A Perfect Match

Great Expressions Dental Centers values growth, but chooses its partners carefully

For Great Expressions Dental Centers, each affiliation with a dental practice or group is unique, says Kurt Harvey, vice president of business development. Even though the dental service organization is focused on growth, it moves forward with an affiliation only if the doctor(s) and Great Expressions are in agreement on what each hopes to accomplish. In most cases, that means the dentist is interested in letting Bloomfield Hills, Mich.-based Great Expressions worry about the business side of dentistry, while the dental professional focuses on patients’ oral health.

“We have a systematic approach built on years of experience and feedback from affiliated doctors,” says Harvey. “That said, every affiliation is a bit different from the last, so we try and tailor the process to help them feel as comfortable as possible. We understand it is a big decision and want them to feel comfortable every step of the way.”

Founded in 1975 as a single practice in Dearborn, Mich., Great Expressions has grown primarily through affiliation ever since. Today, it comprises more than 200 practices in nine states: Connecticut, Florida, Georgia, Massachusetts, Michigan, New Jersey, New York, Ohio and Virginia. Harvey has guided much of that growth since joining Great Expressions in 2006 following a career in public accounting.

Growth is good for the organization and for the dentists whose practices affiliate with it, says Harvey.

“I do feel that there is value in critical mass,” he says. “Healthcare costs, benefits, labs, drugs and supplies, facility costs, technological advances, and several other costs or capital requirements are increasing, yet patients are demanding — more now than ever before — to get both quality care and having it affordable. Our goal is to do just that – provide access to affordable dental care without sacrificing quality or convenience.”

Scale helps doctors handle the pressures that they and their patients face today, he says. “It seems like everything is rising in cost these days, and that includes the healthcare industry. Consumers are becoming even more price-conscious.” In that environment, independent dentists or small groups can find it difficult to keep up with patients’ demands for affordable care and still have money left over to re-invest in the business, or give themselves a fair value for their own services.”

Commitment to communities
Much of Great Expressions’ expansion has occurred through affiliation with groups, ranging from four practices to 40-plus practices. “We believe no other DSO has as much experience successfully integrating groups as GEDC,” he says. “We embrace any group that has a hygiene and general dentistry focus as its core. If they already incorporate orthodontics and specialists into their group as well, that is always welcome.”

Many groups are interested in Great Expressions because of the dental group’s commitment to geographical markets and their communities. “If you look at us on a map, you’ll easily see that we have clusters of GEDC offices within a few miles of one another,” he says. “That is one way practice owners know we will continue to invest and grow in that community with them and ensure that their legacy lives on. We are not simply focused on affiliating with the group and then moving to a different area.”

The regional density of its practices enables Great Expressions to provide a full suite of services in the markets it serves, says Harvey.

“This allows us to have all services within a few minutes of each office, sometimes under the same roof. Our goal is to make it as convenient for the patient to get the care they need from a doctor they can trust. It also gives our doctors confidence that when they refer a patient, the doctor they are referring to is within the GEDC network, so they know their patient is getting the best clinical care possible, and they can be up to date on the patient’s progress.

Its experience with groups aside, Great Expressions has significant experience with affiliating — and will continue to affiliate — with solo practices, says Harvey. “When affiliating with a single-practice location, we tend to look for a general dentist or an orthodontic practice. We work together to understand what the dentist would like to accomplish with their affiliation.”

Typically, if the doctor is looking to transition or retire, he or she has little desire to broaden the services they offer. “In that instance, we offer the ability to take away several business administrative headaches after affiliation, and then begin the transition of new doctor into the practice over a one-to-three-year period,” says Harvey. “This allows for a smooth transition, and ensures their legacy continues on.”

On the other hand, if the doctor wants to shed the administrative headaches of running a practice, and instead wants to see more patients and/or broaden his or her services, Great Expressions can accommodate those goals as well, he adds.

Worry less, focus more
The speed with which an affiliation is consummated depends on the doctor, says Harvey. “If they’ve just started thinking about affiliating, it could take up to one or two years before they are ready to move forward. We move at the doctor’s pace to ensure they are truly comfortable and ready.”

For group deals, an ideal affiliation is one that is similar culturally to GEDC, he says. “If the group affiliation opportunity is in a new market for GEDC, an ideal affiliation is one with a strong leader that has a great base of practices in that market already. If a solo practice, an ideal affiliation is with a reputable general or orthodontic practice within, or a natural extension of, our existing markets.

“Any doctor or group that is reputable and provides great clinical treatment, but wants to be relieved of the administrative headaches of the business, is a great candidate.”

Regardless of whether one is talking about a new graduate or a doctor with 20-plus years of experience, Great Expressions offers them the opportunity to “worry less and focus more,” says Harvey.

“We know that being a successful doctor requires education, commitment, time and dedication. And if you own an individual practice, you are constantly required to be on top of the business of dentistry, such as managing an office, paying bills, checking dental claims, handling team member issues…just to name a few. This is the same for a new doctor who started their own practice or a doctor with 20-plus years owning their own practice. Our goal is to affiliate so the doctor can focus on patient care. Their motivation is to get back to being a doctor.”

New graduates may be more focused on career growth. Great Expressions can accommodate that desire with its doctor study clubs, GEDC University and a well-vetted, formal career path, says Harvey.

“For doctors with 20-plus years, they too are looking to learn and grow, but more important, they are looking to get back what they invested, and possibly transition into retirement. In either situation, doctors are always looking out for their team members, and we understand that 100 percent.”

Great Expressions offers all of its doctors membership to the American Dental Association and their respective state dental associations. All orthodontists are offered membership in the American Association of Orthodontists.

Misconceptions and fears
Some dentists have fears or misconceptions about dental service organizations prior to affiliating, says Harvey.

“The preconceptions are the typical myths about DSOs,” he says. “Unfortunately, some students are taught that DSOs are not about patient care and are about revenue only. This is unfortunate, because our model makes patient care affordable for everyone, we participate with all insurances, and even have a discounted dental plan. [O]ur talented doctors and team members put the patients’ needs first.”

Some doctors fear that Great Expressions will dictate clinical treatment following affiliation. That’s not true, says Harvey. “Every state’s dental laws delineate between matters that are ‘clinical’ and ‘non-clinical.’ How the dentist-owner of a practice chooses to handle administrative needs is left to that doctor. The doctor could choose to manage the non-clinical aspects themselves through several sources as they have been (their own time spent directly, managing several various vendors themselves, etc) or outsource those to a single management source, like a DSO. Regardless of how a dentist chooses to address the administrative needs, the decision has no bearing on how the dentist addresses patient care in the practice.”

Nor does Great Expressions have any desire to “clean house” post-affiliation, as some doctors may fear. “GEDC provides business support to practices, thereby allowing doctors and their teams the ability to focus on better personalized patient care,” says Harvey. “As such, we help the doctor understand that his or her team is as important to us as they are to the doctor. Our affiliation process ensures we agree with the doctor on the plan to ensure the team continues to drive the practice with the doctor, and our added support helps sustain the doctor’s legacy.”

Perhaps the biggest fear facing doctors contemplating affiliating with a dental service organization is that of change itself, says Harvey. And that’s understandable. “Many doctors are entrepreneurs in nearly every sense of the word. After operating in that environment for 20 to 30 years or more, switching from managing several functions themselves to outsourcing many of those non-clinical functions in their entirety to GEDC is a ‘change.’

“[W]e understand that change can sometimes make people uncomfortable, so we openly solicit the doctor’s particular concerns up-front. Then we work with the doctor to help alleviate their particular concerns and show there are not roadblocks, but actually opportunities to agree on the best plan forward. Each doctor or group and situation is unique, and we have had success adapting and executing under numerous varied circumstances.”

Sealing the deal
If the doctor or group has been exploring affiliation for awhile and is mentally prepared to move ahead, the deal can be consummated is as few as 30 to 90 days, says Harvey. Key steps in the GEDC affiliation process include:

  • Initial call or contact to understand the doctor’s goals.
  • Initial face-to-face meeting, which often includes touring the practice(s) and community, and providing the doctor with more in-depth information about GEDC to ensure their combined goals will align.
  • Continuous contact until the doctor is comfortable knowing that Great Expressions will help achieve the doctor’s goals.

Once the doctor is comfortable, Great Expressions requests detailed financial and other operational information, and performs its initial analysis, explains Harvey. “We provide an indication of value letter with potential terms, and solicit feedback from the doctor in order to discuss openly any areas that need further alignment.” Once the two come to an agreement, Great Expressions provides a formal offer letter or letter of intent outlining the terms and economics of the transaction.

“Once signed, we perform final diligence, draft formal agreements, and finalize with the doctor the best post-affiliation transition plan. Finally, we affiliate and execute together on the agreed plan.”

Ideally, the practice undergoes a transformation in the first year following the signed agreement, says Harvey. “The simplest way to put it is this: The doctor and team have asked us to provide all the business support side, and the transition from that standpoint has been implemented and integrated. The office itself will feel they have time, more resources, and more support to focus on patient care, vs. having to deal with the payables, cash posting, equipment maintenance, even small things. The doctors themselves realize they don’t have to be the go-to person anymore for the administrative tasks.”

Mustering the forces
Dental service organizations face a key challenge: Ensuring that affiliated practices stay focused on the mission to provide affordable patient care without sacrificing quality or convenience. Great Expressions Dental Centers has built the infrastructure to support its growth, says Vice President of Business Development Kurt Harvey. This includes:

  • National Doctor Panel, which oversees and trains the DSO’s nationally recognized dental professionals.
  • Affiliation onboarding process, which addresses everything from benefits and how doctors will get paid, to new systems and whom to contact for operational support.
  • GEDC University. “We put a premium on continuing education, and we want to ensure dental care professionals stay on the cutting edge of their respective fields,” says Harvey. “For example, last year we introduced Invisalign®, and are continually holding training seminars to assure all doctors are comfortable with the technology.”
  • In-market operations support. Given its density in given markets, Great Expressions offices have operations support that can help them through the affiliation process, and help them manage their day-to-day business, says Harvey.
  • Marketing. “Since we are commonly branded, people in the community know GEDC,” he says. “That concept is working its way into office design – enhancing the patient flow and helping support the mission and culture of GEDC, both in the office and in the community. We want to solve patients’ problems by making dental care affordable and convenient.”
  • Clinical partners, who hold daily office huddles and are a resource for any clinician who needs assistance

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