Patient Prism Interviews Elliot Zibel at DEO 2021

December 2021

How Select Dental Management Powered Through the Pandemic and Grew Stronger 

Elliot Zibel co-founded Select Dental Management with his lifelong friend Dr. Jonathan Mason in 2018. Over the last four years, the DSO has grown to forty affiliated dental practices. When Amol Nirgudkar, the co-founder and CEO of Patient Prism, interviewed Zibel at the 2021 DEO Fall Summit, it was especially energizing to learn how Select Dental Management is leveraging the Patient Prism AI technology platform to improve same store growth and scale.

Nirgudkar: You started in 2018 and grew. Obviously, like everyone else, you went through 2020 and started growing again in 2021. What are the lessons that you learned in 2020 through the pandemic? I know you had time, like I did, to work on your business and think about what you could do better.

Zibel: In hindsight, COVID is probably the best thing that happened for our business, although it certainly didn't feel that way at the time. COVID enabled us to focus internally on building sustainable processes and systems and making sure we were all on board with the same vision. We came to a deeper understanding of where we were trying to go. 

COVID forced us all, as a leadership team, to work together and solve problems and then define what we wanted to be when we grow up. I had gotten to the point where I couldn’t do everything myself, so we built the team out and developed strong leadership.

This is a common path for entrepreneurs. You think you can do everything and you think you can do it well. But at some point, to be able to scale, you need to empower people and have a great team around you. Fortunately, we came out of COVID with clarity and retained almost 100% of our team. Our volumes came back very quickly, so we were able to grow.

Retaining Dental Teams

Nirgudkar: One of the secrets to success for organizations that have really thrived in 2021, is their ability to retain their teams and inspire them. The demand for dentistry has exceeded supply of operatories, dentists, dental hygienists, dental assistants, and other team members. The fact that you were able to retain most of your team members speaks volumes about the success of getting everyone enthusiastically onboard with the vision, mission, and core values of Select Dental.

Zibel: Our affiliated doctor-partners have run successful practices, and they have long tenured employees. Our job is to support them and to help them provide better patient experience and care. I think that we've done a good job of preserving the identity of their individual practices and challenging them to grow and improve. 

At the end of the day, people want to feel good about what they're doing. It's all about the patients. There are a lot of other things that happen around providing a great patient experience, but if we understand that we're here to help our patients and everyone understands the "why" behind what we're doing and how it relates back to patients, people can get behind that and feel good about it. 

One of our core values is positive energy from The Energy Bus by Jon Gordon. You have to get rid of those people that are dragging other people down. If you have an environment where people feel good about what they're doing, they like the people they're working with, and they're being fairly compensated and rewarded, you have great retention.

Establishing Alignment

Nirgudkar: What I'm hearing from you is that the glue that binds all the offices that are affiliated with your organization is culture. When you are affiliating people who have built their own systems and culture, how do you align them?

Zibel: I think it really comes down to the selection in the partnership process. I always say to my partners, this is a marriage. We're going to be in this for a long time. We're going to be living under the same roof. We must make sure we fit. We're diligent about making sure everyone understands what our goals are and what we value and then that they are on board with that. 

At first, I was embarrassed to say I wanted to grow. It took me a while to be able to lead with, "We are growth oriented. We want to grow personally, professionally, and at the practice level." I firmly believe in that. Being able to communicate who we are and what we are is what attracts like-minded people.

Having the Growth Conversation with Dentists

Nirgudkar: Having a growth conversation with doctors is different than having a growth conversation at the DSO level where you are the “financial guys.” You’ve got to be able to translate the same store growth conversation into the language that resonates with clinicians. How do you talk about growth without it sounding like some Wall Street guy telling them, "Hey, we’ve got to achieve 20% EBITDA.”

Zibel: What is leadership? Leadership is the ability to influence people. And how do you influence people? By setting a good example, by being trustworthy, and by doing things that they can get behind. 

For us, number one is we have doctors that are partners in all our practices; they maintain substantial ownership. They're the clinical leaders in that practice. Getting their buy-in on things we're doing is critically important. Same thing goes with the practice leader. In my mind, every office needs a strong nonclinical and a strong clinical leader. And we call them leaders. They're not office managers; they're practice leaders.

And then the second component of it is explaining the "why." So, we put it this way, “Here are the leading indicators. You have 62% of your patients scheduled for a future appointment, so 38% are not. Do you think it's good for your patients to not come in regularly for re-care?” 

You ask the questions, you let them answer, and you say, “Okay, if we all agree and want to improve that, then here's how we're going to do it.”

A component of the execution is knowing who is accountable. If you don’t have accountability and you don’t have a good scoreboard, guess what? Nothing happens.

We also always talk about building credibility. Credibility doesn't come overnight. When we partner with the practice, I say to my team, we're starting “six feet under.” Growth is intriguing to me, but not to others. And so, we're building up our credibility, our equity. And then over time, we're able to use that because people understand. 

Again, it goes back to the values and the demonstration that we're here for the patients, we're doing things for the right reasons. Once you do that and people know that you're genuine, they will follow you if you explain the why. Why is it good for the patient? Why is it good for the team? Why is it good for the practice? Why is it good specifically for them?

Nirgudkar: And that's it. You nailed it. That's the secret to changing people's behavior. You can't just go in and tell them, "Okay, well, I need you to produce so many dollars a day." That's not how the conversation should go. The conversation should be around, “What do we think about improving oral health for patients? What do we think about periodontal disease? How do we make sure that our patients are in optimal health?” Once the hygienist buys into that idea then they're going to do everything in their power to make sure that the future appointment is there, the maintenance patients are coming in, and there are people moving into restorative. That's automatically going to happen when you have the buy-in from a patient perspective.

Zibel: Once you have that, I think that it's very easy to identify the opportunities and to execute on them without driving turnover. Once they say, "Hey, we do care about periodontal disease. We care about this." Then I say, "Okay, great. Here's what we're going to do. I'm going to show you the perio percentage visits in your practice versus all of our other practices." 

One of the big advantages that we have as a group is data. I can say, “By the way, here's a practice down the street from you, where 30% of the patients are in perio-related programs. You're at 1%. Would you like to talk to Mary? You can go and shadow Mary for a day, and we'll also get you a refresher education course on perio.” That's where it becomes powerful. They feel like we're all aligned with that patient focus, and the outcome of that is growth. It's reverse engineering in some ways.

How does Select Dental Management leverage technology to help dental practices grow?

Nirgudkar: One of the things we talk about is the value of data and having intelligence. How are you leveraging technology to really give you the right information at the right time to make the right decisions so that you're moving forward?

Zibel: We have talked about how we drive growth, and I think it all ties together. Artificial intelligence like Patient Prism gives us better insights based on information we could have never gotten even a year or two ago. We know now how many new patients are calling, and coming in. We know how many are being retained. If we’re growing a dental practice there are only two ways to do it. It’s a steady recurring model of a growing number of active patients and we need to retain them. Retention of active patients is the first driver. It’s hard to fill up a bucket with a big hole in the bottom. It takes a lot of work. The second driver is new patients. 

Knowing the retention rate of patients by provider, is critically important. “How many patients have been back in the last 6, 12 and 18 months? How many have not?” We can drill down on much more, but that is a metric people can focus on. On the new patient side, there’s excitement around how many new patients each provider has. “How many new patients do you have this month? I've got 25. Oh, you have 25. We're at 40.”

We look at the number of new patients coming into the top of the funnel. Are we answering the calls? Then, if we are answering the calls, are we converting them? And if we’re not converting them, why? So, we leverage Patient Prism to have that information. We use that information not to micromanage our team but to help them understand that you can double new patient growth without spending a dollar. You do that by better answering the phones.

Another component is level of care per patient. Production and collections are outcomes of providing the care that our patients need. If we can't drive active patient growth, we're not going to ever be able to sustainably grow our practice.

What does Zibel bring to the table? Actionable data.

Nirgudkar: How did your time in private equity and hedge fund management prepare you to run a dental support organization?

Zibel: For the past 15 years I've been analyzing companies and businesses. What I can bring to the table is the analytics. They make what is happening visible and understandable in a granular way. By providing that information to the partners, they can create action to address shortcomings.

What you can't measure, you can't manage. Patient Prism monitors patient calls and conversions coming out of our marketing. If I couldn’t measure marketing ROI in a channel, I couldn’t know what we are doing right--even if we're successful. Maybe we should be spending more money on this channel. Maybe we should be spending less. But if I don’t know objectively what is happening, I can’t intelligently adjust.

Nirgudkar: You've taken the Wall Street in you and humanized it in a way that it motivates people to be their best selves in terms of the care that they're going to deliver to patients. And that's beautiful. I'm excited to see you grow over the next few years, and we're excited at Patient Prism to partner with you. We really appreciate your business and what you're doing in this industry to change people's lives.

Zibel: I feel the same. We don't grow if our patients aren't getting better care and better outcomes. Everyone is genuinely focused on improving access to care and quality of care, so it's been enjoyable. I’ve had a great time being in this industry versus my hedge fund life.

About Elliot Zibel:

Elliot Zibel co-founded Select Dental Management with his lifelong friend Dr. Jonathan Mason in 2018. He manages all non-clinical aspects of practice management for practices affiliated with Select including finance, human resources, and marketing. Prior to founding Select, Elliot was an investor and serial entrepreneur. He has invested in and advised startups as well as multi-billion-dollar companies.