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Jonathan Levine:
Welcome to Think Oral.
Mariya Filipova:
Where we connect the unconnected between oral and physical health.
Jonathan Levine:
I’m your host, Dr. Jonathan Levine.
Mariya Filipova:
And I’m your host, Mariya Filipova.
Jonathan Levine:
Let’s get at it.
Mariya Filipova:
All right. Welcome to the Think Oral Health Podcast. In this edition, I am very excited to be joined by a thought leader, executive, and a creative innovator. So we’re in great company today. I am also, as usual, joined by Dr. Jonathan Levine, an oral health physician and a partner and co-conspirator in crime for me in this podcast. Jonathan, without further ado, why don’t you introduce our guest for today?
Jonathan Levine:
I would love to. Super excited to have David Kochman on the Mariya and Jonathan Think Oral Podcast. David is an executive of Henry Schein. He is, as Mariya says, a thought leader. Henry Schein is an amazing company, one of the largest dental companies in the world. He leads multiple initiatives in the more than the double-digit realm, working closely with the senior management team. It’s just fantastic to have you here, David. Let me start us off a little bit. David, you deal with multiple initiatives, multiple headwinds in the industry. What are you seeing today as the major trends in dentistry that Henry Schein has a clear line of sight for, and the things that you’re working on that matches up to those trends?
David Kochman:
Thanks, Jonathan. Difficult to encapsulate in kind of one area because of Henry Schein’s breadth. We’re the world’s largest provider of solutions and products to office-based healthcare professionals, both on the dental and the medical side. And since a lot of care is moving from the acute care space to the subacute space, it’s gravitating right into the markets that we serve. I’ll give you a couple of things that we think about, and a lot of them have a commonality of expanding access to care and integrating care. So on the technology side, an integrated and interoperable workflow. This is certainly coming on the heels of, if you look back about five, six years, this fourth industrial revolution and Internet of Things. Certainly, in dentistry specifically, there’s a lot of really cool tools and technologies that are being developed. The key is how do you integrate them and bring them together into a seamless workflow. Folks have pieces of it, but no one has the whole part, Schein is one of the companies trying to bring that all together just because of this unique space within the healthcare ecosystem that we occupy, where we have practice management software, we work with all sorts of different suppliers and vendors. So we think ourselves just an opportune nexus to try to bring these together for the betterment of the profession, and ultimately, it’ll create a better patient experience. It also should create a better provider experience, being able to have your scanner connected to your charting, connected to the printing, connected to patient responses and feedback mechanisms afterwards. So the workflow is an area that we’re looking at quite heavily. Secondly, a macro topic would be the integration of oral health and overall medicine. As you had indicated, we just think as a company we’re in a perfect position to be able to hasten this. It’s not to say that it won’t happen without Henry Schein, but it can happen faster and more efficiently if we get involved. And this includes everything both from the industry side connecting the workflows, connecting the distribution mechanisms, as well as us trying to encourage physicians and dentists to think a bit broader and perhaps work together more. And then I’d say, finally, this bleeds a little bit to doing well by doing good, which is a prevailing ethos within the company. We think that there’s massive opportunity to increase access to care for vulnerable populations and one population, not to the exclusion of others, but one that I would specifically point out is we think there’s a massive opportunity with special needs care. You know, the estimates are that one-fifth to one-sixth of the US population, and certainly, there shouldn’t be any reason that this isn’t representative globally, but one-fifth to one-sixth of the population qualifies as being special needs. So why do we still think of that as a specialty? Every GP should be able to treat 80 to 90% of individuals with special needs. There is certainly a percentage that should go to a specialized care professional, but we can’t leave 20% of the population out there flailing in the wind. And we know the data shows that this population suffers from higher incidence of oral challenges and just healthcare challenges overall, a lot of which is because they have difficulty finding care. Almost every dentist has their patient that they’ve taken care of up until they’re 18. A lot of patients see this, periodontists see this. Take care of their patient up until they’re 18, and then they have nowhere to go, and they end up caring for 20, 30-year-olds, 40-year-old patients just so they get care. So again, Schein is focused on a lot of areas, but those are three that that really resonate with me and that I think we have a fantastic opportunity in the near to mid-term to impactfully influence.
Jonathan Levine:
So you articulated.
Mariya Filipova:
I’m hoping that our … can hear the passion because it’s really amazing through, and we do talk to a lot of passionate people about this, but I love the energy. I love the passion, and you’re amongst friends. So Jonathan, go right in.
Jonathan Levine:
Let me jump in on that. So you articulated those three areas, which is fantastic, and the energy is high. How can we impact the, through these efficiencies, how can we impact the fact that healthcare is 20% of our nation’s GDP? How do these efficiencies really get to a level where the connection between oral health and overall health, where the tip of the spear of healthcare is understood, where the idea of oral health can help lead to overall health? And how does, how do we positively impact each other and the actions that Henry Schein can take, the initiatives you take on, how can we create greater efficiencies, spendings, and get ahead of healthcare instead of the sickness model?
David Kochman:
It’s a fantastic question, and of course, I don’t have the antidote for this at all. I think the macro solution is a stakeholder initiative where folks are collectively involved to move the initiative forward, but it will be ultimately kind of 10,000 hands pushing the stone up the mountain once we ultimately get there. Would comment that it is amazing what we can achieve when we don’t care about who’s getting credit, but therein lies a little bit of the challenge, right? Because in our system in the US, which has many benefits on the payment side, the benefits of how we, of our system, is that there’s a lot of great innovation. People can make money on it, folks want to invest in it. The downside of this is that cash ultimately dictates, and folks that are companies that are public companies need to have investors and need to show results, and this is a stakeholder approach to solve this. So, Jonathan, I’ll give you, when you focused in on integration of oral health and overall medicine, I’ll give you a couple of thoughts there. First, and I should lead with this is, is that we must speak to folks outside of our bubble. The average person on the street walking around thinking about paying their mortgage may be worried about their jobs. We could be right 100% that they should care about their health. But how do you actually get them to care about that? That’s a real challenge that we can’t overlook because perfect policies is not the silver bullet to actually get folks engaged, right? We have to get more than 40% of the US population going to see a dentist, right? That’s a huge needle mover. You get 180 million people that aren’t going. You can make a huge impact with some small influence. But on the profession side, which I think where you were driving at, in our view of the world, there’s really four journeys that have to be walked to be able to solve this, truly solve it. First is scope of practice. We have to make sure that physicians and dentists can each do certain procedures in a way that their state licensing boards will allow them to. Second, they got to get paid for it, doesn’t necessarily need to be a huge revenue generator, but it can’t be shared, it can’t be a money-loser to go and embark upon trying to do simple diagnostic tests or procedures to get each of the sides getting the right information about the patient. Third, there needs to be the infrastructure set up to be able to allow physicians and dentists to work together. This includes bilateral EMRs, and certainly, we’re seeing with the ONC rules movement in that direction, but it doesn’t feel like it’s fast enough. So we have to get the back-end infrastructure solved, and that’s certainly an area that China is playing a lot in. And then fourth, and I think perhaps the most nettlesome, is the behavior piece. How do you get a physician to really care, meaningfully care, about what a dentist is doing, and a dentist to meaningfully care about what a physician is doing, and actually create that relationship there? We take these high performing, we put them into rigorous sets of studies where they’re competing against one another to be top in their class. And then, if you go to a specialized thing, become an oral surgeon, right? You’re, or you become an orthopedic surgeon, right? You are now even more elite where it’s competing against one another. Nothing within that inculcation process is about thinking, how do I work with other people for the betterment of the patient, right? It starts from school, but then extends beyond where if I’m not getting reimbursed for this, why is it going to work? And philanthropy cannot be the strategy for integration. I don’t have an antidote, but I think that those four journeys are ones that need to collectively be worked on. There are pairs that are working on that, there are providers that are working on it, but a concerted collective effort, I think, ultimately, will drive this. And I think my last comment is if you look at the way trends emerge and evolve, it’s not generally a static arc up, which is a lot of coalescing and movement, then maybe it’ll hockey stick, then plateau for a bit, and then something else, things will collectively grow and come together, and then it’ll move up. I perceive that we are on the precipice of another set of hockey stick growth. I think a lot of the factors are starting to come together. I think there’s energy behind on the table, and awareness is really that first step of the journey to start bringing these pieces together.
Mariya Filipova:
I love it. This is a great recipe. Let’s just try to follow your thinking here. David, let’s highlight the role and the importance of intermediaries like Henry Schein in that collective effort. You’re uniquely positioned to do a lot of things, you’re, just purely based on market cap, your market cap has doubled in the last ten years. You must be doing something right. You’re adding a lot of value to the system. What is your role that you see in orchestrating that collective effort and advancing the field along those three things that you called up at the beginning?
David Kochman:
Yeah. So I think that the way we see ourselves at Henry Schein is that we can play a key part in advancing each of those journeys, but also knowing that none of these are going to be led purely by Henry Schein. So where we have the opportunity to, we are trying to bring pieces together from our distribution side, bringing together medical and dental. It used to be not so long ago, within the past five, six years. If you wanted to buy this cotton swab and you were a physician, and you wanted to buy the exact same cotton swab as the dentist, you were going to pay a different price because from Schein we were being sold those from the same company different. Why? They were, there were differences that were there. Obviously, with price transparency that has caused that to come away, so we’re working to bring together that side, on the electronic health record side and certainly on the software and equipment side, because we work with so many different suppliers and vendors, and our view is one of open architecture, that we should be working with everyone, physicians and dentists, all have the types of software or products or equipment that they like to use best, and they have good reasons for thinking that way. So our view is not to censor or to conscript that, instead, we want to go and elevate each of those pieces, can’t be everything, but to take the best of breed of each of them and allow them all to work together. Because, ultimately, that’s how innovation can continue to persist. You have to allow small companies to come up with something great and then give them a pathway so that it can actually get put into the ecosystem. And then I’d say, thirdly, we are working to create awareness amongst our customers of the importance of the various issues that I talked about and truly just bringing them together so they can start working together. We did a, what I think was a really great event with Care Quest Institute for Oral Health a couple of months ago, which was purely a pilot just to see could we get a bunch of physicians and a bunch of dentists in the room and see how much they actually know about what one another does and the what their patients are facing and how each of the behaviors at the various dental office and physician office can influence one another. And I got to tell you, it was a great event. The downside was that I don’t think a lot of people listened to what we were saying from the stage. The upside was that every single person in there was talking and creating new connections. So part of this is incubating these relationships at the provider level so then we can go and influence behavior and policies at the government level and at the payer level.
Mariya Filipova:
Literally getting people in the same room to talk to each other. Doesn’t get any more complex and simpler than that. Jonathan?
Jonathan Levine:
No, that was going to be my next question because I couldn’t agree with David more, that when we look at the space and the gap between medicine and dentistry and the lack of knowledge of understanding each other’s history, let’s call it industry and the separation, this wall between us. The question is how do we break down the walls? Just as a simple example, if we knew that the mouth seats the gut and that inflammation of the mouth, those bacteria, those pathogens are found in all kinds of organs and especially in the gut, if we know the impact of oral health and overall health, whether it’s salivary diagnostics, whether it’s the ability to do CAT scans in the dental office now through our CBCTs and impact sleep, if we can get ahead of these systemic inflammatory diseases, and that’s why we say the tip of the spear, so that the healthcare system, the patients never get sick, we move more to a wellness model. Henry Schein, from what you said, David, just to reiterate, and what Mariya said, you’re uniquely positioned to help connect the dots, start that medical-dental dialogue so everybody has an awareness. What, how do you think about this? How can we, how does Henry Schein want to advance this because of that unique position that you’re in both industries?
David Kochman:
I’d say we have a number of initiatives underway. But I think, first, it’s really important just to be very transparent about what our interest is here, right? From a Henry Schein perspective, we want more people going to the dentist and physician. We think it’s the right thing for patients. It ultimately will reduce cost to our system overall, make folks more productive, less days missing work. And ultimately, the more people that go to the physician and dentist, the more they’re going to buy at a percentage of what they buy will be from us. So there is an enlightened self-interest that kind of fits within that realm there. However, that should not dissuade from the fact that this is the right thing ultimately to do. But just because your patient will be healthier if they take these steps, unfortunately, has not been enough historically to really influence behavior. Where you do see it happening is in single-payer models. So certainly in FQHCs and CHCs, where you do have a single-payer, the government. If you look, it’s required by law that they have to have a dental center in them. So in areas where the ultimate payer themselves has to be responsible for the outcomes of the patient, you’re seeing that change now, a challenge we have in the private system, right? Is that a covered life, we have, what, about 180 million people in the US that are covered by private insurer, covered by employer insurance. However, very few of them, if any, have actual dental insurance, right? It’s basically a coupon that you get, but tenure of an average covered life within the payer system is somewhere around the 14 months. So just if I’m going to pay for a doctor Levine to get that extra care, the wellness and prevention care, I don’t necessarily know that I’m going to reap the benefits of it. That’s a real challenge. So this is why I started off by saying that it can’t just be even industry or payer, we have to engage the public in this. And I would go one step further from where you went. I think that it’s actually an overall mindset, which is holistic health. Wellness has a number of key components. Going to your physician regularly for checks and getting regular lab tests, oral health as well as mental health and mental wellness. I would simply submit that getting more folks to the dentist for regular cleanings and checkups is the lowest-hanging fruits to advance the ball towards an integrated care model. Bam! All of this can happen with visionary leadership that has a mindset of collaboration and advancing. And the reason our company has been able to do this is because we’ve got someone like Stan Bergman who sees this as important, who really views the success of our company as inextricably intertwined with the investment we’re making in healthcare. And same for each of you, right? The fact that you’re bringing this up on a conversation helps to really make it relatable and to connect it. Ultimately, we can’t do any of this unless we have folks from the top really driving this. I’m not sure if you see that within your organization.
Mariya Filipova:
I love that you’re going there because that’s where we were going to take you next.
Jonathan Levine:
I want you to go there, David.
Mariya Filipova:
The role of the individual leader.
Jonathan Levine:
The role of the leader and how it trickles down into everybody else, that trust and inspire leadership …, said another way.
Mariya Filipova:
You said …
Jonathan Levine:
Leadership.
Mariya Filipova:
David, you and myself are a little bit of a maybe at a disadvantage or advantage because we are the non-clinicians typically in the room, and I’ve decided that this is to the benefit of the conversation more often than not. And so let’s talk a little bit about the non-traditional paths, the folks with different backgrounds coming in and contributing to the, to healthcare and to grappling with some of the biggest and most interesting problems or challenges that you outlined. Or in other words, what is an attorney doing in healthcare?
David Kochman:
Yeah, so I don’t know that I can comment on everyone, but let me comment just on what I’ve seen and then I’ll speak personally. I think that certainly healthcare is one of those things put to the side or disregard until it impacts you personally and then you care about it. And I also think that a lot of folks just look at the world through their own lenses, right? If you’re in finance, you say that as long as economics work out, everything’s going to be okay. If you are a lawyer, you say as long as the law’s functioning well and people are understanding of it, the world can actually make sense. And if you’re in the healthcare, say, as long as people are healthy, they can ultimately go and do things. I can’t say exactly why a lot of folks getting in, but there is a really exciting moment happening now in healthcare and the interdisciplinary influence that is starting to come in and seep into healthcare is really exciting. Look, there are some folks that certainly just see it as a revenue generator and see a lot of opportunity there, especially on the dental side, and there’s nothing wrong with that, but there’s a lot of shared learnings to be gleaned coming in. I’ll give you one example. In our business, we spend we have quite a large number of people around the world that focus on fixing equipment. We have a lot of equipment that we service to keep practices running. One of the areas that we have found a lot of folks that have wanted to come to join is from the military. They spend a lot of time fixing equipment. They have really good processes and SOPs, and they have been among our best new recruits that we’ve brought in, because they are trained in that way, they understand that things are going to break on a certain period of time, and if something goes down, that’s a real problem. Anyone in the dental office truly understands that. For me personally, longer story than we have time for now, but I’d say my animating North Star throughout my life has always been, I wanted to deliver impact. Can I really try to help folks around me? I saw that with the law and certainly around social justice and criminal justice issues in particular, I saw the opportunity cities that were put before me to really help an individual life. And I’ve loved this quote that, to the world, you may be one person, but to one person you can be the world. And I do think that has helped to drive me in looking for opportunities of where you can make an impact. And ultimately, what I saw with Henry Schein was a company that sat at this incredible intersection of so many different avenues at healthcare in a really exciting industry of healthcare, at a great time for healthcare and with incredible leadership, with so many opportunities ahead. And so all of those to me helped drive me to join a company like Henry Schein, and I think that there are so many examples all throughout healthcare, dental, medical, wherever, that these opportunities exist.
Mariya Filipova:
Yeah.
Jonathan Levine:
David, that’s, that leads me to another question that follows that, which is the type of culture that exists in Henry Schein today, and you’ve seen other corporations with other cultures? When you think about this, servant leadership or trust in buyer-type leadership where it’s not a command and control, but truly the opposite, where you’re inspiring people. How have you seen Henry Schein, since you’ve been there, inculcate that thinking into the leadership and everywhere else in comparison to some other companies that don’t make that a focus of who they are, what they do?
David Kochman:
It’s a great question, Jonathan, and it’s true. And I wouldn’t want to disparage other companies that I’ve worked with. I’d say at a base level, right, when you’re involved in healthcare itself, there has to be that empathetic connection. I’d also say as a guiding philosophy within our company, there’s a view that the customers we serve, the office-based healthcare professionals. For the most part, one of the top two reasons they got into their profession is because they want to help people. So if we don’t share that symmetry, then how far are we ultimately going to be able to get? How well can we connect with our customers if we are only about the transactional, and a portion of what they’re doing is to help out? How many, is there a single doctor or dentist in the US that has not taken a call at midnight and gone into their office and not maybe charged the patient just because they wanted to help them out? If we don’t reflect, that’s a miss on our part, and I’d say that from an institutional standpoint has been a guiding force. And throughout Schein, then this notion of purpose-driven leadership, the fact that we’re working for something bigger than ourselves is a universal attribute and trait throughout all of our 22,000-plus team Schein members, is how we call them. And again, I won’t say it’s truly unique because I’m sure there are other companies that have that, but for us as an organization, it is something really universal and something you’ll find within all of our members. The fact that truly everyone cares about trying to help the customer because we know ultimately this is about helping the patient and making a life better. And I think when you dimensionalize it in that way and focus it, that this isn’t something trying to just drive a profit needle, this isn’t trying to have better earnings. This is ultimately about better patient care, better caring for our customers themselves. And that yes, we are part of, but we’re part of building something great. Stan says this quote a lot, See someone on the side of the road, ask them what they’re doing. He says, look, I’m digging a ditch, and you ask the person next to him, what are you doing? And he says, I’m building a church. It’s all about that perspective. And that perspective is, I think, what helps to separate us and allow us to continue succeeding because folks worry less about what is my position, what’s my title, what am I doing? Am I driving impact? Am I really helping that I think has been among the special sauce that’s helped Schein to be successful.
Jonathan Levine:
I love that. I love that.
Mariya Filipova:
Yeah. Maybe on that special note, let’s just put a pin or a pause in the conversation. We are way over time and very grateful for the chance to actually have at least a beginning of a conversation with you. Take that as an invitation and a promise to pick up the conversation from here. And with that, I invite all of us to take a moment and think about the church rather than the ditch that we are working on in the daily grind, because if you look, sometimes you don’t have to look hard enough to see the inspiration and the impact. So with that, thank you, David. Looking forward to our next conversation.
Jonathan Levine:
Thank you for developing this beautiful clarity and sharing with us your thoughts, and it’s just an honor to have you with us. We look forward to bringing the CEO, Stanley Bergman on our podcast, and thank you for leading us off here. It was very inspiring.
David Kochman:
Thank you, guys. Thanks for what you’re doing and urging folks to think orally.
Jonathan Levine:
There you go.
David Kochman:
All right.
Jonathan Levine:
Thanks for listening to the Think Oral podcast.
Mariya Filipova:
For the show notes and resources from today’s podcast.
Jonathan Levine:
Visit us at www.OutcomesRocket.Health/ThinkOral.
Mariya Filipova:
Or start a conversation with us on social media.
Jonathan Levine:
Until then, keep smiling.
Mariya Filipova:
And connecting care.
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