDC. About 150,000. I'll repeat that number. 150,000 inquiries. Just pings about clear aligners every month. And let's take 10% of those going through the next step, which is I'm filling out my name, I am clicking a button, I'm picking up the phone to I'm really interested. Tell me more. So those 10,000. There's a certain number that maybe don't have a dental relationship. Would like one. Feel better about Dr. Emmett in a white coat saying yes, David, you know, I've done some evaluation. I have some diagnostics. This might work for you. Here we go. So we wanted a place, and places plural, to put that interest in our previous iteration of direct to consumer, only that just didn't exist. And so what we're building is this network of partner practices. So starting there then, I'm an interested potential patient and I live in zip code 89511. And that's where you are, Dr. Emmett, and you are our partner. So we're going to do one of two things. We're going to set up an appointment for you in Dentrix, what have you, so that we manage that exchange, taking a little bit more off the plate of the practice, or we're going to call the practice on your behalf, if that's what you prefer, and let them work it out up at your door, take a scan. You're going to say, you know, have some evaluation time with the dentist and say, okay, great. You know, David, I think this might work for you. Your. Your malocclusion. Let me imagine ortho relapse for the sake of argument. Yep, pretty mild. No problem. Obviously, our solution, clinically, Emmett, as you know, is mild to moderate, primarily in the anterior. You know, a change in bites. We don't have attachments, et cetera. So there's some easy disqualifiers. If there's something major going on in there, we can't treat it with you being in the office. That's awesome. Because Dr. Emmett can say, well, David, I don't think Smile Direct is going to do what you need to be done. But I've got these two or three other options. If you're interested in care, let's get after it, right? And so I say, yes, we press a button and we get some aligners. Now, the only time I'm going to see you, Dr. Emmett, is when I want to see you. Or need to see you, because there's a 247 dental team of dentists and hygienists that I can go to on the weekend, Memorial Day weekend, and I'm, you know, out in a lake someplace and something happens. I can press this number and talk to someone, or we can make an appointment for you when we get back from the weekend. So it's all great. It's all about convenience and treating them, where and how they want to be treated. Now, what we encourage is at the end, you know, there's, number one, some oral care built into this, meaning products, whitening and all that kind of good cosmetic flosser and all that kind of good stuff. And you get it with. With Care Plus. So at the end, what we want is a nice big purple step and repeat. You've got this big smile. You're certainly happy with the. With the outcome. You got this bag of free swag, you're ready to go. Everyone seems happy. And Dr. Emmett says, hey, David, I'll tell what. Your smile looks great. I would love it if we could help you take care of that smile going forward, because previous to this, I wasn't your patient of record. Why don't you come back in six months, we'll give you a cleaning. This one's on me. And we'd love to see you in the practice because you and I, Emmett, know the lifetime value of a practice, of a patient. What if I could put through this mechanism, Care plus and SEC. What if I could put 5 or 10 a year into your practice? Over time, that adds up. And that's the real benefit of our model, in my opinion, is we truly are partners in growing a practice. It's not. I'm buying millions of dollars of TV ads. I am, by the way. You know, you're clicking on Facebook and you're seeing us. You are. But this is a real plan and program to get me into your practice and keep me in your practice, if that's what works for everyone.

The patient wants to go to someone. So the question is, you know, why not you? What if I'm a clinician who's concerned about the clinical outcomes and I want to kind of go deep on. That's great. You have a clinical team. That's great that they'll take care of it.

It.

But, you know, at the end of the day, it's associated with my name and they came into my practice and we're on my schedule and so forth. How do I do that? Due diligence.

Yeah, no problem. That's a great question. It's probably one I don't talk about enough. So note to self, obviously a treatment plan is created based off the diagnostics scan or, you know, someone snapped an impression and either way we get to a treatment plan that's done by a dental team team in Costa Rica. Just like some of our competition of dentists and technicians, it comes to a dentist. In this case in the state of Nevada where I'm speaking to you from today. Lake Tahoe is just a minute or two out the window, but it comes to a local dentist in Nevada who looks at the plan and based on his or her experiences, yep, that's relevant for the conditions. Here's the diagnostics. There's a plan. I like it. Now you, Dr. Emmett, get to see that plan. There's something called a portal and you can go in there and see that plan. And if you have any questions, you can interact with that, that dentist and ask him or her, why did you move it this way? Why so far? Why not far enough so you can get confidence as well? Because you're right, your reputation and your name is on it as well.

Okay, awesome. So this isn't so hands off that I'm like, I hope this turns out well. Like, I can, I can dig into this. I could ask if I've got an orthodontist, I can say, hey, is there anything here that concerns you? You know, those kind of things. And in fact, fact, if I have an orthodontist, what I've seen is that this really leverages the tools in their tool belt because of something you said, which is if they come in and you say, hey, this isn't like the right path for you. Like, you've got a lot more complex stuff going on then, then I can push them that way. Correct.

You sure can. AI don't think it's a zero sum situation here. I think that you can continue to feed and water your referral relationship via this. I also think that should you be confident with other treatment modalities in your practice, in your own two hands, you could choose to offer that option to the patient as well. So you are directly true partnership.

Yeah, it's a true partnership.

And we have no idea when I, I use the euphemism when the light turns red, meaning our solution won't treat that. I, I have no problem supporting a practice and neither does our team. About, okay, Dr. Emmett, here are some options and are you comfortable with that and can we help you develop talk tracks for the patient? Right. Maybe you you or the team would like a script and we can help you come up with that. Hey, David, you know Smile Direct isn't for you because if Smile Direct sent me there, I'm going to say, well, wait a minute, am I, why am I being switched? Why are you being switched? Because somehow Direct actually won't treat this, but working with them, we've got some other options and sort of a nice warm handoff.

Yeah, that's awesome. Now you've talked about your side bringing in those leads, 150,000 or so, some portion of those needing to go to dentists. What about the other side where someone comes in? Can I leverage your platform to say, hey, I think you're a Smile Direct club candidate and I think this is a more cost efficient, great solution for you. By the way, you travel a lot and now you'll be able to get a hold of a team and I won't get a call at midnight or whatnot.

Yeah, you can. And it's great. In fact, we're just coming out of a pilot with this Care plus product and partner practices, obviously to scale that, we need to have seen as much interaction with patients as possible. One thing from my experience I believed we would see, Emmett, is what you just described, that maybe that patient didn't show up in the practice looking for that, but it was on their mind and something in the practice sort of triggered a discussion and the doctor or their team is having a discussion now about that, but they may have appointed for a cleaning or a crown, something like that. And we're seeing more and more of that. You know, I have some numbers in mind where I think at full volume, you know, what percentage is going to be what we're describing now versus I sent you to the practice, me being stc, you know, I think at the end of the day it's probably going to be pretty even 50, 50. You know, there's a lot of patients in a practice that didn't say yes to clear aligners previously for whatever reason. Many times it was financial, it's a relatively large commitment in most cases and they just weren't ready for it, they didn't have their significant other buy in, etc. Now that, that we're trying to democratize this and not just us, there's other clear aligner companies out there with, you know, price points I think a little bit closer to where most people can afford them. You know, I think you're going to hear more yeses than you used to. And in practices that are able to sort of create the opportunity to welcome that inquiry and that need and turn it into aligners and a happy patient. Those are the ones that are going to continue to manifest this growth that you talked about early on.

Yeah, it's awesome. It's again, another tool in the tool belt to unlock this value. You, David, this is awesome. I think in these times, all of us are looking to be as creative as possible. If someone wanted to dig more into this and see if it's the right fit, you know, maybe they're currently offering some solution or they're like, yeah, I just need to increase the value to patients. What's the best way for them to get more information on this and see if it's the right fit?

Yeah, it's great. Thank you for that. I just wanted to say I appreciate the spotlight here because telehealth and innovation are not, not going away. AI is not going away. How we can leverage technology for the practices that, that you're speaking to, that's just becoming more and more important. So we'd love to have some conversations. If, you know, anyone out there feels it appropriate, they can go to SmileDirectClub.com there's something called a partner portal. Become a partner. You'll see it pretty prominently there. Click on that. And obviously there's some lead fulfillment that we'll go through and we'll get someone, you know, in a space where we can share what we're doing and see if it's a fit to for them.

You know, you bring up a good point. I think it's worth closing on is we don't get to determine this. The market does. And if we all step back and don't think of us in the dental industry, but think of us as consumers, well, what do we want? You know, I mean, I just scheduled something and the reason I scheduled with that place was because they had online scheduling. You know, there was like seven options for me to go to get this done, but they had online scheduling. It was easier for me. I didn't want to talk to people. You know, it used to be that, like, hey, come into my practice, come into my practice, come into my practice. And doing that on a frequent basis, it had its own value. Let's be honest, none of us want to do that on a multiple basis. The more that we can do things from home, that we can do things online, that we can do things over a network, we're in as consumers. We may or may not like it as clinicians and as a dental team, but that is where the market's going and to the extent that we can leverage into that, the more impact we can have. And that's what's really critical.

Yeah, the convergence wins here. And we built some great tools and, you know, we're certainly trying to innovate. I know others are as well. But we appreciate the opportunity to kind of highlight where we are and how it might be a fit for your audience.

All right, David Rodriguez with Smile Direct Club, thank you so much for being on continuing to expand our thinking and our our minds here at DEO. We want to be in that top 1%. So I appreciate you being for anyone else who wants to have more conversation around this, come over to DEO Growth Secrets Facebook page. Come out to our summit out in San Diego. Go to DEO dental groups. You'll be able to see a lot of innovation out there. One of the largest gathering of dental professionals, all innovating. And until next time, keep smiling. Thank you for listening to deo's Growth Secrets podcast for dental organizations. Continue the conversation with on our Facebook group and meet other dental leaders. Get questions answered and the strategies you need to succeed. Plus, we have some free resources for you right there on the Facebook page. Remember, you're not alone. Let's do this together. Join DEO's Growth Secrets Group on Facebook. And until next time, keep smiling.