The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 95

Dr. Ingrid Murra, CEO & Founder and Mike Margolis, Chief of Staff, from Two Front join the Group Dentistry Now Show.

Find out more about Two Front here – https://www.mytwofront.com/
Partner with Two Front here – https://www.mytwofront.com/partner

On this podcast we cover:

* How to make money on your clear aligner patients (most dentists don’t)
* The future of clear aligners
* How to compete / standout with your patients when everyone is offering clear aligners
* Do you really need an orthodontist for high quality Invisalign care?

If you like our podcast, please give us a ⭐⭐⭐⭐⭐ review on iTunes http://apple.co/2Nejsfa and a Thumbs Up on YouTube.

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 North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Bill Neumann:
Hey everyone. Welcome back to The Group Dentistry Now Show. I’m your host bill Newman. Thanks again for listening in or watching us on YouTube. We always appreciate it and always excited to have innovative companies on the show. And we actually have two individuals from really cool orthodontic platform here and it’s called Two Front.

Bill Neumann:
So I love the name and really, really interested in diving into this because I don’t think anybody else right now is doing anything like this. So let’s talk to the founder and also the chief of staff here. So, we have Dr. Ingrid Murra. She is a Harvard trained orthodontist and of course the founder and CEO of Two Front. So Ingrid, welcome to the group dentistry. Now show. Thanks for being here.

Dr. Ingrid Murra:
Thank you for having us. We’re so excited to be on your show.

Bill Neumann:
Yeah, this is going to be a lot of fun. I love technology. This is pretty cool stuff. So we have Mike Margolis, who is the chief of staff at Two Front and he has some experience with operations and finance, and he’s been in some really cool tech companies. [inaudible 00:03:39] that was acquired recently by DoorDash and a couple of others. So Mike, welcome.

Mike Margolis:
Thank you again. Appreciate it. This is going to be a lot of fun.

Bill Neumann:
Yeah. So Ingrid, if you don’t mind, give us some of your background. I talked a little bit about you’re a Harvard trained orthodontist, but just paint a little bit of a picture here. And then Mike, I’d love you to do the same on your bios and then we can talk about the company.

Dr. Ingrid Murra:
Yeah. So I’m an orthodontist, like you said. I spent 20 years of my life becoming an orthodontist. Decided I was going to become one when I was eight. I had my own just totally life transforming experience after four years of braces and just became obsessed with orthodontics as an industry.

Dr. Ingrid Murra:
I then started a residency in 2015 when the first mail order liner company launched. And I learned very, very quickly that the market was just going up and to the right for the demand. People who want to straighten their teeth now that you can straighten your teeth easily with plastic instead of metal, less embarrassing.

Dr. Ingrid Murra:
But I realized in residency that it takes a lot to get high quality care. It’s very much not the industrial revolution, what people were thinking of just straightening your teeth in the mail, hence all the latest lawsuits. And so I realized there had to be a new way to connect dental offices to orthodontists, to basically match the supply and the demands because at the same time, orthodontists have quickly become the number one most in-depth specialty in the country.

Dr. Ingrid Murra:
Of the top 50 professionals in the country, they have between half a million to a million dollars in the student debt. And so they have to have a new way of operating where they’re not running a traditional business.

Bill Neumann:
So thanks Ingrid. Mike a little bit on your background and why you joined Two Front.

Mike Margolis:
Yeah, sure. So the second part’s easy. So I’ll start with the background quickly, which is, I’ve been in startups now for almost 15 years. I’ve been in various different startups, different areas of technology, hospitality. I’ve done cannabis, I’ve done a bunch of different things. Like you mentioned, we were fortunate enough to have an exit with our last company to DoorDash.

Mike Margolis:
And when I was searching for what’s next, it was pretty easy. I met Ingrid and I was fortunate enough to meet her in person. And she explained to me the problem. I was fortunate enough to know some people in the dentist and orthodontic world. And I sort of called them.

Mike Margolis:
I said, “Hey, what do you think about this? What kind of questions should we be asking? What should we be solving for?” And the second I got to bounce everything off of Ingrid and talk to her, the problem was there and the solution that was already being built at Two Front was in my estimation, a really good fit for the market and the void that she has worked so hard to help find. And so obviously you can also hear her energy and how much she loves this industry. So it was a pretty easy decision for me from there.

Bill Neumann:
Yeah. She definitely is energetic about what she’s doing and passionate about it, which makes a lot of sense. And I believe it was Jeremy [Krell 00:06:52] from Revere who introduced us initially. And Jeremy has a way of finding these new, innovative dental companies that are out there. So he put us together and that’s why you’re on the podcast now. Talk to me a little bit-

Dr. Ingrid Murra:
[inaudible 00:07:09] Jeremy.

Bill Neumann:
Yeah. Jeremy seems to be a great connector. And then right after he connected us, I think I saw that you had some funding initially as 3.5 million from Craft Ventures. That was pretty recent. So let’s talk about that and then talk about Two Front. Now, what’s this platform? What does it do? How does it work?

Dr. Ingrid Murra:
Yeah, so the funding, that’s actually how I met Mike is because we have the same investors, Craft Ventures, and we’re very lucky. Our investors, they specialize in vertically integrated marketplaces, which is basically it’s a fancy word of trying just to say giving small businesses tools to run more efficient businesses.

Dr. Ingrid Murra:
So Mike’s prior industries were hospitality and cannabis. It’s the same kind of concepts that we apply here to dentistry. So basically it’s orthodontics in a box for general dentists. And so what we do is we match orthodontists with local dental offices and we help them run the most efficient Invisalign practice in the world.

Dr. Ingrid Murra:
So we basically figured out there’s two parts of it. There’s the acquisition piece, which is very hard because patients are more inundated with ads than ever before.

Dr. Ingrid Murra:
More SmileDirect Club ads, more Invisalign ads. Now there’s InBrace. So people have so many options when it comes to straining their teeth. And so we really help to get in front of every single patient at a dental office and really educate them in a very easy consumerized approach.

Dr. Ingrid Murra:
Why do you need an orthodontist? What are your options? How much should you be paying? How long is the process going to take? It’s such a black box of how it works. And we really specialize in communicating those needs to the patients.

Dr. Ingrid Murra:
And then we help orthodontists run the whole practice from 20 local dental offices. So one orthodontist, they only have to go in once a month. So what we’re doing is we’re basically giving them a system where they can manage their schedules from all of their offices.

Dr. Ingrid Murra:
And we basically give them communication tools where their patients can actually communicate with them directly. So their patients only have to come in 80% less than the traditional Invisalign visits. And we help them run everything from efficient aligner tracking and [inaudible 00:09:26] check management to efficient communication.

Dr. Ingrid Murra:
We pay all the lab bills, we pay the iTero. We take care of all the costs so that it’s completely free to dentists and orthodontists. And basically, it’s the most efficient way to operate together. So for a DSO who has five practices, and their average DSO is treating one Invisalign patient per month, we go in and we can 5 to 10 times that. How? Because we’re getting in front of every single patient and we’re educating a demand that already exists.

Bill Neumann:
Mike, talk a little bit about your role at Two Front. What are you doing there?

Mike Margolis:
That’s a great question. So my job is obviously to support Ingrid in any way, shape or form that I can. Obviously the life of a CEO is quite exhausting and she’s got a lot going on. So I would say my central job is to take what’s in her brain as the industry expert, as the person whose idea this company is turned into and translate that into deliverables, action items to the team, and making sure that we’re delivering all the things that she was just speaking about.

Mike Margolis:
We need to make sure that we’ve got top tier patient care. We need to make sure that we’re converting, like Ingrid said 5, 10 times the amount, the patients per office per month for Invisalign. And so we need to deliver on those tools. We need to deliver on the customer service and the patient experience.

Mike Margolis:
And so that’s really primarily what I’m focused around is taking what’s in her brain and how to accomplish those things and bringing them to the team. And we have a really, really fantastic team here and helping them execute on all of those from a day to day basis.

Bill Neumann:
Thanks, Mike. Yeah. So how do you accomplish 5 to 10 times, the conversion? So that’s the big question because who wouldn’t want that? For sure. So I’d love to talk a little bit about that. Let’s talk about that. And how do you make money from your clear aligner patients?

Bill Neumann:
Because the market is educated somewhat. There’s the awareness that clear aligners exist, but maybe they don’t necessarily know what they need or which one to choose from or whether they qualify or not. So there’s that education process a little bit, but let’s talk about the money and then how does Two Front really kind of multiply the opportunity?

Dr. Ingrid Murra:
Yeah, totally. So when you’re in an industry where tech companies have taken over and kind of advertised to the world, hey, you don’t need orthodontist anymore. You don’t have to pay more than 80 bucks a month. You don’t even have to come into the dentist. You don’t have to do anything. It’s that easy. It makes it a lot harder for the average consumer to make a decision.

Dr. Ingrid Murra:
And so what we’ve done is we basically, we put every patient into a marketing funnel. If 80% of patients can actually benefit from straightening their teeth, either for cosmetic or for medical reasons, because if they don’t fix that crowding, they’re going to get recession or if they don’t fix their bite problem, they’re going to crack their tooth in either crown, then it makes sense to get in front of every single patient, educate them on their teeth and help them make a decision on whether or not they want to straighten their teeth.

Dr. Ingrid Murra:
But it’s a whole funnel. The typical consultation for orthodontics I think has to be so deconstructed and that’s what we’ve done. No one wants to come in, meet an orthodontist, have a traditional experience when they see these sexy ads for candid all over subway stations and buses.

Dr. Ingrid Murra:
And they’re like, “Oh, why would I do this old school thing apply, with this old school financing, have this old school experience?” But in reality, most people know nowadays, if you Google this stuff, people are like, “Oh, okay. Maybe I shouldn’t be straightening my teeth in the mail. There’s lawsuits against all these companies, with the state of California, the state of Texas.”

Dr. Ingrid Murra:
Everyone saw the COVID article in the New York times about how mail order aligner companies make patients sign NDAs. But that said, people don’t want that old school experience. So we’ve really deconstructed the consultation and given patients more of what they want by making it consumerized, making it digital, giving them the kinds of payment plans that patients are looking for.

Dr. Ingrid Murra:
Like 36 months interest free, no down payments. We can offer that through our partnership with the firm. Having everything in one digital platform, being able to make a decision on your own time. So part of what we do when we partner with an office is we send treatment coordinators to the dental offices in a different day than when the orthodontist is actually there.

Dr. Ingrid Murra:
So we have a non-doctor scan day. And so every patient, and we can flex however many we need, depending on how many patients are at that office. But basically we give the ability for patients to come in and get a free 3D scan as the second step after awareness so that they could actually then get a free treatment plan by an orthodontist in their inbox, completely separate from having to come in for a traditional consultation.

Dr. Ingrid Murra:
So I think that’s step one. And then your question around how DSOs make money. I think we all know that especially during a recession, cash flow is king. Running an Invisalign practice is really expensive. Everything from starting with the lab bill, if you’re offering your patients good financing, that can be a 10 to 15% hit to if you’re offering your patients chewies and the vPro, and some sort of virtual monitoring care kit, which can be a couple hundred dollars, then you’re charging on average $5,000 to $6,000 because that’s what the market charges.

Dr. Ingrid Murra:
Then insurance is a factor. And at the end of the day, you actually don’t end up netting much money. If anything, you end up losing money, especially as a general dentist or as a DSO owner because you have so many costs, including the cost of your doctor or your staff and your admin that actually goes into all the continuity of customer service care that happens with an Invisalign patient.

Dr. Ingrid Murra:
And so we’re part of the Invisalign special markets program, which means that we get access to some good data around how much time people are spending. And we have learned that the average dentist spends six hours per Invisalign patient, which is a lot longer than people think because they don’t take into account all the time it takes to actually take down the chair, break down the chair, put it together, all the claims management customer service, clean checks and refinements. And after six hours, you’re not really making much money.

Mike Margolis:
Just to sort of add to that, really a lot of the way to increase conversion is just doing a lot of the grueling work of talking to the patients, hearing their concerns, making sure that we are treating for their concerns and that’s done through top tier care.

Mike Margolis:
So one piece is helping the offices create awareness just generally with their patient population. But more importantly, number two is just creating a really excellent patient experience both before they decide to get treated with Invisalign and afterwards as well, making sure that we have a trained orthodontist helping them throughout the entire process. So that’s really what it boils down to.

Bill Neumann:
Love to get some feedback on this question here. It seems like every practice out there, every DSO, every emerging group is offering clear aligners. So how does one stand out in a very crowded market? And of course you touched on you need to make money too, which it’s tough.

Bill Neumann:
But from a marketing perspective, if somebody’s looking and they maybe don’t have a dentist that they go to regularly, and this could be an opportunity for them to get in through Invisalign, through clear aligner treatment, how do you do that? How do you stand out?

Dr. Ingrid Murra:
Yeah. So really, really good question. And I think this is a question that most dental offices struggle with across the country because the problem is everyone around you is offering it. So the system that has Invisalign has come up with is the gold tier or diamond or diamond plus, which kind of helps you stand out.

Dr. Ingrid Murra:
But at the end of the day, what ends up happening is you’re having to out compete on price. And these people just go lower and lower and lower and they actually end up just losing money, especially considering they’re pretty much just covering the lab bill, and then they are seeing the patients so many more times than they’re used to.

Dr. Ingrid Murra:
And so in terms of how to stand out, I think it’s really kind of what Mike is saying with just the patient experience. People are wearing aligners 22 hours a day for six months to a year. That’s a long time to commit to something and delivering a really good experience is key.

Dr. Ingrid Murra:
And so when we partner with offices, we talk about Two Front powered Invisalign treatment and what that actually means, and kind of market that to the patients, which I think really, really helps to kind of demonstrate the value that you add on top of just the Invisalign treatment.

Bill Neumann:
That’s good to know. Mike did you have anything to add to that?

Mike Margolis:
No. Once again, it comes down to doing the work and that’s around the patient experience and making sure that we’re there and we’re guiding them and that’s what sets a lot of these offices apart that we work with and they talk about is just making sure that their patient has a question that gets answered and it gets answered intelligently with good information. So a lot of people shop around, a lot of patients are interested in different services, but if they know that this is obviously a large purchase that they’re going to get a good experience throughout, that’s generally how our offices like to separate themselves.

Bill Neumann:
Ingrid, you mentioned earlier that you have a lot of really great data on the market and what’s going on. Anything out there that you see that’s interesting that maybe a DSO or an emerging group would want to hear about as far as patients and clear aligners, some trends that you might have some insight into?

Dr. Ingrid Murra:
Yeah. Just how big the market opportunity is. It’s a $250 billion market in the United States alone. It’s a $950 billion market globally. There’s 96,000 Invisalign providers in the world. The average office treats one patient per month, but they’re seeing 200 to 400 patients a month. That is a massive under penetration. You should be getting in front of each and every patient.

Dr. Ingrid Murra:
Invisalign is the most self referred procedure in a dental office. No one’s coming in and saying, “I want a root canal.” Everyone’s coming in and saying, “I want to straighten my teeth.” So serve that demand by giving them what they’re looking for and differentiate yourself. And we really help you make money because the costs are just, even for us as a startup, we look at our Invisalign costs, we look at our virtual care costs, our claims management costs, kind of everything that goes into running an Invisalign practice.

Dr. Ingrid Murra:
And then we map out all the workflows of what goes into running a really good practice and a really good patient experience. And we’re like, how is anyone doing this on their own? If you’re also doing general dentistry and you’re also doing oral surgery or whatever it is that you’re doing, it’s just such a full time job to give your patients a good experience. And so if you can outsource it and really guarantee that experience and not pay any money, why wouldn’t you do it?

Mike Margolis:
Bill, I know this is sort of the antithesis of your question, but just as an example, I was fortunate enough to get married about a year ago and before our wedding, my wife said that she wanted to have Invisalign. She wanted to have some straightened teeth before our wedding.

Mike Margolis:
So about a year and a half before the wedding, she went to our dentist who was a fairly modern dentist. They actually have multiple offices. And she said to them, “I would like Invisalign. I would like to straighten my teeth. It’s something that I think would really enhance my overall experience.” And they did what a lot of offices do, which is they handed her sheet of paper with handwritten three different offices that can help treat her for Invisalign in the area, all orthodontist office.

Mike Margolis:
Two of them were closed for good and one didn’t ever call her back. And so that seems to be obviously that’s a microcosm and that’s a small story. That seems to be a fairly typical experience for those that aren’t treating in the offices themselves. And I’ve heard that from plenty of people that I know, and that’s what we’re trying to get away from. It’s crazy that in 2022, or at that time 2020 or 2021, that was even an option. And that’s part of what we’re trying to solve.

Bill Neumann:
So this is a question that I’m probably get myself in trouble with. Although fortunately I have an orthodontist here, so I guess maybe preaching to choir a little bit, but do you really need an orthodontist for high quality Invisalign care? That’s maybe a loaded question, but it’s a question that come, comes up quite a bit and Ingrid, what are your thoughts around this?

Dr. Ingrid Murra:
So the answer is 100% yes. I didn’t realize that until I was residency obviously. When I was in dental school, I was like, “But I see dentists doing Invisalign. So maybe actually, you don’t need an orthodontist anymore. Maybe there is AI that’s stringing teeth.”

Dr. Ingrid Murra:
It’s absolutely not the case. Half the practices that we partner with are dentists who used to offer Invisalign. And they say they’ve offered it for 5 years, 10 years, whatever. And they basically are like, “It’s just not worth the headaches because you don’t get the results that you want.” And the reason why is just to get the results that you want, you really need to know what’s called biomechanics.

Dr. Ingrid Murra:
Biomechanics is the foundation of how to move teeth. Before you move teeth with plastic or aligners or with metal or with braces, the foundation of how to move teeth is still the same.

Dr. Ingrid Murra:
There’s no AI that changes that. You have to know what position you’re moving the teeth into. You have to know which attachments to use. You have to know if you’re moving your teeth in this direction, here’s how I have to compensate because every action has an equal and opposite reaction.

Dr. Ingrid Murra:
And those are the things that general dentists don’t learn. And so what ends up happening is dentists are like, “Oh, this is an easy case. It’s a little bit of crowding. I’m going to move the teeth,” but then it’s opened up the bite in the back end, or then it’s uncovered an underbite or something happens and it’s created unnecessary stress for the dentist.

Dr. Ingrid Murra:
And you’re not making money because there’s so many appointments that are required to continue to kind of fix that patient. And so I get why dentists do it. It seems easy. And you also just don’t know what you don’t know. And then by the time you get into it, there’s a reason why most people start slowing down.

Dr. Ingrid Murra:
Now, of course, there’s always a dentist that is going to specialize in Invisalign. If you’re going to dedicate all of your time to learning biomechanics, of course you can become an orthodontist and basically become a specialist in Invisalign and become good at it. But I would say for 99% of dentists out there, it’s just better to work with orthodontists.

Bill Neumann:
Makes sense.

Mike Margolis:
This is industry expertise I was referring to earlier. This was frankly all new to me too. So I find it quite fascinating. And I learn things like this every day.

Bill Neumann:
Let’s talk a little bit about the future of clear aligners and orthodontics in general. What do you see Ingrid, as far as how things progress? Obviously, Two Front’s going to be part of that, but what are your thoughts on the future? And, and maybe we can even tie in some of this economic pressure that we’re starting to see already. Is that going to affect things?

Dr. Ingrid Murra:
Yeah. There’s a little bit of a recession during COVID and during COVID the Invisalign market cap doubled from 25 to 50 billion. So it’s like these Zoom calls and it kind of just shows like people between social media and Zoom calls and people just having more time and wanting to invest in more self care, it’s not going anywhere. Moving teeth is recession proof.

Dr. Ingrid Murra:
We saw that in 2008. So the demand’s not going anywhere, especially if you could offer patients these great financing plans, whether they can pay a hundred and something dollars a month without affecting their credit. And that’s kind of what we specialize in is making sure that we can always convert patients because we’re giving them the best financing options and we’re always kind of trying to refine that.

Dr. Ingrid Murra:
So I think the future involves dentists and orthodontists working together. That’s kind of our motto. It’s the future of dental is collaborative. Orthodontists need a new way of operating. Dentists need a way to fulfill their demand. And so we think that by uniting them through this really comprehensive operating system, that’s free to both parties, that offers the best patient experience, that streamlines all costs so that there’s no cost to either party, we think that that’s the future

Bill Neumann:
Collaborative care platform. So makes sense. Well, you can both kind of contribute to this because this is the last question I really have is how do people find out more about two front? They can go to the website which is mytwofront.com, right? So I got that part, but what happens if they want a demo or they want to find out more, how can they contact you?

Dr. Ingrid Murra:
Well, if they’re in Southern California, which is where we’re focusing on expanding right now, they can just reach out to me directly or either way, we’re planning on expanding across the country by the end of next year. For the next few months, we’re just focusing on Southern California so they can reach out on our website, book a demo directly.

Dr. Ingrid Murra:
There’s a button on there to book a demo with me. And if not, they can email me directly ingrid@mytwofront.com. And we’re happy to see if they qualify. Generally we partner with dentists or offices that are seeing at least 20 new patients a month. So typically healthy midsize practices that aren’t startups, since we are filling their current demand.

Bill Neumann:
So DSOs, emerging groups in Southern California would be perfect.

Dr. Ingrid Murra:
That’s exactly right.

Mike Margolis:
Yeah. And once again, the best part is you go to the website, we’re still a young company. So you go to the website, you click book a demo and you get a demo with a CEO. You don’t get with someone like me.

Bill Neumann:
There you go. That’s great. And I know you’ll be going to some of the upcoming DSO meetings. So look for Ingrid and Mike there for sure. What we’ll do is we’ll drop website information, contact info, and the show notes. And this was great conversation. [inaudible 00:28:20] It’s just so great what you all are doing.

Bill Neumann:
And it’s not always easy I think to change some, some habits out there. And I think there’s probably some frustration if you really are a clear aligner provider and you’re only converting one patient a month, but there was a big investment in training and time and marketing. I think a lot of clinicians out there including emerging groups are looking for some assistance and that’s where Two Front comes in.

Dr. Ingrid Murra:
Yep, exactly. We’re happy to help.

Bill Neumann:
Great. Well, thanks everybody for listening in or watching today. Thank you to Mike and Dr. Murra for being on The Group Dentistry Now Show. Like I said, website is mytwofront.com or you can reach out to Ingrid directly. We’ll give you her email address in the show notes and that’s it. Until next time, it’s The Group Dentistry Now Show. Thanks for watching or listening.