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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:
Hi everyone, and welcome to another exciting episode of the Think Oral Health podcast. I am Mariya Filipova, and I’m joined by my co-host, Dr. Jonathan Levine. We are both on the East Coast today, hopefully after a couple of weeks of travel, and we are joined by a thought leader, change agent, and a business guru who has been able to do the unthinkable, which is build a successful business and scale a successful business in oral health. And we’re very excited about the topic and the guests that we have lined up for you today. With that in mind, I will hand it over to Jonathan to give us, to reveal who is our conversation partner today.

Jonathan Levine:
Yeah, we are so excited. Steve Thorne is right at the heartbeat of the connection of oral systemic health. Did you get that? At the heartbeat. He is the founder and chief executive officer of Pacific Dental Services, PDS, and he has built it since, what would we say, 1994 maybe, established that early, but PDS is a global leader in this integration of dental and medical care with a dedicated focus on their practicing clinician? As a company, they’re committed to the achievement of very efficient practices, providing just excellent patient care management services for the dental practices. They have a core value, which is really interesting, it’s called We Believe. We’re going to be asking Stephen of how he takes concepts and good ideas, but how does he really make it all happen? Because that’s what they do there. They have also PDS foundation. It’s a 500 and 1C3 charitable organization, we’ll talk about that, but through Steve Thorne’s leadership, PDS has become really a preeminent authority on what they call the body, mind-body connection, what we’ll call oral-systemic health. And what we’re doing at Think Oral is to talk to people like Stephen Thorne of how they are creating this integration and the delivery of care and delivery of this type of mindset and thinking, but how does it really turn into outcomes to improve the health of people, not only their oral health, but that connection into the overall health? So with all of that, let’s begin. Stephen, thank you so much for joining us.

Mariya Filipova:
Great to have you.

Stephen Thorne:
Yeah, yeah. Thank you for that warm, warm welcome.

Mariya Filipova:
You’re an expert on Jonathan. What a great intro.

Jonathan Levine:
Well, that’s right, I know Stephen for quite a bit, and I’m so impressed because we met together at.

Stephen Thorne:
Yeah, where was the first time we met?

Jonathan Levine:
Yeah, we met at one of their early preceptor programs, and we shared the passion. But Stephen, let’s start there. Tell me what got you passionate about the oral-systemic connection and expand not only what we do in dentistry, but how does it have that impact on the overall health for people? What got you there?

Stephen Thorne:
Well, give you some context for what got me so passionate. The first part was pretty much purely business-minded. I’m a capitalist. I’m a business guy, not a dentist, not a clinician. I think I’ve failed out of high school chemistry and biology and all that stuff, but excelled in the business stuff. It was about 2011, 2012, I started seeing all these articles coming out in the dental rags and journals. I was on a couple of boards talking about the oral-systemic link. I hadn’t really heard of it before, and I’d been in dentistry since I got in dentistry in 1989, and I started by putting in a computer system in my dad’s dental office. That’s how I got started. My grandfather’s a dentist, he graduated Harvard in 1939 or something. …, my brother’s a dentist, one’s a periodontist, and they still weren’t all talking about this link, right? Most of my friends were dentists, but I started seeing all this, and I go, wow, there’s something happening here. And I was watching it over a couple of years, I’d known about the Surgeon General report in 2000 that said, look, basically you can’t, we can’t have good overall health in America if we don’t have good oral health. That was the first, that was the kick-off for this. And then, the 2010 Surgeon General report went much deeper and talked about the importance of dentists in overall health related to cancer, the jaw, the neck, the able to eat what, much broader. So I put together a task force in 2015 to look at this for me, and I wasn’t on the task force because I didn’t want to steer it. And it was a bunch of leaders names you would know from across the country that were on it, Judy Haber, Mike Alfano, a couple of other leaders in this space, and a couple of my team members to collect the data. I wanted to, I wanted this to be real. I wanted to know if this was real. So they came back and reported me. They met for about nine months, collected a bunch of data science, all the things you guys have probably seen out there. I said, Steve, this thing is real. We got to think about. So I say that because one of the main as CEO, I have two main jobs. One is capital allocation, making sure we’re investing in the right places to keep the company going. Second one is pattern recognition and staying, looking at what’s happening in the world and trying to figure out where things are going so we’re there, and we’re not left behind. In the famous example, whoever was leading Blockbuster at the time didn’t really see the streaming thing coming, and they missed that, or Kodak who said, oh, we like film, nobody’s going to switch to digital, things like that, right? Those are the examples of companies that didn’t see the patterns. There’s a lot that.

Mariya Filipova:
Reed Hastings’s example, you always do, you always have to come back, disrupt yourself before you get Kodaked.

Stephen Thorne:
Totally.

Mariya Filipova:
As Peter Diamond is a good friend. Like…

Stephen Thorne:
Oh, really?

Mariya Filipova:
… About this, that’s right. Yeah. It’s always you have to disrupt yourself. Otherwise, you’re leaving the opportunity to somebody else to do it.

Stephen Thorne:
And what got me passionate is, during that time, my mom died of heart attack. So she was 65 years old. No reason in the world she should have died that young. She had just been to the cardiologist three weeks ago, and the cardiologist told her she was going to live to be 100 years old. Now, and she always suffered with bad breath, bad perio, and she married to a dentist. Okay, now, was it a direct causal relationship the … that killed her? She did a lot of other stuff, okay? She grew up in the 60s. But it got me thinking, got me going about the relationship, guarantee it played a part in how, why she died and died at such an early age. So that task force prompted me then to go to a basically a marketing company, because I wanted to see if there was a business here, would consumers understand this, and would clinicians gravitate to this? They came back with a report about took about nine months and said, absolutely. Consumers love this concept of dental medical integration. Being able to go to one location and get most of their primary care. They also told me that the biggest problem you’re going to face is the clinicians, because dentistry has been siloed for so long for whoever took the mouth out of the body way back when, I’d love to meet that person, give them a piece of my mind. So we’ve been separated for so long, so to integrate was going to be very hard. I’m always up for a challenge. And so we learned, and we started our first integrated practice in 2017 with one physician in a busy dental office in Summerlin. So that’s kind of the passion side, but also the business side of it.

Mariya Filipova:
Healthcare is always personal. I’m glad.

Stephen Thorne:
It’s local.

Mariya Filipova:
… your personal. Yeah, thank you for sharing your personal motivation. We all have our own healthcare experience, and we’re all touched as patients when we are another, and that’s what really, really drives us well.

Stephen Thorne:
Also, Mariya, it also caused me to look at myself, and I learned that I have all the bad genetics for inflammatory disease. My perio was a mess, we started the oral bacteria test, and all my IL1, IL6, everything. I got, every bad gene you could get, I got them both from my parents, so I have to go to the dentist like six times a year, get my hygienist dentist to take care of my mouth, and I learned all that from.

Mariya Filipova:
Silver lining of all of this is that you are now an activated, engaged patient that is very much engaged in their own health, which is unfortunately not the majority of patients, but it’s a big piece into moving the field forward and advancing integrated care. Steve, I’ll jump in here, and I know, Jonathan, I know you have something on your mind as well, but tell us a little bit about that integrated model, right? You got inspired. You did your homework. You had a task force. Tell us how this actually works today. And frankly, what took to convince that first dentist in that first clinic to try it out?

Stephen Thorne:
Yeah, so with disclosure, we’re still trying to figure it out, full disclosure, okay? We figured out a lot.

Mariya Filipova:
Yes.

Stephen Thorne:
One of the, ask a couple questions there. How it works in the in the office in the operation. So patient comes in, take their blood pressure, it’s 140 over 100, so they’re full hypertension patient. What does the typical dentist do? Most dentists don’t do anything. What they should do is refer them to their PCP. You have high blood pressure, and the patient always says, oh, I’m nervous.

Mariya Filipova:
The white coat syndrome.

Stephen Thorne:
It’s the white coat syndrome.

Mariya Filipova:
Yeah.

Stephen Thorne:
So what, you’re going to die on my chair? That should be the response. But now it can walk over if the physician or nurse practitioner is available. In this case, it was a physician, grab the physician, go talk to the patient. Or do you refer them over, walk them over to the physician? So that’s a very base level one example, but we do that with diabetic patients, we do that with mental illness patients. We do, all of it, it’s right there. We all know how important it is when patient can activate into care at the moment. And that’s what it was all about, activating into care at the moment. What we learned too, at the time we put in, we had an old dental system only running our company, and we put in a medical system, medical EMR. That was a major roadblock to them, helping patients get healthier for a major roadblock for the work between the dentist and the physician.

Mariya Filipova:
You need the data.

Stephen Thorne:
You need collaboration. They needed the data. They needed to work in the same chart. So we started looking around, and at that time there was only one option, and it was Epic. Epic had the, is the largest health record on the planet. 270 million Americans have some of their health information in Epic. 150, 160 million, maybe more, have a Mychart app on their phone. So it didn’t, and yes, it is a little bit more expensive than a dental-only, whatever we call it, system, whatever you want to call it, but Epic is so much more than that. Epic is the now for us. It is the backbone to the entire company because everything we do runs through that system in order to help the clinicians understand more about their patients, which is key, that health history, but understanding more about the meds they’re on, you know, what other problems they may have.

Mariya Filipova:
Co-morbidities, everything.

Stephen Thorne:
All the comorbidities, all of that. And so we have, we now have that information at their fingertips. And we’re building the menus and the popups and the alerts and all that into the system now, because we can, we have the data, we share, I don’t know what the, probably up to 100 million records now that we have that have been shared. So there’s two things on Epic. One is interoperability. You hear that term a lot, right? And think it’s mandated by law to be interoperable. That’s important, but that’s not the most important thing. The most important thing is the chart reconciliation.

Mariya Filipova:
Interesting.

Stephen Thorne:
So Epic is the only company I know that has done a good job of that, of taking all this disparate information that the clinicians have put in the system. Let’s say a patient has gone to 15 different systems or physicians and been able to put it all together in a pretty seamless fashion. It’s not perfect yet, but pretty seamless fashion for a dentist like Doctor Levine to look at and understand about that patient. So we made, that was, in my 35 years, the biggest risk I’ve ever taken as a CEO. That was my biggest risk I’ve ever taken is converting the company to Epic.

Mariya Filipova:
And I can imagine it’s probably too soon to tell if it’s paid off yet.

Stephen Thorne:
Oh no, it’s not too soon.

Mariya Filipova:
Opportunities to, oh, okay. You think you put it off already? Yeah.

Stephen Thorne:
Oh, you look at our performance since we finished last, last six, eight months. I don’t know if I’ve paid for the system yet, but we’re on record pace. We’re having the best six months in the history of the, and we’re on track this month too,

Jonathan Levine:
And Steve.

Stephen Thorne:
In company.

Jonathan Levine:
With Steve, stay there for a second, because a lot of times the KPIs and the metrics are just the result of doing all of these great things first.

Stephen Thorne:
That’s what’s key.

Jonathan Levine:
Right, so talk about that a little bit. Let’s unpack that a little bit.

Stephen Thorne:
Yeah, so you nailed it, okay? It’s not just the system. It’s not just the KPIs. So education leads to awareness, which leads to activation for many people, those that care. Education to awareness to activation, that goes for clinicians also. We’ve had to go through a massive change in our whole education program, an onboarding program at PDS, for every team member. So I don’t care whether it’s an oral surgeon all the way down to somebody that’s coming in to do accounts payable. We educate everybody on the mouth-body connection, and we’re not done yet. We’re not done yet. But, and we have different levels of it, Jonathan, where somebody working in accounts payable gets a base level understanding, a dentist gets a much deeper understanding of all the world bacteria, the tests we can do. Just, there’s so much happening right now. Yeah, it’s, that education component was, is still critical to driving the behavior change, and we know how hard changing a clinician’s behavior is. We both know that. It is so hard, but it’s working, it’s working. And so now when a patient comes in the doctor actually talking about their A1c and you have diabetes and you know, there’s a correlation between your oral health and diet and your diabetes, and we can help.

Mariya Filipova:
… it to act on that knowledge, Steve, for both the patient and the dentist. Okay, we know this is a hypertensive patient. They’re diagnosed as diabetic. What happens next? How does that knowledge change the workflow of the dental team and what patient what the patient does?

Stephen Thorne:
So that’s a great question. And we’re, again, we’re still figuring out some of these things, okay? I want to, I’m going to back it up a little bit. We have a saying in our company, patients don’t care how much you know until they know how much you care. That’s patients don’t care how much you know until they know how much you care. So the big bet for me as a CEO on the pattern recognition was that as patients believe that their dentist cares about them as an individual with individual needs and wants and cares about their overall health, not just fixing a tooth, right, that they will be more likely to engage in care for fixing that tooth, or for the scaling and root planing, or getting that implant placed to preserve the bone, whatever it may be, for that oral-systemic link, and that is proving out to be true. So the math equation people ask me all the time about Epic, man, you spent so much money. Not really, not really. It’s like related to cars, I don’t think, I don’t drive a Nissan Sentra, and I highly doubt Dr. Levine does. So we’re we probably have nicer cars, and we do that because we want the things that come with that nicer car. Epic is like a much nicer car. It’s like buying a Mercedes or something like that, where you have more things that you can do and like. But if we can get a little bit of turn every year of more patients activating into care on our scale, it’s massive numbers. So we will probably pay for the entire system in under three years for sure. I was going to say maybe even two years, the entire investment, and it was a nine-figure investment.

Jonathan Levine:
Stephen, is there an opportunity outside of PDS, for you to have a greater impact on the profession than what you figured out at Epic? Does that get commercialized to a level where if somebody wants to look at what PDS has done as a model, that there is an opportunity to leverage these learnings, what that you’ve done, and the technology together? How do you think about that as we think about future?

Stephen Thorne:
Yeah, it’s a great question. I’ll personalize a little bit. I think people can probably guess I don’t need, I don’t really need to work anymore if I don’t want. The business has been good to me, the profession’s been good to me, but I want to change, change the world. I want to change how dentists are thought about. I want to get them to think about themselves differently as oral healthcare providers, as physicians, and mouth, and taking care of that whole patient and want to change the profession. So yes, I’m working hard on that. We have, I think, now ten dental schools that have switched over to the Epic platform. I think we have 18 more in the queue that we’re supporting to switch. So I think that’s where it starts getting the dental schools to change over and start thinking more holistically about patient care, not reactive care, which is where dentistry has been forever since my grandfather graduated. I know you don’t practice that way, but most dentists in America still practice the way my grandfather practiced.

Mariya Filipova:
Yeah. That’s right.

Stephen Thorne:
Patient comes in, something’s wrong, they see what’s wrong, they tell the patient what’s wrong, and they fix it, and they’re great at it.

Mariya Filipova:
That’s right.

Stephen Thorne:
That’s a great service. That’s not going away, though. We’re humans. That be, that’s not going to go away in our lifetimes. But we have an opportunity to do so much more as we engage in the oral-systemic way we call mouth-body connection, but there is an obstacle. The big obstacle is the reimbursement system. And I’m working.

Mariya Filipova:
… Again

Stephen Thorne:
Yeah, it’s hard because we’re the only health profession that has our own coding system.

Mariya Filipova:
That’s right. And if I have to, yeah, and you have to bring the quality piece here. The coding system is not used for diagnosis. It’s used for treatments, and it’s very hard to be able to connect the dots.

Stephen Thorne:
And I’m on record.

Mariya Filipova:
An implant is not a diagnosis. And you can’t say what’s the diagnosis for that patient on the oral health side.

Stephen Thorne:
And I want to change that. And I’m on record, and I think the ADA hates me for this, but I would like to eliminate the CBT coding system. And they go over the medical coding system so we have diagnostic coding and the treatment. So move over to the ICD ten coding system and CPT so that we can understand why that dentist is diagnosing what they’re doing. And it’s all there, we can do it, but there’s a lot of, a lot that has to happen to make that change.

Jonathan Levine:
Change so much.

Stephen Thorne:
So much, so much, so much.

Jonathan Levine:
I want to take us where you’re going because, where you’re really going, we believe collectively that dentistry could be the tip of the spear, that oral health is overall health. We believe that. And if we think about the medical profession and the approach and the sickness model, where healthcare spend is literally 20% of our overall GDP, so imagine, trillions of dollars. And what happens when we go upstream? What happens when we get more proactive and we know that patients go to the dental office more than they go to their physicians? And that’s why your approach is so smart, because it’s really the beginning of taking healthcare more upstream and saving trillions of dollars downstream. How do you think about that from a standpoint of the dental profession being more of that wellness model, getting to the diagnostics of all of these systemic inflammatory diseases early and really playing an important role there?

Stephen Thorne:
It’s a great question. And that’s really the big idea from the reimbursement side and why dentists would do this. Because the question I get asked often is, why would I do it? I’m doing fine, right? I tell them, number one, you’re going to help people be healthier. That’s number one. Number two, we got to think differently about the financial model, okay? Dentists can be, they need to be part of the primary care healthcare team. They can be the first line in assessments and early intervention. Let’s just take cardiovascular disease a little harder because it takes longer for you to see the problem.

Mariya Filipova:
High-risk pregnancies. That’s one of my favorite.

Stephen Thorne:
High-risk pregnancies right there. We can test right now, Mariya, if you wanting to get pregnant or are pregnant, we could test how active your periodontal disease is in your mouth with a simple … test. Then what we could do is if it came back high or elevated, we could test your oral bacteria right now and see if you have high levels of …, one of the bacteria that are causal to preterm, low-weight births. Now, does that mean you’re going to have one? No, but it increases your likelihood, and we both know that. And so why isn’t every dentist ask their female patients, if you’re thinking about getting pregnant or you are pregnant, let’s do these tests. And what woman wouldn’t do that?

Mariya Filipova:
Let’s just, you started with the reimbursement. Let me just finish that story and connect the dots. Having spent multiple years on the health plan side, we know that one preterm labor, mom and baby in the NICU, is on average $500,000, that’s half a million. On average, we know that both mom and baby over their lifespan are more costly members in terms of total cost of care to treat, because they have all kinds of other risk factors. And we also know that, frankly, over the last years, because of demographic factors, socioeconomic factors, women are getting pregnant and choosing to have children later in life. So this whole term of geriatric pregnancy is anybody who is over the age of 35, which actually is over half of the pregnancies, if not more in this country, is a geriatric, aka high-risk pregnancy. And so that alone is a very important component in terms of bringing in the dental office, the dental team, into the overall care team. The only wrinkle here, Steve, is that the interventions that need to happen on the dental side, right? Treating your perio disease to reduce your risk of preterm labor happen on the dental side, yet the savings, in this case, would materialize. The big savings avoiding that half $1 million claim is on the medical side. So, somebody needs to talk to each other about the business model is you have to invest on the dental side, benefits on the medical, and these two teams need to share in the savings.

Stephen Thorne:
So what we’re seeing happening, you hit the nail on the head. So what we’re seeing happening is that plans that take risk are coming to us now. Medicare Advantage plans, I know that’s not the pregnancy group, okay, but Medicare Advantage plans are coming to us in droves now because we can help intervene early. We can help get their, save them massive amounts of money by, say, the hypertension patient or a diabetic patient that didn’t know they had diabetes. And then we also can bring up a level of service; dentists on the whole do a pretty darn good job on the service level, right? So we can help bring up their star rating. So we can help these plans by intervening early if we find a problem, let’s say diabetics or maybe it’s cardiovascular disease. They get a higher per member per month reimbursement. We can help them with their star rating where they get benefits for their star rating. Dentists need to play in that pool of money.

Mariya Filipova:
Absolutely.

Stephen Thorne:
Absolutely, dentists need to get reimbursed for this stuff. We’re seeing that, we’re seeing that with some employers. Now we’re talking to some employers that are taking full risk, and they’re really interested in this. We do it. I … 15,000 people, have 25,000 people on our planet, and we do it, and I’m trying to drive down our total cost. So yes, I think it’s only gonna take a couple of these plans to finally go, let’s go for it, let’s get the dentist in the medical plan, and let’s make this happen. Now, we’ve also approached carriers that aren’t taking risk, so that’s a lot of people. And they say, yeah, and then when it comes to, it’s nothing happens, because carriers that model has to change if we really want to have an impact because they’re all about the spread, right?

Mariya Filipova:
And you’re all administrators.

Stephen Thorne:
Yeah. And I’m.

Mariya Filipova:
I’m not taking risk. It’s hard.

Stephen Thorne:
Yeah, I’m not.

Mariya Filipova:
It’s hard to also do the model that Jonathan was describing. If you’re a fee-for-service model you cannot do preventative care, and I think that’s what it comes down to. It’s much harder to be able to execute on preventative care and have a longer-term view. Please prove me wrong. I’m open to it. Tell me if you see it work somewhere.

Stephen Thorne:
We’re trying, we’re trying. We did a deal, it was publicized with Memorial Care here in California, in California today. And the CEO of that gets this, okay, so we did a long-term deal to develop 25 integrated practices. And they already have big commercial and AMA. And so we’re providing the dental plan now for his employees, which is big, and we’re co-designing the dental plan for his AMA pool. So I think it only can it take a couple of leaders like Memora care to step out and go, no, we can change this. We can do a better job, and then others will follow.

Jonathan Levine:
Exactly.

Mariya Filipova:
It’s easier on the CMS side on the commercial side, that …

Stephen Thorne:
Correct.

Mariya Filipova:
That’s absolutely.

Stephen Thorne:
On the commercial side, if you have one employer that’s taking risk and they’re just the TPA, it takes the employer pushing that.

Mariya Filipova:
It has to be…

Stephen Thorne:
… To do it. It has to be…

Mariya Filipova:
… takes the risk. Absolutely.

Stephen Thorne:
Correct.

Mariya Filipova:
That’s right.

Jonathan Levine:
Yeah, it isn’t, it’s getting these proof points. So you take this objective, you create the strategy, you set up your tactics, and you prove it to work, and the numbers speak for itself. And then don’t you, don’t you get everybody’s attention at that point because you’ve taken that action? I think to date a lot of people are talking about it, and I, Stephen, kudos to you and the team. You’re taking the action, creating the partnerships on the collaboration, and proving out these upstream moves that we’re going to end up saving millions and billions of dollars downstream in healthcare, which is a runaway train, and it’s a very reactive sickness model that needs to really change, and everybody is starting to build that awareness to that.

Stephen Thorne:
Had a, had an, I agree, I had an MD tell me the other day at one of the larger vendors, he said, look, this is an MD talking, and he said, there is no better investment for these carriers or the risk-bearing, no investing in oral health or then oral investing in oral health. Maybe only smoking would be at a higher level. And he equated what we can do to maybe only one habit that people may have, smoking, that will do a better job in saving these carriers money. And all the science is there, Jonathan, we know, we’ve seen the studies, we have the science. Oh, I’m over that. It’s like, now I’ve got to get them to believe the science and studies. We have studies from the Mayo Clinic. We have studies from the New York Medicaid system where you are we have studies all around the world, thousands of them, thousands. We don’t need any more studies showing that you guys help reduce costs and help improve care we don’t need anymore. We just got to get them to go, oh, okay.

Jonathan Levine:
Right.

Mariya Filipova:
I actually think it’s a bit more like, the first step is, aha, okay, wow. But the next step, Steve, and that’s what I was asking you about, it needs to be easy to do something about. It needs to be easy to operationalize it. That’s why what you’ve built in PDS is what is pretty unique, because the ability to refer a patient who is either high risk or undiagnosed diabetic, to refer them somewhere where you’re not just telling the patient and leaving it in their hands to say, go check in with your PCP. What if they don’t have a PCP? What if they don’t? They’re uninsured, underinsured. And so we have to be able to connect the dots because that’s where most of the lapses in care happen. And so I don’t want to lose two things that came up in the last five minutes of the conversation. You heard it here first, folks. The dental team is part of the overall care team, and the two most immediate measures, if we’re talking numbers here, are reducing total cost of care, and we’ve seen that in total cost of care when it comes to treatments or conditions like diabetes, hypertension, cardiovascular, high-risk pregnancies, we see the numbers. Sleep, diagnosing obstructive sleep apnea and treating in the, or on the dental side with an oral appliance therapy. All of these conditions you could track, to your point, Stephen. Literature tells us that there’s savings to be made on a total cost of care perspective. Now it’s up to us, our leaders, our listeners, us, the folks on the call, to actually do something, operationalize all those clinical insights. And the other thing is you nailed it when you talked about. So the bottom, one is reducing the cost of Jonathan’s favorite mission, How do we get this runaway train under control? And number two is increasing the revenue side. Because if you have as a plan, if you have higher star ranking, that translates in higher reimbursement rates from CMS. And so on both sides, both on the top line and the bottom line, there is a very meaningful connection on where doing the right thing also allows you to do well financially.

Stephen Thorne:
You’re nailing it. There is the money not only star rating, but the acuity level or the patient, right?

Mariya Filipova:
Stratify patients by risk. That’s right.

Stephen Thorne:
So in our integrated practices, where we have either a nurse practitioner or physician, so the dentist does an assessment, let’s take he has diabetes. We did we do A1c testing now in about 100 of our offices. So say the elevated A1c as a patient. Where did you know your A1c is very elevated? No, I didn’t know that. Refer over, the patient if the patient is on that plan, and we caught it early, now we help that plan get a better reimbursement, okay?

Mariya Filipova:
That’s right.

Stephen Thorne:
And we help them that hopefully, the patient gives them the better star rating through press …, which is what we use. And then the medical team, at the end of the year, shares in that value-based revenue stream. That’s how the system works. So it’s creating the alignment with everybody. Now, what’s not there yet, it is there for us because we own both, but what’s not there yet is that reimbursement back to the dentist. That’s what we have to get. So the dentist should share in that … revenue to some degree. So you asked about, we can’t do it all fee-for-service. There has to be some fee-for-service component, but then an alignment around the savings so it’s in that dentist’s head, If I intervene early and get the, make the referral at the end of the year or end of the six months, however, the contract works, they share in that profit.

Mariya Filipova:
That’s right. Steve, do you guys do anything in redirecting and avoiding ED admissions or readmissions? Because that’s another area that’s very rich for.

Stephen Thorne:
Yeah, we haven’t got quite that far yet. We’re, yes, we’ll get there. We will get there for sure.

Mariya Filipova:
Over half a billion of ED admissions or admissions of folks who present with oral pain. Not much can be done in the ED if you present with oral pain.

Stephen Thorne:
If you look back at the beginning at COVID, there was a massive campaign in the United States. Actually, it went virtual around the world, around staying out of the ER room. Go see your dentist for your pain, and you can track back who started that campaign.

Jonathan Levine:
There you go. There you go. I think we’re looking at him, and the science came out. If you have periodontal disease, you are five times more likely to end up on a ventilator. So people’s awareness of the importance of controlling inflammation of the mouth, I think, is probably at the highest level that, than it’s ever been. And as you were saying, Stephen, the science is so big, thousands and thousands of studies understanding that the body is a complete ecosystem and that the mouth, the inflammation of the mouth and the pathogens of the mouth, number one, helps seed the gut and help and cause really the issues of a leaky gut, and the science of a leaky gut where these pathogens get into the rest of the body, it’s the same thing in a leaky gut.

Stephen Thorne:
It is.

Jonathan Levine:
Though our systems, they’re all connected, similar mechanisms.

Stephen Thorne:
So there are studies that, there’s a couple different studies that now proven out which bacteria embed in our arteries to cause, that are causal to cardiovascular disease and which ones, and we can help you.

Jonathan Levine:
The latest study came out with rheumatoid arthritis where we had a our, the researcher on that on our podcast, Dana, and she’s at Rockefeller, and they were taking the bloods on a weekly basis in people with periodontal disease and testing it for PG. And PG proved to increase the likelihood of rheumatoid arthritis with elevated PG in their blood from the blood tests. And it’s just one more connection of the, right, now 58 systemic inflammatory diseases directly related to inflammation of the mouth. But it’s so important for business leaders like yourself to take action because it’s taking this action, creating the, these proof points to say let’s connect the dots. We will have a more efficient system, but at the end of the day, we’re going to have a much healthier America. And I greatly share, I think, as we get older, the desire to have that legacy and to really help people and help the chosen profession that we’ve gotten involved in. I love that you do that.

Stephen Thorne:
Yeah, and on a second that I think you’re spot on. There’s some some things that are happening that are causing this massive shift too, right? Aging population, in the next 16 years, we’re going to see a 49% increase of people over 65. And I know you and I are getting, we’re not quite there, but we’re getting there. So this aging population, that’s happening. So oral health you said earlier oral health awareness is probably an all-time high. My opinion I don’t have the data on this, is that it is at an all-time high since I’ve been in this in 35 years. And then the tipping point of over 50% of seniors now on Medicare Advantage plans for Medicare fee-for-service. So I think that’s driving a lot of this behavioral change, and we’re feeling it because we’re getting, our phone is ringing off the hook from these groups that want to partner to help where we they know we can intervene early because that’s what it’s all about for them, and we can help raise their scores. And lastly, identify the acuity level that has to go through the physician side, but we can do the assessment.

Jonathan Levine:
Yeah, amazing. Yeah, …, I don’t know about you, but talking to Steve, I have tremendous hope that there’s going to be this wonderful, positive wave of connecting these dots between, as they would call them, mouth-body connection or oral systemic medicine so that people’s awareness increases, our delivery of care improves, dentistry becomes part of medicine, healthcare costs go way down: we save so much money downstream because of these upstream wellness and early diagnostic approach by connecting the professions of medicine and dentistry. I’m very inspired by Stephen, by listening to what you’re doing over at PDS, and what you’re personally so inspired. It’s inspiring for, I think all of our listeners. What would you say, Mariya?

Mariya Filipova:
I’d love to pick up on this note and note of hope in, knowing me, you wouldn’t be surprised if I’d like to add a bit of urgency to it. We are inspired, we’re hopeful, but hopefully, also our listeners are picking up on all the nuggets of call-to-action items that Steve planted over the course of our conversation. If you are a dental school, a dean of dental school, and you are not part of those early adopters, or the list of 18 that are already signed up on being part of that medical record system tracking and integrating medical dental records, please consider getting involved. If you are a dentist who is practicing dentistry and is concerned or aware of the potential of helping patients and really treating the whole person in the chair, not only the mouth, please get involved. And if you’re a patient who happens to be listening to our podcast right now, please ask your dentist about your sleep, about your heart health, about your lung health, about your brain health. Your dentist might have an answer or recommendation, and if not, then you probably want to consider if that’s the right dentist for you. That’s my personal opinion. And so, with that note of hope and urgency, Steve, is there any other call to action on your end that you would want our listeners to be aware of?

Stephen Thorne:
Yes, there are. So in this area, dentists should be on the panels of all the medical plans. It should not be excluded from that. And that’s a, I think that’s a simple change for these carriers. I don’t care what plan. And then, dentists should play a part in Medicare Advantage.

Mariya Filipova:
That’s right.

Jonathan Levine:
They should be on those panels.

Mariya Filipova:
That’s a very tactical note, yeah.

Stephen Thorne:
Very, those two are, I think, the easy low-hanging fruit to get dentists involved in the overall health of patients and get the reimbursement they do deserve for doing that.

Mariya Filipova:
Absolutely. You heard it here, folks. On that happy note, yes, thank you for being part of this conversation. This is just the beginning. And let’s roll up the sleeves and get to it.

Stephen Thorne:
Let’s do it. Thank you.

Jonathan Levine:
Stephen. Thank you so much for joining us. This was fantastic.

Stephen Thorne:
Yeah. Hopefully, it’s good and we’ll see you soon Jonathan.

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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