Latest / Becker’s Healthcare - Clinical Leadership Podcast / Cyrus Lee, DMD, Chief Executive Officer at Permanente Dental Associates

Transcript

Cyrus Lee, DMD, Chief Executive Officer at Permanente Dental Associates · Becker’s Healthcare - Clinical Leadership Podcast

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  This is s Hatton with the Becker's Dental. So podcast,
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  I'm thrilled to be joined today by Cyrus Lee,
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  c e o of Permanente Dental Associates. Cyrus,
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  thank you so much for being here today.
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  Hello, Riz. Thank you so much for having me today.
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  Well, thank you for joining.
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  Could you start off by introducing yourself and telling us a bit about your
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  background?
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  Of course. Um,
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  my name is Cyrus Lee and I'm the Chief Executive Officer of Permanente Dental
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  Associates. Uh,
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  so we are the dental group for Kaiser Permanente Dental in the Pacific
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  Northwest, so that's specifically Oregon and Southwest Washington.
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  So we provide dental services for Kaiser Dental members out of 21
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  Dental offices. Uh,
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  we are a professional corporation with most of our clinicians as shareholders of
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  our group. So we are dentists owned and led. Uh,
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  we have about 120 general dentists and 35 specialists who represent most of the
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  major specialties, and we also have dens. Um,
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  our program has been continuously accredited for over 30 years by the
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  Accreditation Association for Ambulatory Healthcare.
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  I think we're one of only two dental groups that's accredited by Triple hc.
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  Um, and in 2022, we were named, uh,
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  for our size number one healthiest employer of Oregon,
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  and number one healthiest employer in Washington.
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  And we're also a certified B corporation.
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  So I've been practicing for about, uh, 20 years. I'm a native Oregonian. Uh,
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  but I did spend several years away during my college years and in the military,
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  and I've been, uh, with Kaiser Permanente Dental since 2006. Um,
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  today is actually my 17th year anniversary. Um,
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  so some of my highlights have been in January, 2017, uh,
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  I opened our Cedar Hills Dental and Medical Office, um,
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  which was the first full medical dental integrated office of its kind. Um,
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  now we went to Epic as our EHR in 2016. So,
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  uh, that allowed us to have the first true medical dental integrated office.
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  And, uh, we had things like, we had a nurse dedicated, um,
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  to our dental patients to help them close both preventative care gaps like
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  vaccinations and disease management care gaps, like blood draws for, uh,
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  diabetic patients to monitor their A1C levels. Um,
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  and we also had a physician right there on site, uh, which allowed, um,
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  me to have those in the moment, collaboration on, uh, patient care. So,
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  um, I spent most of my career in the care delivery operations side of the house.
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  And, uh,
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  and then last year I was selected as the fourth executive dental director and
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  chief executive officer of Permanente Dental Associates.
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  Well, thank you. That's great to hear.
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  And congratulations on your 17th year anniversary.
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  Thank you.
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  So my first question for you is,
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  what are the biggest issues you're following in dental right now?
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  Wow. And how, how much time do we have ?
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  This could be an hour long podcast. I mean, there,
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  there are a lot of big issues and, um,
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  I think we're entering a very dynamic time in dentistry, um,
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  really all of healthcare, but I think, uh, really in, in dentistry. So, uh,
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  I tend to group the biggest issues into, um, really three buckets in my mind.
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  Uh, first one is around people.
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  The second one is around technology and care advancement. Um,
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  and then the third one is, uh, regulatory government policy. And then, uh,
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  really overarching and touching on all these areas, of course,
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  is the consolidation of dental practices throughout dentistry, um,
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  which we've seen previously in other areas of healthcare such as pharmacy and
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  physician practices. So, um, big issue around people. Uh,
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  of course right now, front and center for everyone is staffing. Um,
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  there aren't enough dental assistance. Uh,
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  there aren't enough dental hygienists and, you know, um,
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  riz when you look at enrollment data, uh,
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  comparing pre-doctoral dental students with dental hygiene and dental
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  assistant students. Um, over the past, um, quite a few years actually,
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  the number of dental students has been going up and is projected to continue
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  going up for another few years, uh,
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  with the opening of new schools and some, uh, class size increases.
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  Um, and meanwhile, the number of hygiene students,
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  and especially the number of dental assistant students, has, um,
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  really not been anywhere close to keeping up. Um, and in many cases, um,
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  maybe going down a little bit. So pretty much on, on that macro level, there's,
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  there's more dentists, uh, competing for fewer staff, um,
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  which has only been exacerbated by the years of the pandemic. Um,
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  here in Oregon, there's been some work on legislation for additional funds, uh,
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  about 20 million to expand dental assistant and hygienist training
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  programs. Um, so I'm hopeful that, uh,
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  that we'll get some of those additional funds, uh, for our state. Um,
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  here at Kaiser Permanente,
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  we've started an internal dental assistant training program, um,
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  which are really aimed at those people who are unable to be a full-time dental
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  assistant student, um, because they might be working another job at the time.
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  Um, and then another issue around people, and this is really, uh,
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  more on the dentist side of things, is the cost of dental ed education. Um,
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  the amount of debt these graduates are coming out with is really,
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  really incredible. Um, for me, uh, 20 years ago,
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  the thought of having a six figure debt load was, was really unfathomable,
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  um, which led me to look at the, uh, military scholarship option for me, which,
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  which I, I think is a great way to go,
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  and it was such a great experience for me. But, you know, when we have, um,
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  new dentists, uh, starting out their career, uh,
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  250 to $400,000 or more, um, in the whole,
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  um, there's some big implications, um, to having those kind of, uh,
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  financial pressures. And then, uh, the second, uh,
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  area is really around technology and care advancement. Um,
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  and I think the one that, uh, probably jumps out immediately right now is,
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  uh, that around generative ai, artificial intelligence. Um,
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  so of course this is gonna have major implications everywhere in society, um,
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  including dentistry. So, uh, a couple initial areas, um,
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  in dentistry would be in, uh, radiology such as augmentation,
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  uh, to, um, clinicians', uh, radiographic exam.
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  And then on the payer side of things, um,
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  really using AI technology for utilization and claims review.
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  And I don't know if these things are, you know, necessarily
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  a bad thing or a good thing. Uh,
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  I think what's important in is that there's transparency into what's going into
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  these models, uh, into these models. It's like with, uh,
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  uh, dental lab, uh, cases, you know, uh, junk in, junk out.
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  So we gotta make sure that, uh,
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  the things going in are really appropriate. And then, uh,
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  how much actual, um, human use do we have to,
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  uh, really help inform on how these technologies are gonna be used, um, and,
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  and where is the clinician's voice, um, in that process. Um,
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  another technology care advancement issue, uh,
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  since I'm with Kaiser Permanent Permanente Dental, um,
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  is medical dental integration. Uh, that's a big one.
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  So we've been doing things around medical, dental integration for decades. Um,
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  and, you know,
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  the challenges in healthcare are so big that I don't think we can continue to
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  have these silos between medical and dental.
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  Dental for a lot of people might be their only regular touchpoint in the
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  healthcare system. So, uh,
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  really the question is how can we work as extenders of primary care and continue
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  to elevate our profession as an integrated part of our healthcare system? Uh,
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  and then that kind of brings me that third area, and that's around, uh,
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  government regulatory and, uh, policy.
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  So we know not enough Americans have access to dental care. Uh,
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  there's so much unmet oral health needs.
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  The 2021 Surgeon General's report on oral health in America, um,
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  advances in challenges.
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  It says that while our understanding of oral disease continues to grow, um,
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  too many Americans still suffer from diseases of the mouth, uh,
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  the majority of which are related to oral health disparities.
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  And that really does underscore the intersectionality of social and systemic
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  determinants that can, um,
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  create both advantages and disadvantages with respect to oral health and
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  therefore overall health, um, across a person's lifespan. So,
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  um, getting back to the government regulatory and, uh,
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  policy aspect, the question is, you know, are are there any levers, um,
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  that there's gonna be a, uh, pressures to pull? So, um,
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  some of those things to keep an eye on would be, um, uh,
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  Medicare expansion in the dental. Uh, you know, in, in medical,
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  Medicare is a single biggest payer, um,
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  and that's had a massive effect in the, um, medical space. So if there's ever,
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  uh, any expansion of, uh, this program into dental,
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  those long-term effects would, would really, really, um,
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  be significant over time. Um, and then that around, uh,
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  mid-level providers, you know, I'm, I'm here in Oregon,
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  and so we are a state that just recently, um, has authorized, uh,
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  dental therapists.
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  So there's about a dozen states with at least some level dental, uh,
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  therapies, uh, in some settings. Um, some are more broad and others are more,
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  uh, narrow. So those are all things, uh, definitely worth keeping an eye on,
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  um, from that government regulatory, uh, policy standpoint.
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  Very interesting. Thank you for sharing. My next question for you is,
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  what are you most excited about and what makes you nervous?
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  Yeah, Riz, I think, you know, all those, um, big issues that, that we just, uh,
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  spent a few minutes talking about. Um, it,
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  it's all related to that because I,
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  I do think that as a profession,
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  that there are things that we can do to get more people, uh,
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  to a better state of oral health and therefore, overall health. Um,
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  I think things like true medical, dental integration,
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  clinical advances and technology, um, more people interested and,
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  and being exposed to dentistry as a profession, you know, for such a long time,
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  uh, dentistry has been, um, largely a, a, a legacy influenced,
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  um, profession for people to go into. But, um, now we're seeing, um,
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  more and, uh,
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  more people from all cross sections of society in our communities entering,
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  uh, to profession, which, um,
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  all means that all those things can help us as a profession to, um, uh,
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  get Americans and our communities to that better state of oral health, um,
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  and overall health and, and help, um, with health equity. Um, I also think,
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  uh,
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  a lot of these dynamics and challenges means that the consolidation of
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  practices will continue and, and probably even accelerate a bit moving forward.
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  Um, you know, we talked about the debt load and, and a lot of that, uh,
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  may be driven by, you know, some of the changing demographics of our, um, uh,
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  dental students. Uh, in addition to that, uh,
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  means that fewer dental students are, um,
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  really interested in owning their own practice than 20 or even 10 years ago.
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  Um, and the challenges of owning a practice, um, uh, with the staffing dynamics,
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  the technological investment, um, uh, all, all those things,
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  um, mean that, uh, I, I do see more and more people,
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  um, moving into, um,
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  a more of a group practice model as opposed to, uh, individual, um,
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  private practice model. Um, in fact,
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  the most recent Ada HPI research brief, I think in 2021,
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  um, it, it forecasted that,
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  that the per capita supply of dentists is projected to increase through 2040.
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  Um, and that's even after adjusting for changes and hours worked and patient,
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  uh, visits due to, um,
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  the dentist demographics in terms of age and gender composition. So, um, it,
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  it should make for a, uh, uh, increasingly more, um,
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  uh, competitive, uh, environment. So, you know, just like ai,
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  I don't know if consolidation is good or bad, but I think there's a,
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  a lot of good things about efficiency at scale. Um, but again,
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  the important thing is how is that clinician voice, uh, factored into, um,
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  the delivery of care, um, for patients and, um, you know,
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  questions about incentive alignment and, um, how that efficiency at scale is,
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  is being used and, um, whether, uh, it's,
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  it's being used to enable more and more people to have access to care that will
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  improve their health. Um, so those are,
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  those are some of the things that are really exciting, um, that, uh,
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  present really great opportunities, um, but also definitely, uh, something, uh,
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  to keep an eye on, on, on how these exciting things will be used.
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  Thank you. My next question for you is,
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  what will the most effective healthcare leaders need to be successful in the
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  next two to three years?
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  Yeah, Riz, uh, you know, the past two to three years has been really tough. And,
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  um, in healthcare and, and, you know, we all know healthcare is really,
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  really challenging right now. And, um,
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  probably that will continue over the next two to three years. Um,
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  and so at the end of the day,
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  I think that the most effective healthcare leaders, um, they need to be able to,
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  uh, inspire and motivate their people. Uh,
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  because while as clinicians we center on our patients,
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  our most valuable resource and asset is our people.
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  Nothing happens without our people. Um, and, you know,
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  we've been asking really, uh,
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  really hard things of our workforce and, um, you know, I hate to say it,
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  but you know, there's probably gonna be more hard things over the next couple,
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  two, three years, um, since there really are no quick fixes to the challenges,
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  um, that we face, uh, in particular with staffing. Um, and, uh,
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  the landscape continues to change and evolve and, um, you know,
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  naturally most people don't like change. Um, but you know,
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  with dentistry being in this incredibly dynamic period, um,
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  changes aren't gonna happen, um, either with or without you.
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  So really tying your people to that bigger why, uh, you know, uh, Simon,
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  uh, Sinek, he, uh, it starts with why. So that common purpose.
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  Um, so if I had to point to one, you know,
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  real foundational thing that healthcare leaders will need to navigate these next
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  few years, um, that would be it.
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  Fantastic. Well, Cyrus, thank you so much for your time and your insights.
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  I look forward to connecting with you again in the future.
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• 15:36
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