The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 37

Ken Cooper, CEO & Co-founder and Dr. Andrew Matta, Chief Medical Officer & Co-founder of North American Dental Group, join the podcast. Topics include their recent partners’ meeting called Imagine, their equity partner Jacobs Holding, creating an international DSO, their growth strategy, and much more. If you want learn how a DSO has evolved over time and is meeting the challenges of today’s unique dental landscape, this podcast is for you!

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

The Group Dentistry Now Show: The Voice of the DSO Industry has listeners across the North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Dr. Andrew Matta:

Our team, it came together like an incredible set of partners that were not navigating the crisis for the organization, but we were able to take our glasses off of our tunnel vision going beyond our organization, and we were leading ourselves, and that was creating leadership for the industry, it was creating leadership beyond the industry.

Dr. Andrew Matta:

That time and space is what we’re navigating today. There’s something that is going beyond time and space that is going on in the world today. And the efforts that we made and where we’ve been positioned as an organization, there’s a duty that we take now, and we’ve always continued to have that aspiration. But now that time is now for us to kind of take this industry on our shoulders and kind of push it ahead in the way a Clydesdale was pulling. That lean in approach is the tomorrow I will.

Dr. Andrew Matta:

That’s the commitment I’m going to ask of everybody, just lean into the change, and ABG is going to be driving change in a positive way. Everybody in here just connect together, it’s going to be uncomfortable, but let’s just lean in. So tomorrow is going to be like nothing we imagined, let’s lean in together, and let’s drive this industry forward, let’s continue to make an ABG best in class.

Ken Cooper:

I’m committed to being a champion for change here within the organization, and I’m asking all of you as partners and leaders to also be committed to this change. Because this once in a lifetime opportunity to really step out there, lean in, and do what we can to be our very best for humanity, for people, for our organization, and then be an example to the industry and drive the industry forward.

Ken Cooper:

Where we’ve been is puny in comparison to what we’re capable of and what we can do. And why do we keep talking about wanting to go back to normal when we’ve just started this journey for exceptional patient care that’s hardly memorable in comparison to what we’re capable of being.

Ken Cooper:

If we take it seriously … And I’ve mentioned ripe and rotting now twice. And what I mean by that is we’re either ripe and rotting, or we’re growing and growing. And as an organization, real simple analogy that a mentor of mine gave me one time, I mean here’s the banana, it’s yellow and turning brown and this thing is about a day away from being thrown out; maybe two at best. And then here’s the green and growing banana. If this was still on a tree, it has a long way to go.

Ken Cooper:

And so I use these props today to just, hopefully, so when you leave and think, “Where are we? Are we ripe and rotting, and are we resisting change and saying, ‘Hey that’s how I did it, it works, let’s don’t challenge it, leave me alone, kind of let me do my thing.”

Ken Cooper:

If you’re saying that a lot, then you’re ripe and rotten. You figured it all out, you know what you’re doing, and there’s nowhere left to go. But if you’re identifying as green and growing, you’re open to change, you’re open to evolution, you recognize you have a ways to go. And I want to always stay green and growing, I don’t want to get ripe and rotten. The minute I figured it all out, and the minute I can tell everybody, “I got this.” That’s a problem. That’s when my leadership ceases to move us forward as an organization and that’s not that’s not where I want to be.

Bill Neumann:

I like to welcome everyone to the Group Dentistry Now Show. I’m Bill Newman, and we’ve got two guests here today I’m proud to have on the show. They’ve had a lot going on, and a lot of news wrapped around their organization in the past year, year and a half with the tremendous growth, and some awards that the CEO has won. So like to welcome Ken Cooper from North American Dental Group and Dr. Andrew Matta. Thanks, gentlemen, for joining me today.

Dr. Andrew Matta:

Glad to be here.

Ken Cooper:

Thank you.

Bill Neumann:

So we’ve got a lot to cover here, and so I’ll just … I think most of our audience probably knows North American Dental Group, and probably knows Dr. Matta and Ken. But just in case you don’t, we’re going to give you a little background on both of these gentlemen, and they’re going to give us a little insight on how they went from one location in 2008, to currently 242, give or take a couple of locations, currently.

Bill Neumann:

So first off, Ken Cooper … And they’re both co founders by the way at North American Dental Group. Ken Cooper is the Chief Executive Officer. His background is in finance and marketing. He co-founded North American with one practice, like I mentioned, in Youngstown, Ohio back in 2008; so only 12 years ago.

Bill Neumann:

As CEO, he is responsible for NADG’s overall day to day business and growth opportunities. He’s been hailed as one of America’s top CEOs for the handling of the COVID-19 pandemic, and we’ll talk about that. That was a recent award he won, so congrats.

Bill Neumann:

The other co-founder is with us, Dr. Andrew Matta. He is the Chief Medical Officer and a practicing dentist. Dr. Matta continues to practice in New Castle, PA; which I think is where he is today. As North American Dental Group’s Chief Medical Officer, he leads the dental advisory board which sets clinical standards for NADG doctors and team members. Dr. Matta also serves on the Pennsylvania State Dental Board.

Bill Neumann:

So I’ll let one of you, or both of you, just give us a little bit of a rundown of the journey, can be the condensed version, from one practice in Youngstown, Ohio in 2008 to 242 in 20 states today.

Ken Cooper:

Andrew you want me to start and you can fill in some blanks along the way?

Dr. Andrew Matta:

Yeah.

Ken Cooper:

So, again, it’s been a tremendous journey, but to your point in 2008, really stepped in and started supporting the first practice, it was actually in Canfield, Ohio which is a suburb of Youngstown, Ohio.

Ken Cooper:

Back then the strategy was very similar to some of our peers, we were looking at single practice affiliation. Within a couple years, had grown up to 12, 15 or so locations. That’s when Andrew and I really formalized our partnership and really had a very clear vision for separating the support services from the clinical side. And Andrew, again, leading all of the clinical initiatives and just being a great partner to all of our providers and doctors, and allowed me to really focus on finding the right new opportunities to grow the business.

Ken Cooper:

And one of our mantras … I think it’s pretty well known at this point is, very culture focused organization. And so as we started scaling the business beyond those first 12, 15 locations, what we learned in those early days was it was really all about the partner or the future partner.

Ken Cooper:

We made some early decisions to not do buyouts, to really focus on affiliations and partnerships, and to help those entrepreneurial doctors, and then eventually groups, empower them to grow under their vision, mission, and purpose in those respective regions and markets.

Ken Cooper:

And so around 2012, we kind of left that single affiliation model although we still do many single affiliations, but we really moved into what is a group affiliation model. So today we sit as the leader in the US of group affiliations; we do more group affiliations than any other DSO.

Ken Cooper:

And what I mean by that is we typically look for a partner with a group founder in a new territory or region where they have successfully scaled their business up to kind of where we started: 10, 15, 20 locations. And rather than have them build that big central infrastructure that we’ve built over the years, we let them plug into that infrastructure and then really become a capital source, and a best practices partner through Andrew on the clinical side, and through us on the administrative side.

Ken Cooper:

And I think in 2012 we did our first group deal with Dr. Al [Choksi 00:08:47] in Toledo, Quarter Dental, I mean, just a great partner, a great human. We’re friends, colleagues, brothers, all of the above, and that really proved out that group affiliation model.

Ken Cooper:

It certainly has its nuances around transitions and integrations is much larger than a single affiliation, so there’s more complexity to that. But from 2012 to now, we’ve done over 30 of those group affiliations, and that was the real catalysts for our growth. So how did we get from one in ’08 to 240+ in 2020 was through empowering those entrepreneurial group founders to do what they do best and grow their market in their respective region.

Ken Cooper:

And I would, Bill, footnote that. Again, we typically or a partner affiliation model; very rarely do we do a buyout where someone’s exiting. These are typically mid-career, entrepreneurial doctors that have a great small mid-sized group, and we really just focus on empowering them to multiply that effort. And, again, the number one thing we look for is culture.

Ken Cooper:

So that’s a bit of our story, there’s a whole bunch of nuances in there around centralization versus de-central, and how we came to those decisions. But, ultimately, we’re a fully centralized support service for these group founders at this point. And Andrew, please feel free to add into that.

Dr. Andrew Matta:

Yeah. No I think you summed it well. And I would just kind of use the word partnership again. The collaboration between the business and the clinical side from our early days, and Ken and I spend a lot of time really establishing those philosophies, and we truly believe that there’s sometimes a tension in healthcare between those two sides of the coin, and we look at it as a partnership.

Dr. Andrew Matta:

And when you can have kind of both exist and support one another to understand and not have a tension or divide, it’s going to create a better patient experience. If you’re supporting the doctors with some of those administrative burdens, but also allowing the doctors to partner together.

Dr. Andrew Matta:

So because we’re partnership model and these doctors bring their practices in, and they’re not exiting, everybody comes together. And we’ll talk about our advisory board, but our doctors partner together really well around the mindset of just standardizing our care, putting best practices, challenging one another to just come up with solutions for the patients, and always trying to update and make those improved day in and day out. So the partnership between the business and then the collaboration among doctors, those are key elements of the company.

Bill Neumann:

Excellent. So can I mention it earlier in your bio, but again congratulations. So you were named one of the best CEOs in America by Glassdoor. And really it was in regards to the way you managed the company during the pandemic which continues on. So let’s talk a little bit about that.

Bill Neumann:

I mean, I want to say that I remember early, early on when you and Dr. Matta really came up with that, the whole idea of essential versus non essential procedures, and we were able to publish that and really kind of help you get that message out there, and what a great resource.

Bill Neumann:

I mean this well before ADA seemed to have wrapped their arms around kind of definitions of what can and can’t be done or just guidance in general. There was just a lot of question marks of, “Should we be open? And if we’re open what can we do?” So, I mean, you were one of these voices out there super early on that said, “Okay, this is what we’re telling our offices and our clinicians to do.” But let’s talk a little bit of it … So again, congratulations let’s talk about why you won the award and really what you did is an organization, and then as a CEO, to provide guidance because nobody could have predicted this.

Ken Cooper:

Yeah, yeah, sure. And lots of unpack in there, but I’ll start with how gratifying it was. Because the award came as a result of the internal team, and their thoughts, and their voice around how it was handled. So that to me, again, is incredibly gratifying.

Ken Cooper:

But I think the key, and I’ve shared this in a couple different interviews since that award came to be was that … And Andrew and I shared this, because we really do act as co-leaders of the business. And so I know he shares the same thoughts, but we happened to be in the seats at the time, The team was really what created this opportunity, he team made all these decisions in what you described earlier.

Ken Cooper:

The group founders in particular, when we realized this was heading our way … And again, we’ll talk about this a little later, but we have a partnership with Coliseum Dental Group in Europe and so they’re sitting up there in eight, nine separate countries. And, obviously, with Italy being ground zero over there, we had a pretty good indication we were getting real time daily feedback from our partners in Europe on how quickly this was progressing.

Ken Cooper:

So we definitely had some insights and access to data and intel earlier than probably some of our peers here in the U.S. So it allowed us to be more nimble and act quicker and knowing that the concept was and the thesis was, we would probably experience similar if not greater impact that they had in Europe.

Ken Cooper:

But digress a little bit going back to the core question, what I tried to do during that time was to be overly transparent, communicate at a very high level. And one thing I always talk about, both internally and externally, is just be vulnerable about it, just share my soul with the organization, “How do I really feel, how am I processing this? What does this mean for me and my family?” And how can I relate and empathize with what I knew our entire team was going through?

Ken Cooper:

Again, that I think is what most people respond well to is they want to know that any leader, or one of the leaders in the organization, any of the leaders in the organization have an understanding of just the humanity of the crisis and how it’s affecting families and in people in general.

Ken Cooper:

And so I just tried to be myself, be genuine about it, and share my thoughts, my honest open, transparent thoughts. Even if that meant saying, “I don’t know. I don’t know what’s coming, I don’t know the next step but we will communicate as soon as we do know.” And I think that made a big difference. And Andrew did the same exact thing from a clinical lens. As I was doing that from a support lens, he was doing that from a clinical lens.

Ken Cooper:

And I think when it really accelerated and we were able to put our culture at work was, we believe in pay it forward at NADG, we feel we’ve been incredibly blessed with the growth of this organization, the partnerships we’ve forged. And so Andrew and I have always said, “Let’s be more of an open source company and not just internally for our partners that join us, but for our peers at [DEO 00:15:48], ADSO, the dental industry itself.”

Ken Cooper:

And so what all I did was say, “Andrew you’ve got this amazing group of doctors, a ton of industry thought leaders on your board, why don’t you guys really sit down and put together your thoughts on what essential/non-essential means, and anything else you can think of that would help the industry right now. Because everyone is in a state of shock, we’re not sure left from right, we’re getting different guidance from the different states. And why don’t you break that down and pull your team together?”

Ken Cooper:

And that’s exactly what they did. They met every day, twice a day for the first two weeks and started crafting and creating all those guidelines. And then we both agreed, “Let’s publish these in an open source way.” So they created the COVID-19 dentalresources.com website, we sent links to obviously your organization and others. We held seminars and webinars of the DEO and other organizations, and just shared it openly.

Ken Cooper:

And again, from a mindset and culture of pay it forward, we all want to help drive this industry forward. We think it’s ripe for positive disruption, and this was one of the steps that we took. And I will, again, give all the credit to A) the team and B) our group founders, and Andrew, and the doctors for just really igniting that and putting that out there; I think it was much needed.

Ken Cooper:

And anecdotally and kind of on the funny side, I’ll never forget this it was probably late March and Andrew forwarded me an email one of his friends in the industry had forward him our essential/ non-essential guidelines and said, “Hey, you might want to check this out. I found this on the ACA website.” And we had a good chuckle out of that because it was kind of neat how it made its way, within two or three weeks, all the way back to our organization as a recommended guideline, and so I’ll stop there. I could talk the whole time on this one, Bill, but big, big credit to the doctors and the partners.

Bill Neumann:

Yeah, Ken, that’s a great story. Andrew is there anything you wanted to add to that?

Dr. Andrew Matta:

Yeah, I think it was just like Ken said. I mean, the collaboration was already a part of our structure. Our doctor community, we have the professional dental alliance and that’s where we put together, again, the philosophies on how we go about any guidelines that we put for how we’re going to set best practices and different things in our clinical realm.

Dr. Andrew Matta:

So we were already used to working together, we already had teams of people. Some that kind of worked on safety recommendations, so it was simply, “Hey, let’s pull together.” Our group founders, these individuals raised their hand were ready to work on the safety team, so we put a task force.

Dr. Andrew Matta:

There was a what we call the war room, and it was … All right there’s all these different task forces that we put together, and a couple times a day we brought everybody together: business, administrative support, operational support, clinical task forces that were working, and we just had a ton of communication.

Dr. Andrew Matta:

And we had the ideas, but then you always need that operational support to kind of framework it. So we were able to say okay, “Our practices are going to answer these questions, if we’re going to go to a central care what does that mean?

Dr. Andrew Matta:

Governor DeWine in Ohio, we have a large footprint there. So when he came out with essential services only and health care kind of still fit into that, it just posed a lot of questions. So it was over the weekend that he created that mandate and by Monday, we wanted to make sure that our officers understood what that meant.

Dr. Andrew Matta:

And then we also made a decision because we saw what was happening in Europe. What was happening in Ohio is inevitable to the rest of our states, so let’s just be a bit more decisive and make it more uniform decisions to take all our practices this direction right out of the gate, and it was great. We had the culture of collaboration and we were able to put things together.

Dr. Andrew Matta:

And then we put in charge for our teams and our doctors, just like Ken said, everybody’s going to have these challenges. I had colleagues reaching out to me, “Hey, what are you doing with this? What are you guys going to … How are you going to navigate it?” So I would share it with them and then that’s when we said, “Let’s make it open source, let’s just make a landing page so that any dental professional can see.” If we’re answering questions they probably have the same questions.

Bill Neumann:

Yeah, well great job guys. And again, congratulations Ken on the award. Let’s talk about … And first off, thank you both for the invite to your partners meeting. It happened recently, it was unfortunately virtual, but it was really, really great to attend.

Bill Neumann:

It had the imagine theme, so John Lennon, little rock and roll there, well produced. So you mentioned it earlier, I think it was you Dr. Matta, where you talked about you kind of looked at … They’re not affiliations or acquisitions, it’s partners. So it’s a partners meeting, you do two of these a year, typically not virtual, but everything’s virtual now. So let’s talk a little bit about why the imagine theme and the meeting.

Ken Cooper:

Yeah, sure. I’ll go ahead and start again. It was pretty clear to us as we went through the first 90 days of the crisis, that it was a tough challenging time and we weren’t alone in that; the entire industry was being affected. But silver linings were really starting to appear, and there were opportunities to look at the business differently.

Ken Cooper:

And one of the things we recognized early was that the crisis was actually going to accelerate certain aspects of the dental industry, and where did we want to be in that learning curve and in that execution curve? So did we want to go back to business as usual, or we just kind of sit and wait for what everybody says going back to normal? Or were we going to use this a catalyst for change internally, and really adopt, and innovate, and pivot, and lean in what Andrew said during the conference, lean into this opportunity?

Ken Cooper:

Because, as much as we all wished it hadn’t happened, and we all were just still sitting here in a bit of shock, the silver linings were everywhere. And so as we got to June in July and we started getting back to some semblance of normalcy within our organization, and even though we still had pockets that we were monitoring closely or that we weren’t quite completely reopened yet, but we were probably 97, 98% open, and patients were coming in and feeling comfortable.

Ken Cooper:

And because of all the work Andrew and the PDA did to establish the safety protocols and high level communication with the team, the team wanted to come back in. We always kept an opt-in/opt-out but, nonetheless, many people opting in and coming back to work.

Ken Cooper:

The whole idea of the meeting was, “Let’s have imagine what the possibilities are. Let’s imagine how we’re going to show up in dental industry 2.0 post COVID. What does this look like for us, what does it mean for us, and what are the challenges we’re going to face?”

Ken Cooper:

And so I actually challenged the organization and the partners during the meeting this year to imagine letting go of the old normal, like let’s stop wishing things would go back to the old normal. Because really was that better or is there an opportunity now to actually improve on patient care, to improve on support services for the doctors providing the patient care? Is there an opportunity here to reimagine ourselves, our business, our leadership, how we show up, how we engage with the patients and what are the opportunities within that re-imagining our business?

Ken Cooper:

And so that was the theme of the meeting, and we typically … Our partner meetings, as you now know, are not focused on numbers and data. They’re focused on inspiration and for our leadership. And our partners are our leaders, they are individual leaders in each office. And so how do we inspire them to really be their best, show up their best, and how did they see themselves in this new frontier of dentistry 2.0 post COVID?

Ken Cooper:

So that was the idea behind it. I think it was well received and we had a lot of work to dom because it was really just the beginning, it was a chance for Andrew and I to talk about, “Hey as a servant leadership team at NADG, here’s some things we’re seeing some of our peers adopt or think about, what we’re thinking about. What is this going to look like?” And then share that vision with the organization.

Ken Cooper:

And, of course, lot of that vision also came from the feedback from those same group founders as we were having those meetings throughout the crisis. So it was just combination of all those ideas, thoughts, theories. And we also look at it as an opportunity, our partner meetings like what’s the social responsibility piece of this? How are we contributing to society, to our communities that we serve?

Ken Cooper:

And even with things happening with the racial unrest in the country, like these partner meetings are an opportunity not just to address COVID/post-COVID, but I mean, what is our plan for diversity? How are we embracing and leaning into all of these things happening in our country and being thought leaders in it, and taking this to the next level to create better future generations?

Ken Cooper:

So that was the idea, and I think we accomplished it. Again we have a lot of work to do now, but we put the bar out there of, “Here’s the bar let’s try to hit that.” And Andrew, please feel free to add to it, I know I put a lot in there, but I wanted to share all that.

Dr. Andrew Matta:

Yeah, I think the spotlight that came up during the pandemic that was evident, especially on the clinical side of the company is dentistry is really fragmented from health care. It was in April when we were going through this wondering, “Okay, if we’re going to go back to normal care, is testing going to be something that is expected for our patients and our team members before we proceed with aerosol generating or whatnot?”

Dr. Andrew Matta:

And I understand that’s still being contemplated in some states and we wanted to prepare for that, incorporate testing, and then scope practice acts and things. I’m on the board so I reviewed Pennsylvania’s [inaudible 00:26:04], talked to the attorneys at the state, “Well we’re not sure if dentists can do a diagnostic test, a pharmacy tech could, but dentist the practice acts were unclear.” So it shed a spotlight on that.

Dr. Andrew Matta:

So we have had this hospitalization on my set. Let’s work together: hospital, teams, health systems. They are work as a community, Cleveland Clinic because we were in Youngstown is something that we’ve been around quite a bit. So as we talked about re-imagining, let’s help oral health care, let’s help dentistry modernize into a workflow and to be able to offer services and such to our patients in a way that is more connected into the health system.

Dr. Andrew Matta:

We’re seeing patients more than they go to any other type of health care provider. That’s an opportunity for us to be more efficient with their care and whatnot. So reimagine just became this opportunity. I mean, we worked really well through the pandemic as an organization and said, “Okay, now what did we learn from it and where do we go from here?”

Dr. Andrew Matta:

So on the social side, like Ken said, we were already developing a diversity inclusion committee for our doctors. There’s a lot of challenges, there’s just disparity between what the population numbers have and what exists in the industry. And so how are we going to be stewards of welcoming parts of the diversity, black and African American practitioners and team members into our offices? What roles can we play? So it just kept coming back to, “Okay, now what, now who can we be?” And that kind of imagined thing just kept coming back.

Dr. Andrew Matta:

So yeah partner meetings are exciting, they’re a place for us to really continue to define who we are and not just kind of what we’re doing. We all know what we’re doing, but who are we going to be as we go about those endeavors?

Bill Neumann:

Right. And back to Ken’s point about since Kim and I were able to attend, you’re right, it’s not about the numbers, it’s more about the culture. And it sounds like the culture in North American is evolving and so kudos to you guys. It was definitely a really fun time. Given it was virtual, it was fun.

Ken Cooper:

Good to hear.

Bill Neumann:

Yeah [crosstalk 00:28:27].

Ken Cooper:

Thanks for making it too, by the way, we appreciate you guys attending.

Bill Neumann:

Yeah, yeah, yeah, you’re welcome. So let’s talk a little bit about … I mean, there was some adverse impact to the practices to North American early on right with the pandemic? So you had to shut practices down or some practices down. Let’s talk through a little bit of that. Just kind of curious what you all did initially. And Dr. Matta, you talked about you were at a point in June or July where you about 97, 98% open. But maybe talk about just how things were shut down, anything having to do with employee communication, those types of things?

Dr. Andrew Matta:

It was, I mean there’s just a whole list of things that we said, “Okay, what do we need to do if we’re going to shut down a practice?” So there’s two sides of it. One is our team members … And we call them team members intentionally, so I’ll kind of start with that.

Dr. Andrew Matta:

We look at our organization as a family, as a community. It was really difficult for us to try to make decisions on … Okay, we made every opportunity to support our team members until it was clear that the government programs, and the assistance packages, and things like that about making a furlough decision, we made that when we finally saw that the aid packages were going to be able to sustain these individuals throughout not being able to work.

Dr. Andrew Matta:

We extended PTO, we gave relief packages, there was a whole donation efforts through our foundation to make sure that any team members that was kind of waiting for a package to come through, or unemployment, or just was kind of in a loophole of challenges for family dynamics. So there was how do we help our team members navigate this on a just a human level and on a support level?

Dr. Andrew Matta:

And then what is that we have to do if we’re going to funnel our patients? And because we’re regional events, because we’re a group affiliation model, and we’re taking the practices that may have 10, or more groups that 10 or 12 practices in one area, we were able to say, “Okay, well we have 10 practices we can funnel all those emergencies and essential treatments to maybe one or two of those practices.”

Dr. Andrew Matta:

So those other practices, what do you need to do with from an OSHA standpoint? How do you kind of close down a practice temporarily? Whether we need to still do sport testing and things like that? So we had to learn and put them all the checklist together which, again, we put on our website things that we were learning and finding out.

Dr. Andrew Matta:

And then reopening a practice. It was one of those that we closed and then, “All right, now we, I think it’s sooner than maybe initially expected in late April, were able to start saying, “Hey, we can start broadening our patients who are coming in.” The amount of essential treatments, we’re getting to the point where those two practices were at capacity, and then kind of ramping back open as many practices as we could through the month of May and June. And then by mid June, really had the majority almost all of our practices reopened.

Dr. Andrew Matta:

And so it was a cycle. It was winding down and almost as soon as we did, wind it back up. We were really intentional about what we would be able to do for our team members through. That having certain team members furloughed and then bringing them back on, retraining them into what the new reality was, all the safety expectations.

Dr. Andrew Matta:

So we did two days of training before our team members were back live and operating at their practices. Of course, PPE there was a whole new world of what was needed for the practice. So sourcing it, and making sure that all our team members had … Of course, there were standards and even one state would have one thing, another one. So we just made sure that ours were above CDC guidelines and any state guidelines, so we just kept it universal at a certain level, and then trained everybody according to that.

Bill Neumann:

Great. So let’s talk positively. We talked about the COVID and you came out of it, so what about business opportunities currently? As we came out of everything and a lot of speculation, some practices might not reopen, there may be some large DSOs that struggle, file for chapter 11; a lot of speculation, a lot I guess doom and gloom, so to speak.

Bill Neumann:

What are you seeing … And we had George Radigan on one of our webinars early on in May, just talking about valuations of practices, kind of setting expectations for solos and groups saying, “This is kind of what we’re looking at.” And what are you seeing as far as docs looking to become partners? Whether it’s a group or whether it’s a strong solo practice that you can actually roll into a local or a group that you already have, an affiliation with a partnership? What do things look like now?

Dr. Andrew Matta:

Yeah, so interesting time. We definitely have seen acceleration again in this area of the industry where singles, smaller mid-size groups recognize how challenging this time was. So I think its opened some eyes to how most of the DSOs have been able to, based on our larger revolving credit facilities, all the things that we had at our discretion, the tools that we had to sustain safely through this, our ability to source PPE, our ability to bring down an organization and bring it back up quickly based on sophistication, the data; all of those things. I think it’s certainly accelerating opportunity for partnership for us.

Dr. Andrew Matta:

We have a very, very active pipeline of opportunities and some of these folks we’ve been talking to for multiple years, some for multiple weeks. But at the end of the day, the number one filter for us is still who they are as an individual, and the culture that they’re bringing in because it’s very important to us.

Dr. Andrew Matta:

So I think we could probably have a record year or two right now. But again, that filter of culture and who are we partnering with and how are they going to show up in the organization is probably the number one limiting factor to how many partnerships we do; so very active in that. So for the right fit, understanding our mission, vision, and purpose here then NADG, if all those things align.

Dr. Andrew Matta:

We’re ready to go and we have been welcoming new partners. I think we just had welcomed three new groups over the last eight weeks; so actively welcoming and partnering with folks right now. I think we’ll probably have our fourth quarter here will be our largest that I can remember; any single quarter we’ve ever had for new partnerships. Again, big focus on that culture piece and who they are as an individual in alignment with our organization is really the limiting factor.

Dr. Andrew Matta:

The other piece of it is because we just had a new partnership with Jacobs in Europe, when you think in terms of outside investment into the industry, maybe organizations that were later hold with outside investors may not be looking to accelerate that growth so much. And whereas we were early hold, we’re brand new with the outcomes, we just celebrated our first year together. Deep resources there, we had wonderful lending base with our senior debt facility.

Dr. Andrew Matta:

All very supportive new partnerships, and so we still have a lot of capital ability to put to work, and the business performed really well. Even through the downturn, we were able to shelter the downside risk, and we were able to stand back up quickly and really post some strong year over year numbers. So as patients have wanted to come back in, as our teams are back in place and feeling safe and protected, quite frankly the amount of patient care being delivered right now is great and we’re very happy. So long winded answer, Bill, but we’re in a great position to accelerate actually our partnerships, assuming it’s the right fit.

Bill Neumann:

Excellent. So we’ll talk a little bit more, you touched on Jacobs. So this a partnership a little over a year. When the news came out, it was big news first transatlantic DSO, what are the implications, what are the benefits?

Bill Neumann:

So Jacobs holding, Swiss-based, and also has ownership in Coliseum Dental. So you touched on it a little bit earlier, you talked about the benefit of Coliseum having some practices in Italy, where Italy was one of the first countries that was hit hard, and so you were able to communicate with them and find out what they were experiencing there. Let’s talk a little bit more about maybe what best practices you’ve learned from Coliseum and what best practices that they’ve kind of pulled away from North America.

Ken Cooper:

Yeah. So first, it’s a great group. The Jacob team themselves, that’s a highly entrepreneurial family, and so that’s more of a family fund versus a typical U.S. based private equity, and so one of their core tenets and core values is entrepreneurship. So it fits really well with our organization because, obviously, we partner with entrepreneurs as well.

Ken Cooper:

And the CDG team, Stefan, my co-CEO over there, and Eddie who is Andrew’s counterpart on the medical side; they’re just wonderful people. And I would say during the early days of the pandemic it was invaluable the amount of data, information, daily calls we could have.

Ken Cooper:

So as we were having our war room here in the U.S. that morning, because they’re six hours ahead, Andrew and I will be on a call with Stefan and Eddie and hearing in real time what they’re doing, how it’s progressing, what the government’s doing, and how they’re approaching it.

Ken Cooper:

So we had about a two or three week window of insight that we were ahead with which is why we were able to act early over here in the U.S. But beyond that, we are designed slightly differently, we’re centralized support, they’re more de-central. So a lot of their leadership is sitting in the country of operation, whereas we have ours more central here in the Pittsburgh market supporting all of the 16 states that we support. And so different approach to the two markets, but a lot of best practice sharing.

Ken Cooper:

And I think one of the things that we’re helping them with is our partnership model. So how to look at these group affiliations through a partnership model versus a buyout model, our path to partnership program for our associate dentists. Andrew and I’ve always said this for almost 10 years now, we have a fundamental belief that every doctor should have the right to become a partner in this organization. And we train on that, and we work towards that, and we help them become … We finance that, we make sure that they can become a partner here.

Ken Cooper:

And so they’re adopting that in Europe, so between kind of our group affiliation model, partnership model there, between our associate path to partnership model, those are kind of the two big areas that we’ve been really helping with.

Ken Cooper:

And then, of course, that’s on this support side what I lead. But on the medical side, what Andrew has done with the professional dental alliance and all of the committees he’s set up: he’s got the compliance committee, the peer review committee. All of the different committees he has, he’s now helping Europe establish all of those same committees over there.

Ken Cooper:

And so it’s been a really wonderful partnership, they’re very open. We do have plans to eventually merge the two organizations. They’re similar, slightly larger size group than we are so I would say, collectively, the two organizations are slightly over $1.1 billion of annual revenue. And we see probably four or five million patients on an annual basis, collectively.

Ken Cooper:

And so it’s a large organization, both groups growing well, and have very clear mission, vision, values and very aligned on those mission, vision, values. So we see a huge opportunity as a first global group. And we think that, again, can be a catalyst for helping the entire industry kind of as we move into integrated oral health care, and not instead of just dentistry where both sides are looking at that integrated model. And Andrew and Eddie are leading that charge, and Stefan and I are just trying to support that effort.

Dr. Andrew Matta:

Yeah, the collaboration has been really good. So like Ken indicated, Dr. [Quell 00:41:11] and I meet regularly. There was a lot [inaudible 00:41:16] how Europe, what they were going through. Right now what’s exciting is while there’s a lot of cultural differences, there’s also a lot of similarities. Oral health is oral health, a patient’s health is a patient’s health.

Dr. Andrew Matta:

And we’re collaborating on creating consistent first examination systems. The first time you see a patient, the digital experience on using [inaudible 00:41:41] scanners. That’s something that we are integrating on kind of both sides and etc., etc. What are information that you bring in to make sure that you’re coming to a diagnosis, etc.?

Dr. Andrew Matta:

So we’re challenging ourselves to look at things like the patient record and how do we become consistent with that? Just the expectations. Even things from how do we measure outcomes if we’re both going through procedures, how can we do it in a consistent way and then determine what is the success or complications that come from that?

Dr. Andrew Matta:

So there’s a lot of really good collaboration occurring, we’re learning on both sides but we’re also really intentional about trying to see how can we create best practices that are the same? Both sides have an academy, we both have a really strong passion for developing young doctors, so there was already that structure.

Dr. Andrew Matta:

We had some mentoring things going on that we’re sharing with them about how we take our doctors through their first 12 months, 24 months. They were doing some things on some more implant type tracks and things like that, so we’re seeing that and adopting that. It’s a lot of good best practice going on.

Bill Neumann:

Good stuff. So, I mean that’s exciting news. So right now it’s Jacob’s holding, so it’s the holding company in North American here, Coliseum over here. And talking together best practices, but there could be in the near future a merger where you become one DSO?

Ken Cooper:

Absolutely. Yeah, both sides would like to see that happen and we are working towards that. And so we do plan to report on a consolidated basis here actually in the near term. I think it’ll definitely be a 2021 initiative.

Ken Cooper:

And, obviously, COVID put a little bit of a wrinkle in the timing of that. So whether it’s mid-year, late-year versus what was going to be earlier, but that is our plan. And we do think that between the standard of care that the clinical side is creating, the ability to measure that standard of care, and our patient experience, focus on patient experience both we have such a large dataset now across such a widespread demographic in nine countries.

Ken Cooper:

It really, again, can be tremendously valuable to the industry in general. And that’s, again, our main goal is how can we help nurture and evolve the industry together. So having this more global view and data coming off this global view in a very standardized environment which is what Andrew and Eddie have been working towards, I think it’s going to be something special for sure.

Bill Neumann:

Oh this will be the big news when it happens; so documented. Lets kind of shift things away from business side for a second, talk a little bit about clinical care. Maybe touch on some of the things that you’ve had to do from an infection control, cleanliness standpoint, making patients feel comfortable. There’s a what you need to do, what you do for the patients that come back in, there’s a little bit of a fear factor with a certain percentage of the population as far as COVID, so touch on that a little bit if you don’t mind.

Dr. Andrew Matta:

Yeah, I mean that’s the number one focus is safety. Making sure that both our patients, but also our team members, our dental hygienists and the dental hygiene community, was really concerned about making sure that the practices that they were seeing patients in were attentive to the safety concerns.

Dr. Andrew Matta:

And there continues to be a lot that’s being learned about aerosol, and how to reduce aerosol, and could create cross contamination. The good news is, is dentistry is really, I think, doing a very good job of the PPE standards that the CDC put in by health care type. And we took that and said, “Okay, let’s make sure we’re always beyond that.” And respirators making sure not just that they have them, but how can we make sure that we’re understanding, “Okay, that creates a fatigue factor.”

Dr. Andrew Matta:

So there’s team member concerns that we had to pay attention to and taking kind of, “All right, let’s creat- … If you need a mask break, how do you do that in a safe way so that you’re by yourself in the break room, etc.?” But make sure that we are safe at all times for our teams, and then making sure that we’re not just safe for our patients, but making sure that they know that we’re safe.

Dr. Andrew Matta:

So we made videos as to all the different aspects of, “Okay, what am I going to expect? I’m going to go to my first appointment, what is that going to feel like?” So posting short 30 second videos, more comprehensive videos if they wanted more detail, email this to every patient ahead of their visit.

Dr. Andrew Matta:

We made sure that we repurposed. We called our patient service center, which is our call center, to not just … It was more inbound in relation to field calls that came in, but made it a lot more outbound to reach out to patients that had their appointments missed to make sure that they came back in, but talked them through, “Here’s what you’ll expect at your visit. We’re going to screen you, we’re going to ask you to stay in your vehicle and allow us to come and take your temperature. We’re going to bring you in and have a certain limit to individuals within the reception area.”

Dr. Andrew Matta:

Make sure that they are not just getting a bib, but a full gallon on for their care. There’s a whole list of things that we go through and make sure that they know this is out of an abundance of caution, and what to expect from.

Dr. Andrew Matta:

Because there was some concerns, “Is this dentistry safe?” Oh well wait there was the World Health Organization put something out like months late and that created a lot of turmoil. So making sure that we responded to it, we are staying close to the facts, the CDC, etc., and just being as proactive and over-communicate on safety, and to our team members too.

Dr. Andrew Matta:

Our team members, they got trained, they got comfortable I think really quickly. So asking them, “Make sure you’re sharing that with our patients, etc.” And I think the country is a little bit fatigued from COVID, they’re getting a little bit tired it. But now that there’s a resurgence going on, it’s a reminder that we can’t let our guard down.

Dr. Andrew Matta:

So there’s a weekly safety message that we put out to our teams, there’s an ongoing landing page for them to stay current with it. But yeah, those are a lot of the things that … It’s a new way to practice. I don’t know if that will shift back; I actually am starting to think that it may not. There might just be these new PPE standards that become the norm. We’ll see what that looks like in six months or so. But for now it’s here, and we need to continue to make sure our safety measures are at the highest level.

Bill Neumann:

Great point about the safety measures. It’s not just having them, but it’s the communication that you have them, and making the patients feel comfortable. And staff, I know there’s there’s some staff fear factor, whether it was hygienist, or assistants, or office managers. Some they held back, didn’t want to come back in, some that may have retired early. So in some cases, you’re training this almost this new generations in dental assistants that maybe were never in a dental office before and so just really interesting dynamics around it.

Bill Neumann:

And I think the communication part almost ties back to your focus on what Ken talked about the culture aspect right? Because communication’s such an important part of the culture in an organization; so good stuff.

Bill Neumann:

I’ve got a couple of last questions for you here. And this something that I almost think was initially … Felt like as an industry, we were getting closer towards this oral systemic connection right? That overall, “Hey, how do we communicate that your oral health is connected to your overall health?”

Bill Neumann:

And we were doing really well and then COVID hits and then it’s like, “Well, we’re not essential.” It’s like, “Wait a second, if it’s connected it should be essential.” So let’s talk a little bit about that and how we kind of fight that.

Ken Cooper:

Andrew all you. I’m going to let you run with that one.

Dr. Andrew Matta:

I mean it’s … I think this actually where the DSOs really did a nice job. The ADSOs, so some of our peers, ourselves, making sure that … We were really the first to kind of come out and say, “Wait a second, we are essential. These mandates don’t make sense of why they’re broadening outside of, or to dentistry.”

Dr. Andrew Matta:

We put out this non-essential guideline, but that was just to answer and create some initial guidance. But the end of the day, it’s really hard to say that any disease should not be addressed. Right? Maybe it’s not at some emergency situation, but the less you handle on the front end, the more that you’re going to burden an emergency room.

Dr. Andrew Matta:

And then, okay now we do realize that COVID actually has high risk in patients with periodontal issues and things like that. So oral healthcare is exactly that, it’s a part of health care. And dentistry, even the name, if focuses on the tooth and things like that. The profession started to really expand to the entire periodontal situation, etc.

Dr. Andrew Matta:

But this one of those things that we can’t talk enough about, and it’s also what kind of reverts back to modernizing oral health care, etc.; that is a huge component of what we’re passionate about. But there was other DSOs that I thought did a great job of hosting webinars, and trainings, and connect with cardiologists, and things to continue the conversation on oral health care and how it really has a direct link to systemic disease from cardiac health to mental health, etc.

Bill Neumann:

Excellent. So any last points? We’ve covered quite a bit here and I appreciate both you, Dr. Matta and Ken, taking some time today with me and in the Group Dentistry Now audience. I’ll let you both have a final word before we sign off.

Ken Cooper:

Yeah, well first thank you, Bill, it’s been our pleasure to be here. I would just say to all the folks listening, have a great fourth quarter, stay vigilant around safety high, communication to your teams.

Ken Cooper:

We are open source organization over here if anybody needs any assistance, help, guidance, any of that please; feel free to reach out. We really do see ourselves as a part of an industry resource and in playing an active role and helping to educate, and help small, emerging mid-sized groups and not for any expectation other than just to be there; we were that size one day too.

Ken Cooper:

Remember that not that long ago, we know the challenges. And so I would just put out there that Andrew, and I, and our entire team we welcome interaction, collaboration, and we just see ourselves as a part of this wonderful, emerging, growing industry of oral health care.

Dr. Andrew Matta:

Yeah. Bill, thank you very much for both attending our partner meeting and getting to know us and really our culture and who about. Group Dentistry Now is a great publication and podcast, and appreciate everything that you are doing to just bring these conversations to life. So thanks for having us.

Bill Neumann:

Yeah, thanks Dr. Matta, and thanks Ken. And yeah, to your point, it’s a great industry, it’s dynamic, it’s ever changing, it’s fun to be a part of it. So we’ll have you on next time once that merger is complete and you’re at 200 and over 40 plus practices in 25 states.

Dr. Andrew Matta:

Right.

Bill Neumann:

All right. Thanks guys. Thanks-

Dr. Andrew Matta:

All right.

Bill Neumann:

Everybody for listening and watching. Until next time, I’m Bill Newman.

Speaker 1:

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