Helping Healthcare Scale
Imagine you're friends with multiple CEO's of billion dollar organizations. You can call them anytime you like and ask them all that they've learned about real estate and investing, including some of their biggest mistakes.
That's the mission of this podcast, to teach the insider strategies used by the big guys to everyday healthcare operators in order to get access to the best strategies and real estate at the best prices.
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Helping Healthcare Scale
Pioneering Full Arch Dental Solutions and Mastering Patient-Centric Growth Strategies
Strap in for a deep dive into the business of smiles as we scrutinize the marketing finesse required to integrate fixed full arch dentistry into a thriving practice. We dissect the direct-to-consumer approach, emphasizing the necessity of nurturing trust and the substantial investments involved in patient acquisition. The conversation spotlights the delicate balance of amplifying clinic revenue without overshadowing the essence of general dentistry and the critical systems needed to curate a seamless patient journey – from lead to final consultation.
Lastly, we explore the patient's path post-commitment, where third-party financing and follow-up strategies come into play. Greg imparts his wisdom on keeping patients engaged during the interim of decision and surgery, addressing the unique obstacles for those new to dental care or with fragmented dental health management. Insights into how Dental Service Organizations (DSOs) weave full-arch procedures into their fabric provide a glimpse into evolving market dynamics. Peek behind the curtain of full-arch therapy and see what it takes to fortify a dental practice's approach to not just change smiles but to elevate its market presence to unprecedented levels.
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And they did that magic where they'd take the mirror. They don't show them their teeth and then they bring in the mirror and then have them show. Look at their mouth and this woman. It was just amazing and she started tearing up and crying and I got emotional over it.
Speaker 2:The goal of this show is to help healthcare organizations scale by leveraging real estate strategies and interviewing high-level healthcare executives in order to pull out lessons learned along the way. If you'd like a pre-site selection analysis from our team, or you'd like to learn more about how we're acquiring real estate for our fund on the blockchain, visit us at wwwreuniversityorg and drop us a line. That's re as in realestateuniversityorg. Hello everybody, welcome back to Helping Healthcare Scale. I'm Austin Herr, your host, and I'd like to welcome our guest today, greg Essenmacher. He's the CEO and founder of GNA Consult. They specialize in converting lead calls to consults, and he's been doing this for 18 years and focused on FullArch for 11 of those years. So he is a very specialized man and I'm really excited to tell his story and share some of his insights. So thanks for helping on the show today.
Speaker 1:Yeah absolutely.
Speaker 2:Thanks, austin, appreciate you having me, so I always think it's interesting to find out how did you get into this crazy world of group dentistry?
Speaker 1:Yeah, I backed into dentistry. I was actually looking into medical device after a career prior to this in rental car, and the regional rental car company I worked for was purchased by another, much larger, sound, familiar right Consolidation, which happened in rental car. And then I was looking at medical devices and happened upon an ad for a dental opportunity and said I'll throw my name in the hat, went and interviewed and I was one of eight candidates and the other seven had dental experience. But I guess I was pretty influential and got the opportunity and built, grew and scale that way, just by industry partners, using resources and what I like to do, which is it's all about partnerships and relationships and that's what I did collaborating with others in the industry to be able to build and grow my business Cool.
Speaker 2:And this was 18 years ago. It's 18 years ago.
Speaker 1:Yeah, it goes back oh that's awesome. It's been a while. I can't believe I was 18 years ago. It doesn't feel that long ago. I'm not that old man.
Speaker 2:Come on, you got started when you were six. It's all good. I don't know about that.
Speaker 1:So that'd be a little weird. But okay, we'll go with that. I like that. I like the way you're going with this.
Speaker 2:Cool, yeah. And so then just take us on the journey. How yeah? And so then just take us on the journey. How did that?
Speaker 1:cross over into FullArch. Yeah, so I was working for my first job in dental was with a company that had just one bone grafting material and it was a beta TCP, so it's very niche. And so I collaborated with at the time which was the dominant implant company in the US Nobel Biocare. And so I collaborated with them because they didn't have bone grafting but we built that company up. It was amazing, great experience and that opportunity ended with the company selling and so I was looking for some work and Strauman Group at the time purchased or made an investment they made a 49% investment in Neodent, so into the value segment and at that time we're looking for individuals. I was hired on as one of the early ones before there was any revenue in the US, even though it was dominant down in Brazil, which is where the implant is from and from there.
Speaker 1:We went after the full-arch market because part of the product portfolio, different aspects of it, and so we went right after the full-arch market. We did, and we did very successfully, and it was all about really helping clinics clinicians how can we help their business grow? It wasn't so much a woodblock implant, so it wasn't really product specific, even though the product is fantastic. It was more about how can we help build and grow your business. What is everything around you building and growing and scaling your business so that you'll buy more of our product and with that concept and philosophy, is how we built and grew that brand and in turn, it really gave me the foundation in Full Arch and I really have a sense I got attracted to Full Arch though it was really way back then and it was my very first patient reveal when I was in an operatory.
Speaker 1:A patient had had their surgery. They got their temporaries delivered, their temporary teeth delivered, and they did that magic where they'd take the mirror. They don't show them their teeth and then they bring in the mirror and then have them show. Look at their mouth and this woman it was just amazing and she started tearing up and crying and I got emotional over it and that really was. I wouldn't say it was like the moment where I'm like I'm going to do this forever, but it really it. It touched me in a way that I thought this is different. What they're doing here is different than other procedures in dental, and it was the first time and at that point I'd been in dental about seven years that I knew there's some, there's something there and I want more of this. It's the first bag is free. I probably shouldn't say that you did that.
Speaker 1:Thanks, and I did and really just pursued that and continue to pursue that, even after I decided to branch out on my own with GNA console.
Speaker 1:I first launched it in 2015, but it's dormant and then I launched it again about three years ago and really have been building and scaling since then, helping full large clinics with what they do, which is really the patient experience, which is like I focused on just a few minutes ago.
Speaker 1:It's every touch point of that patient experience, because full arch fixed full arch is so different from pretty much any other aspect of dentistry, where you have patients that either have not been to a dentist in a very long time or they've got like this piecemeal dentistry that's been with. They've gotten a root canal and a crown, they've gotten a bridge and they've gotten more and more in an entire arch and eventually gets to the point where it's just not functional anymore and they've suffered for so long that it's really time to be able to fix that once and for all with a fixed prosthesis and giving them back the ability to chew and function morning, noon and night, and it's really an amazing transformation. But to be able to work with their teams to be able to do that profitably is a whole nother matter whatsoever, and that's what I've been able to really build a business around.
Speaker 2:Yeah, okay, so maybe let's just start high level too. How does Full Arch differentiate from just general dentistry?
Speaker 1:Yeah, when you're talking about fixed Full Arch, you're talking about fixable arts, you're talking about cases that can be $20,000, $30,000, $50,000, $60,000, right. So in general dentistry, say, for example, a patient calls into the practice right, the patient acquisition side, you're still trying to get new patients. But in general dentistry you're looking at like the lifetime value of a patient. They're calling in, you're booking a hygiene patient because typically they'll come through hygiene, unless it's an emergency or things of that nature. They're coming through the hygiene route. That phone call and that initial inquiry lasts maybe one to two minutes on average.
Speaker 1:In fixed for large, if you're doing direct to consumer, which means you're advertising on some platform, whether it's meta, facebook, instagram or pay-per-click, or it's SEO or television, you can go down any route. This direct to consumer model, there's really no trust built in with that patient. And when you're making that connection, you have to make an emotional connection with that patient in order for them to trust you, to say, okay, I'll book a consult with you, whether it's paid or complimentary, and then to actually show up, because the no-show rate can get super out of control and you can reduce that in different ways. But that trust has to be built all along the way, because this isn't just a thousand dollar procedure or a couple of hundred bucks where they can swipe a card. This is a long-term commitment.
Speaker 1:Think of a car payment and, depending on what kind of car that you drive, whether it's a Toyota Corolla or a Mercedes a long-term commitment with many months or years of a payment plan. So this is a long-term commitment for a long-term solution to a challenge that they've had for a very long time. So that's where Fixable Arch is so different from a patient who may come in for hygiene and, yes, there's a treatment plan that's involved but it's a much different opportunity that they're dealing with. Does that make sense? Yeah, so like how does?
Speaker 2:it affect the revenue going from if you start to incorporate Full Arch like maybe a percentage standpoint.
Speaker 1:Yeah, so in fixed full arch it's an all or nothing game, right. There's not like part way, like okay, so we'll do part of your full arch. You're either removing all the deep placing implants and getting a screwed in prosthesis or you don't get the case conversion. It's all or nothing, it's yes or no type of thing. There's other treatment modalities. But if we stick in the 1.5 billion annually fixed full large arena right, and yes, I said that accurately $1.1 billion annually just in fixed full large, not in implants but just in that particular lane that grows at about 8% annually and has been and continues to. That's why it's so popular for so many clinicians to get involved. It's immensely popular, it's very lucrative. The impact on revenue in Fixable Large it's a $1.5 billion industry just in Fixable Large and it grows every year by about 8%. So that impact can be significant. But also on the cost side, in order to do a patient acquisition or an ARCH acquisition, it can range from $1,500 to all the way up to $3,500 or more. So it really is a risk reward game. I don't mean to call it a game, but it really is. And that's why you have some of the big DSOs like Clear Choice and Nuvia and Independent and others that are investing a tremendous amount on the growth side because having those systems in place to be able to drive down the patient acquisition cost or the arch acquisition cost is so critical. But you also have the independent locations and also some of the small emerging groups that are trying to figure it out, because the profitability side can be immense but it's also high risk, high reward. You have to be able to put a lot of money into the marketing and into the team and into the system in order to do it well.
Speaker 1:And if you're a general dentistry practice that's adding full arch into the mix, you have to give up some, right, because if you're a busy full art, if you're a busy general dentistry practice, you're profitable. And if you think about that profitability, if you're doing, say, 200,000 on a monthly basis and you're profitable 20%, you've got a good profitability margin. If you're going to take that 40,000, invest that in team members and in systems and in marketing specific to full large. If you don't get a return on that investment in three, four, five months and you get no patience right, because it's an all or nothing game If you get no patients out of that, you can literally wash away all of your profitability from the general dentistry side.
Speaker 1:Anything that you're doing on the general dentistry side whether it's the hygiene, the clear aligners, the bridges, the crowns, everything in fixed full arching gets no return, and so that's why it's that risk reward and having systems in place and training in place, and it's a different game, so it's an all or nothing. You don't get base hits in fixed full arch. You either get it or you don't, and so there's so many things that are important to put it in place.
Speaker 2:I do dabble in fixed full arch. No doubt, there's no doubt, yeah, so that means you got to have a shift in culture. Probably so can you talk about like the importance of defining the team roles, the responsibilities, that sort of thing.
Speaker 1:Yeah. So team structure is critically important and, like I shared before, that that very beginning of answering the phone just is critically important, that initial inquiry of the patient, which is that first touch point of the patient experience.
Speaker 2:Real quick, how do you know, like when you say answering the phone of the patient, which is that first touch point of the patient experience, real quick? How do you know, like when you say answering the phone for that patient?
Speaker 1:how do you know whether?
Speaker 2:they're calling about a full arch versus just something else setting up systems.
Speaker 1:That's an amazing question. It really is, because if you're going to do fixed full arch and you're going to advertise for and market for on the direct-to-consumer model that I mentioned, you really should have separate, a separate phone line that it comes into or have the patients do what in the marketing terms is called a form, fill a survey and then the response time back so that you have somebody dedicated toward responding back to them very quickly, right? So the Harvard Business Review did a study recently that talked about if you're going to have somebody fill out an online survey, if you get back to them within the first hour of filling out that survey, you're eight times greater to have a meaningful conversation with that potential customer, that client, that patient, than if you don't in the first hour. That's in the first hour. So having somebody dedicated to and there's ways to set up notifications and systems, oh, you have a new survey filled out. That's critically important. And, yeah, the dedicated phone line, the dedicated email, the dedicated notification system. So, absolutely like you said, it's the systems in place. It's not just oh, you know what my arch acquisition costs for the marketplace in my area is $2,500. Here's five grand. Give me two arches this month.
Speaker 1:It doesn't quite work that way, because you've got to put the systems in place and it's working that marketing funnel in order to be able to be successful at getting that, like you talked about, what's the revenue potential and hitting that home run. Getting that, because there's no big sets, right, either do or you don't. It's an on or off, it's a yes or a no, it's not a we did okay with that. Now there's other treatment modalities. Right, I'm talking specifically, and that's the lane that I purposely have been in, because it's what I know, it's what my team is well skilled in and it's what we work with and are successful in. There's overdentures and there's others. Right, there's many other treatment modalities, but specific to this is what I do and this is what we do all day, every day.
Speaker 2:Okay. So then, yeah, I think it'd be good to go granular. So what strategy do you suggest for, you know, communicating with patients and the full-life treatments? I feel like we got started on that and we got.
Speaker 1:No, absolutely. And so the individual that started it all starts with connection with the patient and emotional connection. Right, in order to have that trust to start to build, no-transcript another appointment scheduled for or they need to make a payment. On right, they have to have undivided attention and being able to paraphrase and being able to share back experience, because those calls typically on average right, they can be shorter or longer, they'll last eight to 10 minutes, sometimes much longer, those calls inquiring about full arch therapy and so having that time dedicated in order to have that conversation, to be able to express empathy.
Speaker 1:And what we teach then is assurance right, you've called the right place without saying we're the greatest, come on in. And there's ways to do that. Right, and that's really through acknowledging what they're saying, answering their questions and then asking another question. So it's driving the conversation forward using your unique selling proposition. What makes you unique about the doctor, the practice, about why are you different from the guy down the street or the four others that are within 10 miles that do the same procedure, that are actually 10 miles, that do the same procedure, that are actually advertising the same procedure? And it doesn't have to do necessarily with price or product or all of that. It has to do with the experience.
Speaker 1:So it's making that emotional connection, assuring they called the right place. It's talking like we are here with some zeal right, so it's actually lifting up the conversation because a lot of these patients I've listened literally Austin, to thousands of calls and they usually start out real subtle. Hey, so I saw your ad about implants and if you talk with a little more energy, they'll pick up a little more energy. Now, if it's somebody like me that's pretty animated, typically you want to settle them down, you don't want to get them more riled up and get off the races. They go. But this is a formula, not a script, because I'm just not a big fan of scripts because then they sound too robotic. You can tell.
Speaker 1:Yeah, you really can, but I believe in formulas because for me, a 52-year-old white male from Detroit is going to sound like different than a 27-year-old female in Houston. Right, their life experiences are different and if we're going to make an emotional connection with a patient, it's got to be through story selling, it's got to be through our life experiences and connecting with them. If they talk about a challenge that they have, we might not have that same experience of having a loose upper plate right, that's been irritating our upper right. But we also might know what it's like to be irritated because our son or our grandkid or the neighbor's dog, or we've been irritated before. So, identifying with them, with the feelings behind the facts as well as the facts and these are some of the strategies, because you asked me that those are some of the strategies- that we teach, coach and train and listen to calls with them and coach them after.
Speaker 1:We work on the formulas so that they have some of the tools that are critically necessary to be successful. And it works. The numbers really prove it out with clients that we have.
Speaker 2:Yeah. So and then I know another difficult part is, just like sales guys always love to blame it on, you know, the marketing team or whatever. So like how do you, how should practices? And like how should they manage patient expectations through the marketing?
Speaker 1:Yeah, and so that's one of the biggest ones too, austin, is that, when I work with clients and when our team works with clients, understanding the metrics that you're trying to accomplish right, and it's not the metrics necessarily that the marketing companies give to clients. It's the metrics that we want to see from the marketing company, right? So we want to see what's the. It's one of the things that drives me nuts and forgive all the marketing people that are going to listen to this or watch this. Right, if you tell me how many impressions that you give me, I'm not impressed. Right, because I can tell you, because I'm on LinkedIn a lot. So are you.
Speaker 1:You can post something and you can get thousands of impressions and it doesn't mean anything. So it's not your audience, it's not your target audience, so I really don't care how many impressions you give me. Where are the leads and where are the qualified leads? And then, do they actually? Are they meaningful conversations that can lead to consults, that can lead to conversions, that can lead to both cases and my closing ratio and patients in the chair and lead to my production revenue? That's what I really care about. So, having these metrics in place and then reverse engineering it back to the marketing companies and being collaborative with them and knowing what you should hold them accountable to. That's what's critically important. So there's a lot of that. I agree.
Speaker 2:Yeah, I think it's really interesting. From a high level, it just sounds like it like anything like if it's worth doing, it's worth doing well, and so if you want to go do this, then you got to go all in, which totally makes sense. Have you seen a lot of changes in the patience and the full arch of space since you started? How patients change?
Speaker 1:Yeah, I could take the layup and say, oh, when you're talking about big cases and financing and third party financing on the last little while, everybody knows the credit crunch and things are getting more expensive. But I want to be a little more specific than that, austin. So I have two clients specifically in the last three months and specifically what they're dealing with is a greater propensity right for patients to want to not do treatment. Or they've committed to treatment day up and then they go back and say, before they actually start surgery, of saying I'm having cold feet, I want to do a refund, I don't want to move forward with treatment, and I think it has a number. It has to do with a number of things.
Speaker 1:I thought at first because it tends to be that annual people do shopping during the holidays, they get their credit card bills and then this and that happens.
Speaker 1:But what we've really seen is not just myself and it's others in the industry that work specifically in my space big case, third party financing, talking with partners of mine in the industry what really happens is when patients commit to a big procedure like this, from that point to the time surgery actually happens, because then they're pretty much commit right Between those two points of time, it can be two, three weeks sometimes. During that time, what happens? And with these two particular clients, typically that third party financing they sign the paperwork, they get their first bill from them and then they get all the details. Because it's like when you've agreed to buy a car or you lease a car and you see what the monthly payment is and you're like, okay, that's digestible, I can do that. And then you go into the finance office and you sign all that paperwork that's 57 pages long and you end up seeing what the total number of payments and the total amount is that you pay If they're at home and may get this information from a third-party financing company.
Speaker 1:If they get that, they can certainly get spooked by that. So we talk a lot in Full Arch about follow-up cadence for those that don't say yes to treatment right, how to move them along and nurture them along to get them to a yes. What I think one of the gaps and this is what I'm working on lately, just in the last couple of months with clients is the follow-up cadence after they say yes, before they come in for smile design or records or whatever you want to call that procedure, and then even before surgery, to really keep that momentum going with the patient, because some of them may have said yes and then they have to go home and convince a spouse or a significant other or, and mind you, these patients whether they fall into one or two categories and I generalized it right One might be they haven't seen a doctor, a clinician, a dentist in 20 years, or they piecemealed their dentistry for a long time. What's incentivized them, what's their motivation to say yes now compared to before, or to make that call or to move forward? Right, maintaining that momentum for them and giving them the confidence that this is the right decision, especially when it's a long decision when it comes to the financial obligation. Keeping that momentum going is critically important and that's really one of the finite changes.
Speaker 1:Just recently, the last six, eight weeks, two, three months, with specific clients of mine that I've been working with. That, I think, is going to be more indicative of the marketplace. I think it's more of a hangover of the finance charges and what the APRs look like and what the total costs are and things of that nature For those that can slap down $30,000, $40,000, $50,000, god bless you, because I don't know that's not most people especially for this type of treatment. When you look at 34 million Americans that have 14 teeth or more missing, and as we expand more and more into being able to service these types of individuals and give them the functionality to eat and chew again at 90% functionality of their second set of teeth right First set of teeth are the baby teeth. That come in second set of teeth are your adult teeth. We're giving them a third set of teeth. To give that 90% functionality again is amazing and to be able to meet them where they're at. So that's specific of kind of the changing dynamic that we're seeing in clinic with clients. That is pretty poignant and for those that might be listening and hearing that, something that this is the nugget to take away Look at your follow-up cadence after they've said yes and are your treatment coordinators?
Speaker 1:Is your team, are members on your team getting those touch points to maintain the momentum and the motivation with patients all the way up to and through surgery and even after. But once the surgery happens, then it's a lot of aftercare that happens and they're committed. At that point, right, it's like the chicken and the pig when it comes to ham and eggs. Right, the chicken was committed, but the pig's all in. Right, you want to take a swipe out of them, but they're there. Right, there's no going back. So that's one of the big pieces for my clients and what we're seeing in changing patient dynamic fairly recently that we're working on to be able to level up our ability to patient experience better, to service clients better and to really be a better asset to clinicians and groups.
Speaker 2:Yeah, so then, what does this mean? What are you seeing with DSOs right now and how do you think this is affecting the overall market? And I would touch on it a little bit, but I'd like to go into a little bit more detail.
Speaker 1:Yeah, so with DSOs it really depends on their model. So some that are full-arch clinic models, right. So if you look at, like I mentioned right, Clear Choice and Independence and Nuvia, that are the full-arch clinics, if you will, and others the DSO models, where they're adding full-arch into their treatment modality. They may have multi-specialty, where the specialist will come in and actually do the treatment therapy or they'll send it to their specialist With those types of opportunities, not the first model.
Speaker 1:The first model is pretty straightforward and similar. They're doing direct-to-consumer. A lot of what I've already shared is specific to them, right, so it's gathering patients and it's direct-to-consumer and all of the other fits into that model. The second model, though, where it's more of the internal referral network and it's the team models that the teaching and coaching and training. You can have the best sales playbook and I've been asked to do and I've been contracted to do and our team has done sales playbooks for a number of whether they're emerging or even a large one.
Speaker 1:It's the implementation side, it's how well are they implementing those pieces that they're given and the follow-through on the teaching, coaching and training aspects, because there is there's turnover, but it's also on how specific are they following up with all of the touch points in it, because they're busy, right, and there's a lot of other pieces and I don't want to call them distraction, but I've been saying it's a large circle, everything that's not fixed full up to distraction.
Speaker 1:There's a lot that they have to learn and so, understanding what is this differentiation? How are we dealing with these patients that are big cases Because they do significantly impact revenue, top line productivity, production, profitability, and how are they being integrated and treated as they should be with the white glove service and are we differentiating them? Do you have a project manager that actually handles those cases within a group, within your system of a cluster of five or six or as a whole? And how are they being tracked? So what's the workflow and what's the monitoring and tracking of those? So those are some of the most important pieces that a number of the DSOs are figuring out and those that have are being much more successful, and those are the systems that we're helping a number of them put in place in order to be more successful in executing on full-arch therapy for their patient flow internally.
Speaker 2:I love it as we get close to our time. Is there anything that you want to talk about that we didn't get a chance to talk about?
Speaker 1:Yeah, I want to just go back to a point that you mentioned, right, it's that this is full-arch. Fixed full-arch is not something that you dabble in, but it also is something that can be extremely rewarding and with patients I've mentioned it before it's all about their motivation. The product is all well and good, don't get me wrong, but in fixed full-arch it's not so much about the product, it's about the motivation for the patient, the why now, why is this the time for you to move forward with the? Yes, the easy ones are I'm going on a cruise with my husband, my daughter's getting married and the pictures are forever. I want to fill in the blank. Right, those are the easy ones.
Speaker 1:But whatever the motivation is for the patient, I would ask any of the clinicians, any of the groups, any of the fill in the blank, what is your motivation to getting into Fixed Full Large? Is it the money and it's okay if it's the money, right, doing it profitably is great. Is it that emotional connection that patient revealed that I talked about? Is it that you just need a really good challenge? Right? You want to take things to the next level because you work, whatever it is, understanding what your why? Is what your motivation for wanting to do it, if you're adding it or to do it better, that's going to affect your entire team or your entire group, and identifying that is going to be critically important to being more successful faster, because that really becomes your motivation for the entire project and so the entire course of action.
Speaker 1:And that comes through when it comes to the patient experience, because ultimately, it's the patient experience that's going to matter most, because they become your best referrals, because you don't have to pay for that marketing. When they go back to their school, work, church, synagogue and they have this brand new smile when they were ashamed to smile at the floor and suddenly they've got this brand new smile and they say, wow, that's amazing. And they say, you know what? Yes, and I had it done at ABC Dental. And they're amazing because it might not be the person that they're talking to that could use this type of treatment therapy, but they might have a neighbor, a sister, an uncle or a mother who could use it and that referral is worth everything. That's what's going to add to your success and that's really what it's all about to do it successfully?
Speaker 2:Yeah, so anybody wants to reach out and learn more. What's a good resource for that?
Speaker 1:Yeah, the best way is to find me on socials. Greg Essenmacher, if you can't spell it, that's okay. You can reach out to me on my cell phone, 602-743-5262, or just google gna, the letters g, n, a, console, and it'll come up and you can learn more about what we do and reach out for a discovery call. We'll be happy to have a conversation of where you're at and where you want to go love it man yeah, thanks so much. Yeah, appreciate the time. Thanks so much, austin.