Welcome to the Group Dentistry Now Show, the voice of the DSO industry. Kim Larson and Bill Newman talk to industry leaders about their challenges, successes, and the future of Group Dentistry. Visit groupdentistrynow.com for more DSO analysis, news, and events. Looking for a job or have a job to fill? Visit jointdso.com. We hope you enjoy today's show. Welcome everyone to the Group Dentistry Now Show, I'm Bill Newman, and as always we appreciate you listening in. Maybe you're on Apple's spot of flat fire, Google, or maybe you're watching us on YouTube. We appreciate your support because we couldn't get great guests like the next two guests we have on the show today. Just a little bit of background here. We're going to be talking about medical dental integration, and one of these guests has been on our show, this will not be his third time on our show, and we probably know him, unless you've been living under a rock in the DSO space, his name's Steve Thorne, he is the founder and CEO of what was formerly known as Pacific Dental Services Now, PDS Health, so we're going to dive into that name change which just happened, I think it was about a week ago or so. Yeah, thanks for being here, Steve, good to see you. Good to see you. And of course, since we're talking about medical dental integration, we have a medical doctor on as well, and he's also part of an organization that a company called Midmark, so we have Dr. Tom Sweeterman, Tom is the chief medical officer and vice president of clinical affairs at Midmark, and Midmark works in both the dental space and the medical space, and Tom's really going to give us that medical doctor side of things that we don't always hear when we talk about medical dental integration, so that I think this is going to be a really interesting podcast today. Tom, thanks for being here. Thank you. So topic of passion for me, so this will be exciting. So I think I mentioned, I think most people know who Steve is, but Steve, for the two people that are listening, that don't know who you are, maybe a little bit about your background and a little bit about PDS health. Hi, everybody, thanks for the warm welcome. I am Steve Thorne. I am the founder of what was formerly known as Pacific dental services. We just announced our new rebranding to PDSL last week. We moved our corporate global headquarters here to sunny Las Vegas, Nevada, actually, in Henderson, a suburb of Las Vegas, but I say Las Vegas because everybody knows where that is. And, right, we've reorganized our company around dental medical integration about the fact that oral health has such a major impact on our overall health, and we've been working on this for years, most of you that follow me know that this probably isn't a shock to you because we've been working on it for years, and we are super excited about where we're at. We are super excited about the future. When I think about oral health care, and I also now start thinking more and more about primary care physicians, too, out there and nurse practitioners, we're really coming into the Golden Age for all these practitioners, and it's such an exciting time to be in this space, and looking forward to this conversation. Thanks, Steve. Tom, a little bit about your background and what you do at mid-mark, and maybe for the folks that don't know a little bit about mid-mark. Yeah, I appreciate you having us on the show here. It's fantastic. Yeah, my name is Dr. Tom Sweeter. I'm the Chief Medical Officer and Vice President of Clinical Affairs at mid-mark. As Steve alluded to, we're both the medical market and the dental market. We've been in the medical market slightly longer than the dental market, but we're seeing a lot of interesting parallels into Steve's point. The amount of interest and scientific validity between the oral health and systemic health has been building for nearly a decade now, so I had the pleasure of being in the audience during Steve's grand announcement, and I think I told Steve I was smiling from you to here because as a primary care physician myself, it's high time that we bring these two disciplines together into a form of holistic care, and so with mid-marks understanding of both medical and dental on the ecosystem level, we're really excited about how we might be able to contribute to this visionary lead that Steve is taking. That's Dr. Tom, and for everybody in the audience, you have sat probably on a piece of mid-mark equipment. They make just about every exam table out there, so if you've gone to, hopefully everybody's gone to a primary care physician. You've definitely experienced mid-mark before, and in quite a few operatory designs, cabinetry in the dental space as well, and thank you to mid-mark for sponsoring this podcast. Really relevant topic, and the timing is great. Steve, you've been talking about medical dental integration for a while. This isn't a new thing to Pacific, for sure, or new to you, but you've done the name change, you've done quite a bit, you've had that partnership with Memorial Care, you talked about Henderson, I know you have a practice there, at least one practice that I've been into that is medically dental integrated, so we have, I think if I remember, you'll walk in, and on the right side is pediatric, and dental care, and then to the left side is primary care. This isn't new, but why the name change, and tell us what's going on now, and why are you so excited about this? So thanks, a little history, so I've been studying this area for about 11 years, 12 years now, and just watching the number of studies released, and especially the science that has come out of all sorts of universities all around the world. It just isn't US-based, all around the world, about the connection between oral health and overall health, and the connection has gotten tighter and tighter and tighter, and the things that are happening in our mouth, it doesn't take a rocket scientist to figure out that what goes in here affects the rest of our body, it goes into our mouth, goes into our throat, it goes into our gut, and if you were watching your reels in the last couple of weeks, it goes out the other end too. They just connected oral bacteria to colorectal cancer, and that it's in 50% of colorectal cancer deaths. So the timing is so ripe to bring oral health care providers back into the core primary care health care team. I think you'll hear some more about that from Tom. We are moving that needle, we've been moving that needle, so we have about 20 integrated practices now in Arizona and about it. We intend to have thousands as we continue to scale. The way I think about it, Bill, is almost all Americans, and in most industrialized countries too, they access their care through four main providers, dentists, dentists through physicians, right, MD or DO, nurse practitioners, or a pediatric dentist. I call them the gatekeepers, and from there, 80, 90% of people, that's where they first see their care provider, and then we go out from there to experts in different areas. And so dentists are set up so perfectly to be part of that primary care team, so uniquely set up to be part of that care team. And there's a lot of obstacles, which we'll talk about, but we're busting through them. I don't have all the answers yet, for sure, but we have a lot of answers because we've been out of a long time, but it's an exciting time, and it just makes sense. It's where, you know, I use this term, "O-D-A-O-D-A," "Observe or Ant, Decide Act." And it's actually a military term of how we're, as leaders, where we are supposed to be looking out ahead. We're supposed to be connecting disparate events, we're supposed to be connecting the dots of what's happening in our field or area of interest, in order to stay ahead and stay relevant. And I think that's the key. I really believe that this move to dental medical integration, it's going to take time, but I believe it is going to happen, and it's going to happen for the vast majority of dentists who want to stay relevant, and the vast majority of physician groups that need oral healthcare providers as part of their offering as they continue to move towards value-based care and center-based care, whatever we want to call it. So the timing is great to make this move, and we're doing it. Bill, if I could add a little bit to where Steve was going, I've noticed since the COVID pandemic, where virtually every immunological physician or infectious disease doc was focusing on the basis of disease for this new pathogen, and what we discovered in that round of research is that there's an inflammatory basis for disease that is fairly fundamental to all disorders, or most of the major ones at least. Diabetes, cardiovascular disease, kidney disease, CVA, it's even cognitive disorders like Alzheimer's. So I think the groundswell around the need for the oral cavity to be part of the conversation every single chronic disease management paradigm is because the oral cavity is so incredibly vascular, it creates an enormous amount of inflammation all by itself. So what we're discovering on the medical side is you cannot effectively treat the systemic disorders without the oral healthcare being minded as attentively as everything else, there's a bi-directional model, so the oral healthcare paradigm and inflammatory condition leads to disease, and the disease makes the oral cavity inflammatory situation where there's parodontal disease even worse. So that's basis number one, and then on top of that, in the medical side, we're seeing a huge push, again, where Steve was going around value-based care, and we have to reduce costs and improve outcomes. So the healthcare providers are beginning to realize that their goals and their key performance measures include the necessity of sending that patient to an oral healthcare provider or the oral healthcare provider being a member of the primary care physician team, which I think is where Steve's also going. So all of these forces are aligning, it's not simply a, "Hey, it's time and we got the opportunity to do this," I think as a mandate clinically, as a mandate financially, and I think the industry is ready to go, and there are many, many barriers, but one by one, those are getting checked off. Yeah, and I think we want to certainly talk, we'll talk about some of those barriers as we get further into the podcast later, but let's talk a little bit about how you start with you, Steve. How do we see this evolving? So you started off really, I know it evolved with PDS, at least, from you actually, you being PDS, having those co-located primary care physicians and dentists in one location, then you had that partnership with Memorial Care. How do you see PDS evolving, and then how do you see the industry as a whole? Because you're really, really one of the first movers here. There are a couple of other providers out there, dental providers that are doing this, different ways, but they're still out there, but right now, you're definitely in the minority, for sure. So you've got a real good, you've got some insight as to how you kind of see this taking place, what it may look like. Yeah, there's definitely been some others to your point that have started in this area before us, and we've been helping each other out, working together, for sure. But to your point, we're the first to go make a statement to do this on scale, the skill I'm talking is these thousands with serving tens of millions of people. So there's three things that I think are the most important here. The first one is the mindset of the clinician, and it doesn't matter which clinician, it can be a cardiologist, it can be a general practitioner, it can be the dentist, it can be the hygienist, it can be the oral surgeon, you know, Dr. Schwerman is awesome of this, he gets it. So it's a mindset that I am there to care for this person in the best way I possibly can, and oral help really matters. That's the first thing is that mindset and clinicians are mostly, you know, they're scientists, that's what they do. They've studied science through their whole careers in college and schooling, the four years of schooling, and then if there's specialist beyond that. So they want to based on science, the science is there, that courses left the barn, and now they have to have the mind shift of how they do that. The second step is then is how they use it and integrate it. And that's where a company like Midmark comes in, where we can integrate the systems, now we've integrated with ethics, whether it's on the dental side or the physician side. So the integration of that health record is critical. We've tried it without it, they have to see the same data, and it's not just about interoperability, it is much more than that, it's about charge reconciliation, we can get into that if you want, and what that means. And then lastly, which we're working on, which we are not there yet, is the reimbursement system. That's the reimbursement system takes hold, and physicians are reimbursed properly, and especially dentists are reimbursed for areas that they weren't. I think that's when it's really going to take hold. We work in two systems, dentists are the only healthcare providers that have their own coding system. That has to change. We've got to cross that chasm soon, we're working hard on it, and growing this area, there's just massive demand. So we know how to do this, we know how to scale, and it's not for lack of demand. We're still working through the economic model bill to make sure this all works. Bill, if I could jump in on that last nice beautiful segue on the economic model, where we're seeing a real heightened interest in this is around those who are vertically integrated between the payer systems and the provider systems. And for instance, federally qualified health centers, community health centers, academia, they're very much aware that this clinical science is beyond the possibilities and absolute fact at this point that the two disciplines seem to be brought together. So we're seeing that, and what when the dentists now coming out of the professional schools and the physicians coming out of their professional schools are understanding this co-morbidity of disease pattern, they're coming out knowing this clinical information from from out the gate, which is really powerful. What also we're seeing is the ability for both medicine and dentistry to identify particular biomarkers of disease. A biomarker is really a situation where you detect something in the system of the individual that indicates that there is some pathology going on underneath. And so it could be a simple blood pressure task, it could be an ankle brachio index into different blood pressure variation, it could be a serum level with a certain biomarker. And those are very good early indicators for identifying areas where the patient is suffering from something that they're not aware of symptomatology wise. And to see each point about the perspective, we need dentists and physicians alike to learn from each other. I see that dentists are so much more for down the path when it comes to just a standard preventative care visit where every twice a year, since you're cradle to grave, you're expected and often do go see a dentist or physicians don't get that luxury right now where people sometimes are a little more arbitrary on their visit to the physician. So if we can kind of dual purpose the physician and the dentist around biomarker detection and sharing of that information on the in Steve's case, an epic database, that information sharing gives you a better holistic view and you can then do something on an execution side of the therapeutic management that's proactive for the patient's health. And then you're asked what sort of driving this, one thing that we're seeing on the medical side that is really exciting is is the value based medicine measures are incentivizing earlier detection early interventions on disease states. The firefighter mode of payment models where you go when you're sick and heroic measures get taken to resolve your health issue are given way to a fire prevention mode where we're looking at how can we stop Susie or Joe from developing diabetes. And if you're seeing your dentist and not your physician, why not utilize that resource in the equivalent, equivalent powerful way. And to Steve's last point, I think it's all about workflow. What we've discovered in the medical world, which has gone through this revolution before the dental group is if it doesn't work in the professional workflow at a very elegant, seamless way, whether that's data or the execution of the test or the integration of the behavior modifications, it doesn't happen because it just needs to be an inherently beautiful way to engage with a patient where you're not interrupting your normal, you know, procedural type work. So that's what we tend to try to bring to the equation is understanding what that workflow could be and should be and then design the systems and operations to make that work. So you've got a question that this is a two-parter. So you've got the patients coming in, right, and from a patient perspective, they can either be coming in to see the primary care physician where they could be coming in to see the dentist. And then they're potentially as a referral to, you know, from primary care physicians, dentist to primary care physician. So Steve, what are the dentists at PDS doing? What are they looking for? What are they testing for? Where all of a sudden they go, "Oh, we then need to, in turn, refer to a primary care physician." Yeah, it's a great question. I mean, really simple things like blood pressure. Does every dentist in America take the blood pressure of every patient every single time? And then what do they do when the patient has a blood pressure of 140 over a hundred? Do they actually make that referral of a hypertension patient? In our environment, we're working on getting 200 percent, but they can walk next door and bring them over a nurse practitioner or a physician and have a talk with the patient. We're doing A1C testing constantly throughout our network. I think saliva diagnostics is the next big thing because we don't have to get stuck with a needle, and we can learn so much about a person from their saliva, especially around inflammatory markers and some DNA. So we're doing all of those things, too. And then you can, with a complete family history instead of a traditional medical history that dentists have traditionally been taught in schools, they can definitely go further and learn about any family history of the chronic diseases that Doc was just talking about there. Any chronic inflammatory diseases the dentist should know about, especially when they look in the mouth, and they have red puffy gums, and we know the difference between different inflammation and chronic inflammation. We realize that that patient's mom died at 45 years old of heart disease or had dementia at 60 years old. The dentist can now engage with that patient at a whole other level for the proper referrals. What Doc was saying there, and I don't know if everybody heard it as clear as he and I would both like everybody to hear, is early intervention is the key. The earlier we can intervene in any of these areas, the less or the more we can help people first off, and the less health care costs will be down the road. And people are programmed to go to the dentist a couple times a year whether something is wrong or not. People in the United States are not programmed to go to the primary care physician world whether something is wrong or not. We go there when something only when we think something is wrong generally. That whole paradigm has to change. That's why I say dentists are so perfectly and so uniquely set up, and they can do many more screenings in the chair or in the offices than they already do and help catch things earlier. Let's just talk about Medicare Advantage as an example. Medicare Advantage is paid to help people stay healthier, keep them out of the hospital. That's how they all make it. I think we generally all know how Medicare Advantage works, if not we'll let Doc talk about that. But it's over 50% of seniors in America, and in the next 15 years, we're going to see a 50% increase in seniors in America in the next 15 years. That population is going to explode. Their help for almost all those people is the most important thing. We have such an opportunity in the integrated care model to help them be healthier, help them learn about any areas that might be problematic earlier. Help them in so many different ways breaking down the silos that currently exist. It's the silos out there that are crushing the system, and that's what we're working on together to break down those silos and help people stay healthier, live longer, live stronger. Steve, I'm going to jump in on your Medicare Advantage hook because that's exactly where I wanted to go. I've been studying Medicare Advantage for a decade, but in the last six months it's gone to a whole new level of investigation because I love our government, I don't always give them the credit of proactive thought on the care management thing. I started to see the trends in the Medicare Advantage world. First off, I think 90 plus, I think it's getting close to 95% of all Medicare Advantage plans include some form of dental. It's not adequate for what's required, but it's there. Secondarily, what Medicare Advantage is doing, as Steve was just describing, is they're really proactively incentivizing earlier detection disease to the point where the 50% mark of people under Medicare Advantage plans, in fact, I think it's 51% now, it's 60% of the expenses on CMS. The reason it's a 10% delta is that CMS or federal government is actually putting the cash back into the system for that proactive disease care management concept. It's just time to seeing year visits, complicated hospitalizations, implantable stents and things that could be avoided. I think it's a bit of an every hand on deck kind of scenario, whether it's your neural health provider or a physician, is this proactive management game, I think is upon us. I don't think this is no longer a theoretical scenario. When the largest peer in the world is putting a 10% premium on the reimbursement model to drive this initiative towards value care, it's going to hit everybody. I think the dentist in the DSOs to understand here is that there is an enormously positive economic model involved in this. $0.4 of every dollar or roughly therein goes to oral care in this country. What I'm seeing is that that 4% is the mouse that roared because it can dramatically influence the other 96%, and when you start talking to $2 trillion industry and the 4% can drive value through the whole system, people are going to wake up real quick that this is where the game should be played and will be played. Lastly, I'll say is that there are indicators in the marketplace, and rather they're not everywhere, that these early preventative hands-on behavior-modifying solutions around advanced primary care, as they're calling it, is reducing these long-term costs to a point where it's in the high percentages of reduction of costs of care in a lifetime. The model has been somewhat proven with some of these 10 meds of the world and oak streets. They're showing that they can do this preemptive management to prevent long-term costs. I guess the takeaway from this is the procedural side of the income for our DSOs is always going to be there. It's a requirement. There's procedures involved in the rootplating and scaling for periodontal disease, just as well. But I don't think you dare minimize the advantages that dentists have in driving down the 96 cents of every dollar. There's going to be a heavy reward that comes from that at its time that I think dentists are paying attention to simple things where Steve is going, accurate point of care blood pressure that is usable by both sides of the equation, he would go to able to see some measured diabetes. Those are not complicated things to do with the point of care, and I think they're just going to become major mainstays of every operatory visit. Dr. Tom, so I asked Steve the question about dentists referring to primary care. What about primary care referring to dentists? What do you see? The ultimate, I guess, example that's already on the books is every time I would see a diabetic patient, I would make absolute certainty that they saw their ophthalmologist, their eye doctor, once a year for a retinal screen, because it's again a two-way street. The diabetes induces retinal pathology, which most people realize the diabetes can cause blindness. Secondarily, the retina contains a lot of information about what the diabetes looks like in the human body of the medical patient. I am quite confident that in my career and certainly in my lifetime, we'll see this where doctors who see anybody with a metabolic disorder, which just for the audience who doesn't understand what that means, that's diabetes, heart disease, strokes, vascular disorders, and now increasingly cognitive disorders like Alzheimer's disease and other dementias. I think every one of those patients is going to have to be required to have a good oral exam to do assessments of the oral cavity for like digital hyperplasia, digital retinus to make sure that I'm not fixing the problem on one side and filling the bucket with more problem on the other side of what it comes to be a problem with oral cavity inflammation. It's that fundamental. Other one's strategy, which I think embodies every two stats at you. One is the research shows very clearly that periodontal care, periodontal disease impacts preterm birth by 30%, meaning that if you don't have good oral care, you have about 30% were likely out of having a preterm birth, the number one or two, depending on what state of Medicaid funding goes to preterm infants, the complexities of NICUs and that sort of thing. That's an enormously powerful metric. Number two, the stat I recall is almost a $2,000 delta to a patient with diabetes who is co has also has peridontal disorder and the treatment that peridontal disorders and many studies reduces that span significantly. So the bucket of money that's available to have oral health care providers integrated into the care models of every major systemic disorder, I think is as close to the people think. I'd like to add something to that bill because we do have data on that. They are incredible at referring over. They are much better than the dentists at this point. Physicians have been trained on that as far as how to refer when they're catching a problem or seeing a problem. So they are great and those patients in the dental setting have the best show rate. So if they are referred from the physician or the nurse practitioner, their show rate is much higher. Their willingness to engage in the care they need it's typically peridontal disease to reduce the bacteria load is higher and most not most every dentist out there can measure the bacteria loads of their patients if they chose to most do not today. Many of our docs do but not all of them yet, but we can measure bacteria loads and Dr. Tom was talking about for a preterm low weight births. We know what that bacteria is is typically FN. We can measure that and we can help people out with that, but we've got to get all that moving in the right direction to help that. But I can tell you for sure, physicians, nurse practitioners, once they understand how to do a good oral exam which, frankly, they aren't trained in school, so we have to train them on that, they are incredible referrers over to the dental side to help get the care they need. Can I, I'll jump in there Steve because I was a guest of your announcement that you had one of those setups and for testing your saliva and I did. And I was ignoring a molar issue in my mouth and I got the results back and I think it was less than two hours later I made an appointment to get my oral care managed because it was not where I wanted it to be. And to your point about this simplicity of a biomarker like that, to see physicians or scientists, they love objective data, they like the concept of something that can be done relatively quickly in their point of care. And so, so things like that can really drive an industry because it's a, it's a red yellow green thing where you get a result and it's either red like you've got a problem, you've got to do something about this yellow, let's, let's pay more attention to this or just have ourselves to a little more aggressive management or green is, hey, let's worry about something else. And that's another trend I'm seeing in medicine is the ability for physicians or the requirement of physicians to point to the exact risk profile of that patient in a very specific way in a very sensitive way is really where we need to spend our efforts because you can't afford to send somebody to a diagnostic screening test or a consultant when you, that problem is a very low probability of being a consequence. But things like oral health are so systemically wide in their impact that having a salamory study like that, which was, you know, I think, Steve, designed by the Harvard, the Harvard people and high-end clinical experts, it really drives a sense of, of quick response, therapeutic decision-making, which I think is what the game is all about. On the medical side, to Steve's point, we are better, in many cases, at well-child benefits, that it's a standard fare, two, four, six, nine months, checkups. So what we're seeing in the FQHCs is the implementation of fluoride, varnishes being applied by the primary care team, the pediatric office. It just feels like there's an opportunity where we could align these resources as I think Steve's, I know Steve's doing the PDS health. So it's just, it's just really powerful to see where this is going. I'll give a plug for that and then give back, we're, we're working on the CDC study that most of us cite, it's, it's old now, it's 10 years old. That CDC study said roughly 50 percent of Americans over 30 years old at some form of periodontitis. I think we've all heard that study, right? So I think we should have, in the United States, every 30-year-old has a periodontal check with the right tests. We have the tests available today that's nothing new so they can understand where they're at with their periodontal disease by 30 years old, just like we would with a colonoscopy, just like we would with a mammogram, just like we would with the wild check, so he was talking about four babies. I think it should be standardized in America. Yeah. Now, I'm sorry to take your over your show here, Bill, but I also think care acceptance is a real issue and the dental community is in a DSOs. There's a lot of beliefs and I think it's an unfavorable perhaps, and it's a cosmetic issue or a while I'll lose a tooth or at some point, you know, I'll get this, this situation by mouth, it does not hurt me now, I think the care acceptance for periodontal care and managing, you know, entries of bacteria for, you know, deeper inflammatory conditions like cavities and other restorative requirements. It's a dentist has the patient, I should say, has awareness that this is not just in that small cavity in my mouth of an issue. This is a systemic issue. I think the care acceptance of doing something more substantial and definitive and caring for that is going to go up. So I think, you know, all dentists, DSOs suffer from a care acceptance issue and I think the ability to connect these two will drive a much more cohesive perspective on the patient that this is important, that this, because I always remember sending people to ophthalmology, they would go every single time. And so it because they sense the importance when their primary care docs saying you need to do this. And I think that we should have the same perspective on one of this. That really leads into the next point, which is patient engagement. So how are we educating patients, how are you communicating with them to, you know, explain the importance to get them to the dentist, to get them to the primary care physician. What are you doing, Steve, at a PDS, because this is a bit of a mindset shift for the patient as well as the provider. Yeah. And again, it's a great question. It's been, for us, has been years in the making. So it takes time. It takes a, I got taught by one of my mentors, when you're teaching a new subject, you've got to keep repeating yourself over and over and again until you want to throw up. And once you feel like you want to throw up, no, you just begin the messaging. And so you have to stay on the messaging about the connection. Now we focus on five key areas. We focus on cardiovascular disease early on said dementia, diabetes, preterm, low weight births and cancer. So we're really intense on that area and have gotten that the communications down across our network of a thousand plus offices and four, we're probably about 5,000 providers working today of how they, how they talk to patients to keep it simple so they understand. We also have it on our main website, smallgeneration.com. You guys can all go check it out. It's free. Just go look at all the materials you want and understand the connection. Here's the basic principle bill. The basic principle is patients don't care how much you know until they know how much you care. I'm going to repeat it, patients don't care how much you know until they know how much you care. You can't just come out as an encyclopedia of the former name oral systemic health. We call it the mouth body connection. That doesn't work. We have to demonstrate to them we really care about their overall health. Everybody gets trained so we all understand the link between what's going on in our mouths and those bad bacteria or bone loss and other problems and/or abscesses especially in our mouth and how they can affect our overall health. We have the data now after doing this for years. What Tom was talking about there on patients acceptance levels, it's clear as a bell to me now because we have the data. Definitely better acceptance once we start talking to patients about the connection between the mouth and the body, definitely better case acceptance. Steve, I'd like to add to that it's trust is such a critical part of this whole equation and the beauty of oral health providers and their physicians and PAs is that there still is a tremendous amount of trust there and to secondarily behavior modification and being a proactive manager of your own health requires that trusting relationship with the physician and saying this is important or a oral provider saying this is important. That trust is something that we take extremely seriously at Bitmark. We make sure we design our ecosystems in a way that that intimate encounter can be very much preserved. We don't have any barriers between the doctor and the patient, both disciplines and on top of that the trust also comes in the way of making sure what you're doing at that point of care is accurate whether it's the actual test itself or the data transmission because that sacred bond you have with that patient to make sure you're doing the right things at the right time are critical and that's one of the things I really love about PDS is there a deep attention to the connection between the provider and the patient. It's a fundamental basis for which you can get some things done that are proactive because it takes a lot of trust for a patient to walk into any outfit and the person in the professional behind the powder says you have hypertension, you're going to need to take a pill for the rest of your life or you're going to need to do this multi-thousand dollar procedure. There's a lot of trust that needs to be brought in that equation so we're very attentive at our side of the fence to make sure that we are fostering that exact sort of ecosystem dynamic where we can get that done and the beauty is we're starting from a point of strength whether it's the industry's perspective on these providers and also I think the companies you're speaking to on this podcast are very deep in that batch. Talk about Roblox certainly we've been both dental and primary care are siloed and they're just starting and really it's I think because of PDS and maybe some others out there trying to come together but besides being siloed we practice management software you know you've got Epic on one side and you've got one of a number of other solutions on the dental side. Let's talk about some of those Roblox and maybe how you kind of work through some of those and that's probably like three podcasts but maybe we can highlight some of those Roblox and how we can get through some of them. The Roblox are starting to come down in those schools. I don't know as much on the medical schools but I sit on a lot of boards of dental schools and work with the dean so the first Roblox I think is the education process and that's starting to break that's starting to come together. So as they start learning about the importance of the connection between oral health and overall health in schools there won't be such silos and they won't operate in such different manners as as we've experienced in the past. I'm seeing that happen now many schools are breaking down those silos. Next we have got to work on the education once they're outside in practice and how they work together and the key to that is the electronic health system. We happen to use Epic it's great on the integrations and that's why I went with Epic there are others out there too but it's not just the integrations it's the chart reconciliation so clinicians are so busy and so they have to have screens that are popping up that kind of tell them what to look for and it goes the whole spectrum of clinicians. So whether you're a hygienist or you're a cardiologist and you want you want to see what's important to you. That's still not quite there yet but it's coming companies like ours and lots of others on the medical center way out of us by the way in developing and I call that the chart reconciliation process of getting in front of the clinician what they need to see what they need to see for their area of kind of expertise and then the big one to really make this work at the end of the day is the reimbursement system. We have got to solve that area ultimately the payers and we're seeing it with MA Medicare Vantage we're seeing it some with Medicare actually providing some benefits for dental service. Seeing it with some corporate plans we're seeing it with some self-funded plans. The payers of the healthcare for everybody here in the United States has got to get the connection and be willing to pay for that service because what dentists do what oral health care providers do can and I believe will reduce their overall health care costs when they're looking at their annual budgets for what they spend on their health care. We at PDS we invest heavily in it because I'm so convinced that everything we do on the oral health care side will reap big rewards on the medical side. It's now getting it done getting the integration done getting the reimbursement systems working together. I can't say it enough and I do every time I get a public audience the fact that dentists work in a different coding system than everybody else is a major barrier and we have to solve that barrier. Yeah I know we're getting short on time though but I'll throw a couple of additions to where Steve was going. I couldn't agree with him more on the EPIC and the data integration requirements. He can't treat what you don't see. So the physicians seem to be armed with your health paradigm and vice versa and that's coming together. There's new interoperability requirements now from the federal government on data interoperability. The data systems are getting better and it's systems like EPIC which is the biggest of all it's starting to realize that the dental care community is a core part of their fundamental mission in life. So that's number one. Number two I think the mindset change that's going on I'm seeing in health care around value-based care is settling in. I've talked to a lot of physician leaders around the country and what they're saying is they're absolutely putting their money and their investments around the areas that can improve chronic disease management at lower total costs of care and they're doing this because of many of the Medicare Advantage incentives that are out there and also the fact that they know that they're getting graded increasingly on these clinical outcomes. Now I'm just with this is this inflammatory basis of disease is just starting to become the next big wave in medicine scientific clinical and what that's saying is that inflammation is the big evil as far as health concerns and long-term chronic disease progression and it takes a while for the medical community to shift from clinical idea to implementation and finally to pair models but I've seen all three of those things starting to gel together in a way that creates a fairly powerful unified force around this and once the health systems which control the majority of the health care now in this country realize they can't get to their goals without the oral health care providers this is going to move very very quickly so I would advise the listeners of this to pay attention to this because this is an esoteric concept of an idea this is actually real dollars and cents and real business opportunity and I'll credit Steve to having such a proactive vision around it. Can I add the most chronic inflammatory disease in the world is diabetes cardiovascular disease oral paradigm disease I got you crap me in my own trap Steve you're trapped in this chronic inflammatory disease in the world is paradigm disease all those bad bugs all that chronic inflammatory disease affects the rest of our body that continues and you can't get rid of it we all know they're training dental school right bill we know that from years you can't get rid of paradigms you just have to manage it whether there's a reason you have to manage it you want to stay healthy you want to prevent a heart attack prevent early onset dementia prevent it will preterm low weight birth from help lessen or reduce diabetes which is clear as a day and help prevent different forms of cancer see your dentist often I go I go in six times a year I'm going tomorrow you go so as we wrap this up final thoughts from you Steve what is the rest of 2024 look like I mean we're not even halfway through it you've already changed the name of your come your organization what's the rest of the year look like so our our PDs of what we're doing here PDs our PDs dental is our core a PDs medical is growing and accelerating we have a few things left to do on the value based care initiative it's it's a little complex on how the administration works there so we're doing that we have a new company called PDS help technologies where we're providing epic primarily for schools now but any other progressive organizations that want epic and some of the other things we have so that's called PDS help technologies and a bunch of different schools are switching to epic right now because of they see the same thing this is where things are headed and then our our new business like I said is as PDS plans and we are going to recreate I'll call it what PDS what dental plans should look like in America and also a we're not getting in the medical insurance business but a medical health plan that can help people understand these inflammatory markers and genomics in a much better way so that they can work with their primary care physicians and other other care providers in a much more sophisticated way about their own personalized care because at the end of the day it's about our personalized care each of us have either two ex chromosomes or an xy chromosome all of us we know what we have but the genetic expression of those is different for every one of us we really want to go after taking better care of ourselves we have to have that personalized care and it's actually not that hard given the latest science and the latest tests and the latest screenings are out there so we're going to be going after that in a big way and I know mid marks going to play a key role in that because they're all about integrations helping physicians and dentists be more efficient and and we got to all work towards that we will drop the latest press release with the name change announcement in our show notes you can also go to pdshealth.com to find out more so thanks Steve and then Dr. Sweeterman on Denmark's side what's what do you have planned for 2024 what do you would products and projects do you have going on well I have a downstream marketer staring at me right now so I got to be careful what I say but we've got lots of things coming out that are very exciting for the industry my email blew up on Monday Steve actually you're announced because of what's going on and we you look for canaries in the coal mine but a canary diet something's going on that you need to pay attention to and you're one big canary we're like a bald eagle that died in the coal mine so we're we're very attentive now that we need to be on full hands on deck getting a medical dental or dental medical integrated solution sets runner ecosystems going we've been looking at this for 10 years to see it's point about epic integrations we're aggressively pursuing to optimize our ability to bring on new biomarkers new concepts to the epic world that we live in today just for the for the customers to know and the people in the podcast a year we're the first device to be integrated in epic and an ambulatory sense so we know how to do this we were doing for decades so that's a big part of our area of focus is to get this integration between the medical and dental community going on especially on a device level and finally we know that behavior modification proactive health management end up a sea and trust between the doctor and the patient are critical so Roy is looking at ways our ecosystems where we can borrow the knowledge we have in debt history 12 o'clock data clock positioning and all the issues and musculoskeletal scalar issues from the dentist we're trying to take that and bring it to our medical community we're trying to take the medical side where they do a lot of more point of care testing on the physiologic side bringing that to the medical so we got this beautiful mashup that we're looking at but it's going to take us a little time to get things out to market but it's happening a lot faster and fun to see that and Steve thank you for we're getting some of my vision work here at midmark going faster because of 800 pound gorilla comes in a room you got to pay attention thank you well thank you both thanks Steve that was your third podcast with us now in the record books so thank you and doctor tom thanks for being on this is the first time for you and hopefully not the last oh by the way I forgot to mention if you want to find out more about midmark easy enough you can go to midmark.com and go to their main page and you can go click on dental and they do have DSO specific solutions if you happen to be on the medical side there's you go down that section of the website and find out what they have for primary care but that's it it's a great conversation I know there's probably another hours worth of content we can talk about do a follow-up podcast but again thanks Steve foreign PDS health and doctor tom sweeter men from midmark thanks so much for joining us and thanks everybody for watching us today or maybe you're listening in again without a great audience we couldn't get these great guests so until next time I am Bill Newman the group dentistry now show has listeners across north and south america europe asia and australia if you like our show subscribe today and please tell your colleagues about us [MUSIC PLAYING]
