Building a Consumer-Focused Oral Healthcare Industry – Dr. Jeremy Krell and Dr. Ro Parikh, Dental Industry Leaders

Shiv Gaglani: Hi, I'm Shiv Gaglani. It seems like there's always a lot of change happening in the oral health space, with constantly evolving technology and business models— including direct-consumer, which we've talked about previously on Raise the Line. Well, we have two dentists with us today who are also business leaders in the industry to discuss what's new, what's ahead, and how the industry has been impacted by COVID. I'm particularly interested in hearing about the role of digital health and innovative consumer-centric models in dentistry.

I'm happy to welcome Dr. Jeremy Krell, a longtime investor and entrepreneur, who's currently managing partner at Revere Partners, the first ever venture fund focused on oral health. And Dr. Ro Parikh, who was recently named president at dntl bar in New York City, and who was previously the head of dentistry at Walmart Health. Ro is also an associate at Revere Partners. So, Jeremy and Ro, thanks so much for taking time to be with us today.

Dr. Jeremy Krell: Thank you so much for having us.

Dr. Ro Parikh: Thanks for having us.

Shiv Gaglani: You both are obviously trained as dentists and now are business leaders, and I know a lot about you and your background. But for our audience, many of whom are currently in dental school or pre-dental—obviously in other health professions, too—can you share what drew each of you to dentistry, and then some career highlights? Let's start with you Jeremy, and then go to you, Ro.

Dr. Jeremy Krell: Yeah, sure. I'm Jeremy, I'm a general dentist. I have been so for the better part of the last decade. I went to Tufts Dental School and I come from a medical family—nobody in dentistry—and saw the need for a lot of change in dentistry, and it was an attractive space, for me to both be able to get the patient care aspect, but also be able to work on the technology side. I had an entrepreneurial itch from an early age. I have about 18 years of startup experience and an MBA. I started in tech, and then to health tech, and then to oral tech.

Some of the companies in my background include Oscar Health which had an IPO, as well as Quip which just did a Series B. And then my own management consulting firm, the Barchester Bay Group, and now Revere Partners. Sort of an alternative career track. Although I do have several dental offices, I also am now 100 percent focused on the business side of dentistry. I'm a what they call a "dry finger dentist."

Shiv Gaglani: I remember when we spoke before you came on the podcast, you introduced me to that term, "dry finger dentist," which is pretty funny and interesting. For anyone who's listening who doesn't know that term, could you explain what that is? And then we'll go over to you Ro for your background.

Dr. Jeremy Krell: Yeah, this is sort of a mockery of the '70s or so, when dentists actually would not always wear gloves. Everybody was a wet finger dentist, right? They treat patients, meaning their fingers were actually wet. And then slowly, gloves became part of the safety and compliance norm, first with individual finger gloves, and then full hand gloves. Now, a "dry finger dentist" has become one that does not practice—sort of a funny shift in the name.

Dr. Ro Parikh: I'm Roshan Parikh—Ro—also a "dry finger dentist."  I'm born and raised in Chicago. I went to dental school at UIC College of Dentistry. I went to business school before dental school. My whole career I've always thought about the value proposition for the patient versus for the doctor. The first office that I purchased in 2008, I extended the hours, added additional providers, made the facility larger, and started to have some success during a period of time in our country when it was a recession, but I didn't know that because I graduated with a whole bunch of student loan debt. I was growing that and added a specialty and had a few other offices that I started to acquire over the next few years, and had myself a little group, and had some private equity capital infusion, and grew a DSO in Chicago which is now 35 locations. 

I stepped away to do some advisory and consulting work. When I was starting to do that and got the business up and running in 2019, Walmart approached me about being head of dentistry for Walmart Health, and I couldn't pass up the opportunity. I joined Walmart in 2019 and was there until 2021 as we were building out Walmart Health, which is now in four states. I left there and went back to advisory and consulting work. I worked with Jeremy and the Revere team. And then, I started to learn more about a group in New York called dntl bar, some great patient experience, doctor experience, and retail healthcare. So now I have a new operational role as president of dntl bar in New York, albeit while I live in Atlanta.

Shiv Gaglani: It's very exciting and reminds me of how we first got in touch, Ro. As you know, my sister, Dr. Anushka Gaglani, who we've had on the podcast, is running her own DSO with my brother-in-law, Dr. Abhishek Nagaraj. She went to UIC Dental, I think with your brother, or she knows your brother as well. And then when you worked at Walmart Dental we got connected probably through Marcus Osborne, who also has been on the podcast as well. It's a very impressive career for both of you. And you've had a front-row seat, both as practicing dentist who then have been very successful in business.

Let's go into some of the broad trends that you're seeing in dentistry. Obviously pretty much everyone who's listening this podcast at least has a mouth, so at least consumes some sort of dental tech or goes to the dentist, hopefully regularly, so they could at least be consumers of products you're building or investing in. Many of them are actually in dental school. We work with several dozen schools at Osmosis and do dental education too. 

Let's stick with you first, Ro, and then go to you, Jeremy. What are some of the big picture changes you've seen over the last say, five, ten years, or other things that maybe accelerated because of Covid—things that you think our audience should know are happening. We mentioned direct-to-consumer, telehealth, customer centricity. These are some things we've seen across the podcast, but in your own words, what are some things that you're most excited about changing?

Dr. Ro Parikh: Yeah, I think over the last five to ten years you've seen more and more consolidation in dentistry. It's a cousin, or a distant cousin to medicine, so you've seen a lot of consolidation and growth in terms of number of groups, number of groups that have institutional capital and backing from private equity funds. With that, I think that we see more and more sophistication in terms of dental groups and DSOs. And then the sophistication, a lot of it is as much focused around the human sophistication as it is using technology to make a more seamless and a better patient experience, or a better provider experience. 

I think we're seeing more and more technology in dentistry and oral tech, which, I know, Jeremy will talk about even more. That is very interesting to me. And then, if you accelerate throughout Covid and the pandemic, I think that money value of time has its highest currency value that it's ever had. People are looking: at how do I—the same way that we're in three different states and we're communicating today—how do I see my physician or my dentist in a tele-way? Because it's what I want and what I'm used to. I was surprised that my mom knew how to use a QR code and now she's fluent in it.

Shiv Gaglani: Yeah, that's a great point and it seems like it's become a must-have, and people, different groups that had been left behind by technology, it became a necessity it seemed during the pandemic. One of our investors, a guy named Alan Patricof, and his whole fund, Primetime Partners, focuses on technology for elderly, and it has become table stakes for a lot of people who are over 60, 70, 80 at this point. But Jeremy, sorry, I interrupted, go ahead. What were you about to add?

Dr. Jeremy Krell: No, I interrupted. I was going to say, you mentioned the QR code. It's seeing its heyday right now because the restaurant industry has kind of ditched the paper menu. On to the QR code. I saw an article the other day. That is the official launch of the QR code. It's seeing more usage than it ever has because of restaurant menus.

Shiv Gaglani: That's a really good point, I got to check out that article. That's actually a good segue into the work you do. I know when we connected before and I brought you onto the podcast, I was really impressed with your pedigree: Oscar Health, Quip, some of these leading brands in consumer health, or consumer-centric healthcare and digital health. And then Revere Partners, all the things you're doing there... Maybe you can give us a bit of background on Revere, and then also answer the question around trends you're seeing in the space that have been accelerated by Covid.

Dr. Jeremy Krell: Yeah, absolutely. Revere is kind of the first and only VC fund in oral health. Its global. We launched the fund in early 2021. We were in stealth mode for about 18 to 20 months prior to that. So baout a two to three year-old fund. 

The fund has done three major accomplishments to date. First and foremost, research: We've created this huge database of early-stage oral health transactions. They tell us how startups in this space perform in a statistically significant way. Second, we built this world-class team of about 75 dental leaders, inclusive of Ro. And in addition to that, we went and fund raised and structured the fund in a very creative way where it stays open, which allows us for ultimate flexibility in what we do. We invest in—we say—anything oral tech, or anything inside the four walls of the practice. And we look at deals that are seed, Series A, post-Series A stage, as long as they have an application to oral health.

In terms of trends, there's no right way to answer this question. But I see at least six major buckets. One of them would be software, right? A lot goes in there. But think AI for dentistry is one. Or patient engagement tools that live in that digital ecosystem. 

The next area, biotech, also can include a lot of things: Think 3D printers, think implants. 

Third is this area of consumer products. Think up-market premium products, direct consumer and doctor-driven models. Think Quip. 

And then you see, this area of fin-tech, pay-tech, insure-tech, if you will. Things that help that process, help meet consumer demands and how we can pay and do it of affordably, finance things and afford things in dentistry. 

There's this fifth area around access to care and prevention, which can be also anything from digital to physical diagnostics. 

And then lastly would be oral systemic health links—these areas where dentistry crosses with the rest of the body and our health. Whether that is our brain health and neuromuscular health. Whether it's our cardiac health. The list goes on from there in terms of really proven linkages between the two.

I think two high-level things to look at in oral health this year—and these are these are not necessarily tech buckets per se, they're more sort of philosophical and industry goals: I think one is, we really need to heavily even the playing field in terms of the resources that different groups within our profession are seeing. I call these the PGTOs, this term I learned recently, the Power Groups Targeted for Oppression, right? The women in our industry. In addition to that, the LGBTQ community. You have true minorities, right? Dentistry is a laggard in some ways even though there's so much innovation. Some of these groups really are impacted by the lack of resources amplified to them. 

I think the other area is... everybody thinks of, off the top of their cuff, some of the tech buckets that I mentioned before, because they're sexy. Because they're quick returners. We sometimes leave out the technologies that have a really significant clinical trial pathway or regulatory pathway. These things can be groundbreaking. They just take a while. They take a lot of resources and sometimes they're involving the non-sexy back end, the plumbing, so to speak, of how the dental office works. And I think those are just as important as those more front-facing intuitive tech buckets, or startup buckets if you will. That's how I would capture the industry. and where it is today, and where it's going.

Shiv Gaglani: That's really, really great. Very insightful, thanks for that. And it reminds me of one of my favorite Raise the Line podcast episodes, with Dr. Richard Park, who is in New York. He runs a Ascend Partners and helped scale out urgent-care centers across New York. And he made two points that echo what you're saying, Jeremy. 

His new company through Ascend Partners is Rendr Care. It's about: how do we provide the best primary care experience to traditionally underrepresented groups in, like, Chinatowns across different urban centers. Not necessarily native English speakers. Not very high income necessarily as well. But how do we create an experience for them? They have higher rates of hepatitis B and other conditions. It speaks to your diversity equity and inclusion aspect there Jeremy

Second is the less sexy things, right? Like, the reason they were able to scale the urgent care centers everywhere was that they realize that that most physicians were just not even doing standard of care, right? Like they had some physicians who, when somebody came in, they would send 2 percent of their patient population to the ER, and others who would send 20 percent. It's a 10x magnitude difference, the less sexy things of just getting people to follow the guidelines and checklists were actually the things that led to the most growth and most improvement in health outcomes that he found. 

Similarly, I think we all get very caught up and excited about things like the metaverse and we overestimate the impact those things will have in the short term and eventually underestimate the impact in the long term, so hose are really good points. 

Moving back to you Ro because you've worked in leadership roles now at some of these leading companies, Walmart Dentistry and now dntl bar, can you talk to us a bit about both of those experiences, and how the landscape has shifted there? Plus what you're most excited about with dntl bar. I've only heard about it once you became president of it.

Dr. Ro Parikh: Yeah. I mean, when you're maybe two ends of the spectrum... I think Walmart Health and Wellness is 75 thousand employees. But Walmart Health wanted to solve the access to care problem or help in their own way. When dental or primary care, optometry, audiology... taking advantage of the 160 million Americans that go to Walmart every week, and out of that, I think the average person goes two times a week. 

From that, it's like how do you... if that's already something that's in their routine of where they go, what can you do to have convenient hours, convenient services, and transparent pricing? That experience was, I mean, phenomenal being able to start from the ground up when we didn't have anything in dental to having 20 plus sites now. It was such a neat experience. We were working also at Walmart Health looking at the mouth as a part of the whole body and if you needed a medical clearance, you could go down the hall and there was your primary care or primary care physician that can look at the blood pressure and look to sign off on it so that you can take out an infected tooth.

Those things made it very interesting and very fruitful. We were starting to look at, like, when you look at Walmart and look at the inside like the retail box, what does the oral healthcare aisle of the future look like? We've all been to Walmart, Walgreens, a CVS, a Duane Reade, and you stand in that oral health care aisle and two out of three of us are dentists. And if I forgot my toothbrush somewhere or didn't know what toothpaste to buy like, I mean, there's so many choices. There's way too many.

Looking at the oral health care aisle of the future and how much more consultative it could be or looking to use your own metrics and make it more personalized—that care model, I think, makes a lot of sense. And even on the consumer side I think it makes a lot of sense. That experience had multiple facets—so interesting—and then going from that to being a part of a start-up like dntl bar that has four locations right now in Manhattan, street-level visibility... Our Chelsea location is on 26th and 6th and it gets hundred thousand eyeballs of just people walking by a day, so it's like going from a juggernaut and a Fortune 1 company like Walmart, and using a lot of that experience plus my clinical experience to then focus on a start-up is definitely two different sides of the spectrum, but obviously very applicable because at the center of all of it is patients and patient care.

Shiv Gaglani: That's definitely exciting. And understanding how retail intersects with the consultative aspects... We've seen that with Apple, the probably most successful example of a retail strategy that became very consultative and led to great brand loyalty. Clearly seeing what dntl bar, and what consumer-centric, patient-first companies like that can be doing to make people more connected to their oral health.,, because as Jeremy was mentioning, hopefully most of our learners at this point know that there are proven linkages between your oral health and your cardiovascular health and your microbiome health, and all sorts of other aspects, and we're just at the beginning of some of that research too, which would be very exciting. 

I have two more questions for each of you. The first is, given that our audience is primarily current and future health care professionals, many of whom are in dentistry, what advice would you give them about meeting the challenges of the Covid pandemic and beyond, and just approaching their career in healthcare and business, dry finger dentistry, if that's what they choose, etcetera. And maybe we'll start with you Jeremy and then go to you Ro.

Dr. Jeremy Krell: Yeah, I think you really need to look at where the industry is going. There's an article that predicts—kind of 2022 projections on our Revere PartnersVC.com website under resources—and we talked about a few key areas there, right? These are backed by dental-tech startups as well. One of them is alleviating burnout through innovation. Staffing in an office. Everything from recruitment to retention to training and implementation. These are difficult areas, right? There's a great resignation going on right now, right? 

And so it's important that you think about what is that balance in your work? What's going to be satisfying, what is sustainable for you, and how are you going to sustain that in your office? These are new norms, kind of post-Covid. Another is, what tools can help in areas that we're otherwise sitting there, spending lots of inefficient time in the operational throughput of a practice? One of them mentioned on this call already is, more AI tools, right? Look for areas where you can work smarter not harder, and how that affects your clinical practice post-Covid. 

How do we reach patients, right? We know that they're not coming into the office. Covid has only amplified that. They're fearful of coming in. It's another excuse not to be there. What are the high-tech solutions that can help us reach a broader audience, right? What are the different models? Is it mobile dentistry, is it telling tele-dentistry? Is it some kind of niche used cases of those that help bring our care to more people, or more people to our care but in a different way? 

And maybe last but not least, more and more I think there's acceptance of viewing oral care in the context of improved medical outcomes. What are some solutions that can deliver truly mouth and body value adds to the patient, where we can we tell them something about their saliva, their genetics? Can we diagnose things, but not just diagnose them. Can we actually give them a way to treat that problem? I think those areas are really the future.

Shiv Gaglani: Totally. That makes a lot of sense. And I love how you pose those questions because if you're a student listening to this right now, the practice environment and the consumer health environment you're going to be graduating into is very different now, or in five years than it was ten years ago. It's like not your dad's or mother's dentistry. 

Just asking yourself those questions, at least one or two of the questions, Jeremy just pose, I think is very productive. It could lead to you maybe forming a business that then Jeremy and Ro invest in through Revere Partners, so definitely keep your eyes and ears open to that. How about you, Ro? What advice would you give to our audience?

Dr. Ro Parikh: Mine is going to be far on the qualitative side. I think that as much as like our oral tech in our world is spinning as fast as it is, I really think that networking and goodwill matters. When you find mentors, whether it's inside of your university or the first group that you join, being able to use that mentorship and networking, I think is just as valuable, if not more valuable now, being in a hybridized environment. 

A lot of the dental students that I help mentor, I tell them, you should get to a conference, or you should mine LinkedIn, and find people that you want to network with. Probably for all three of us, the messages that we get, I mean, we all spend a lot of time wanting to return those messages, because you want to pay it forward. And you want to not only leave the industry in a better place than you found it, but you want that generation to surpass what we're able to do right now.

Shiv Gaglani: I love that advice. It's very close to our heart and again it's how we got connected, right? Through those kind of personal relationships and genuine interest, curiosity, and respect for the work that you guys do and we each do. My last question is: Is there anything else that you'd want our audience to know about you, about Revere, dntl bar, about the industry as a whole, or anything else. Open question. And let's start with you Ro and then end with you Jeremy.

Dr. Ro Parikh: I think that the patient convenience part matters. dntl bar—were open seven days a week, so that retail aspect of healthcare is the broad convenience being for the patient. Even at Walmart Health. We were open seven days a week. It really seems to matter more and more to the patient population because, coming out of Covid, I think that people want to spend more time with their family and less time doing traveling or doing some other things. I think that being more open to knowing that maybe the four best days of the week to work are Thursday Friday, Saturday, Sunday. And having weekdays off. That seems non-traditional if I told my mom that but that. But I know a lot of folks that do that. Providers.

Shiv Gaglani: Yep, that makes sense. And how about you, Jeremy? Final word on anything else you'd like our audience to learn about you, and Revere, etc.

Dr. Jeremy Krell: Yeah, two things: one is to echo Ro, and in closing, this term retail healthcare has become quite popular now. To me as I break that down, wearing both the clinician hat and the business hat, is we as providers need to be able to look up from our clinical workflow, understand that we're running a business, and that were running a business in 2022, and that we need to meet consumer demands, right? Consumers do things in other verticals. You're a consumer, each one of the providers out there is a consumer, right? You know, how you pay for things in other verticals? You know how you like the convenience and how you order things, and how you engage with different platforms and other verticals? Consumers want to see that in oral health care too. 
 

I understand that there are rigid workflows and ways that we're taught to do things. Think outside the box, right? Because, you know, time is a continuum, right? Things are always evolving and so our workflows can also change. I think, in terms of Revere yet, please visit Revere PartnersVC.com. Those interested in investing—if they come in with code, osmosis22, we'll have a discounted fee. Very much looking forward to hearing from the community, and I'm so glad we were able to be here today.

Shiv Gaglani: Likewise Jeremy and Ro, really impressed with everything you've done. And I'm excited to watch the space of oral health care and consumer-driven healthcare in general. 

With that, thank you so much for taking the time to be with us on Raise the Line, and more importantly, for the decades collectively you two have put into improving patient care and raising the line.

Dr. Jeremy Krell: Thank you so much for having us.

Dr. Ro Parikh: Thanks, Shiv.

Shiv Gaglani: Awesome. And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show. And remember to do your part to flatten the curve and Raise the Line. We're all in this together. Take care