Webinar: How to Scale Growth – A Conversation With The Largest Orthodontic DSO

Learn how a 250+ location ortho-focused dental support organization (OSO) is growing through innovative digital marketing strategies rooted in data.

Webinar: How to Scale Growth – A Conversation With The Largest Orthodontic DSO

Lauren Leone, SVP Healthcare Marketing, Cardinal Digital Marketing
Jacqueline Ruma, VP, Sr. Director of Media & Analytics, Smile Doctors

Quotes From the Webinar:

“You have to measure ROI to make sure that you’re not top-line spending through the roof. When it really comes down to the bottom-line is: what does it cost for us to bring one additional patient into the fold? The CRM database allows us to make that match back from when we started communicating to when a patient signs a contract, and tie that all the way back.”

“We lean into quite a bit of user-generated content from our doctors and our team members out in the field and tap different groups of doctors who are interested and/or excel in different things. For example, we have doctors that have huge social media presences and love creating TikTok videos and educational things. It truly is getting to know your organization and leaning on your local teams to get that content for you when you need it.

“For us, adopting the right CRM database has been a game-changer. Obviously, there’s a lot that we have to think through when it comes to HIPAA and Dental Board compliance, and making sure that as we’re communicating with patients in a digital way, we’re still respectful of everybody’s rights and the compliance that’s put in place. It took a lot of work between marketing and legal in our different associations and organizations. Our whole CRM database, existing patients, and most of them prefer to communicate with us via text.”


Read The Transcript:

Lauren Leone: Hey there, everyone. Thank you all for joining us. Sorry, we’re just running a minute behind. Thanks for joining us on our Scaling Growth webinar. I’m really excited today. We have an amazing guest, and I’m really excited for everyone listening in, and everyone who may be listening to this in recording format later to get to hear from Jacqueline. You guys are getting some really great first-hand experience from someone who has been in the marketing world for quite some time, been in both the agency side in a number of different verticals, but currently works at the largest orthodontic DSO or OSO in the country scaling very quickly.

I know a lot of you guys listening in are within organizations that are growing fast so what Jacqueline is going to share with you guys is some first-hand experience on how she’s navigated some of the challenges, what she sees as the areas of opportunity, and hopefully, you all can walk away from today with some tips and tricks to be able to apply at your own organizations.

Really quickly on our agenda, this is primarily going to be a very informal Q&A session, so I would love for you all to get on the chat as we start talking, and post some questions to both Jacqueline and myself things that you specifically want to know as we go through the conversation, but I’ve got a number of questions that I want to ask Jacqueline about so I’ll guide the conversation that way and supplement with your questions. But the primary areas that we’re going to talk about today are how to scale and promote digital collaboration across groups when you’re making acquisitions when you have a De Novo strategy how do you ensure that everyone is unified even when they may have individual brands that they want to retain at the local level?

What kind of growth strategies can you look at both in the digital and offline space to help your groups? Digital technology is really important so how is it being used in a very successful organization like Smile Doctors? What kind of digital tech should you all be looking at to incorporate into your organization? Then I want to leave it on a couple of Jacqueline’s thoughts on the future of the vertical, the orthodontic vertical, the dental vertical, and even more importantly, just where large multi-location and multi-brand groups are going into next year, so you guys are thinking about where to invest your dollars in the marketing world.

For those of you not familiar with Smile Doctors, like I mentioned, the largest Ortho-focused DSO or OSO in the United States in terms of number of locations and geographic footprint. I think they just released some new numbers: 260 locations, 24 states, and growing rapidly, so you all listening know that that hyper-growth can cause a lot of growing pains so we’re going to talk about how to navigate some of those.

What Smile Doctors offers to its affiliated practices is the tools in tech so that those orthodontists can focus on providing patient care, not about marketing, not about tech stack, but really about the patient care and this is what we want to talk about. How to implement those things so that you can successfully scale.

A few other things, there’s a number of organizations that Smile Doctors is a part of. If you’re in this vertical, I encourage you to check these out. A great way to stay on top of what’s the latest and greatest in the industry. If you’re not in the dental or ortho space and you’re looking for associations, your vertical will have them too, and I’m more than happy to help you find out what those are.

Then Jacqueline, specifically, Jacqueline has a title that is a lot of things in one. She’s a jack of all trades. She’s the Vice President and Senior Director of media and analytics. She has been at the organization, Jacqueline, I think almost 9,10 months?

Jacqueline Ruma: Yes.

Lauren: But 15 years of experience in the digital space so it expands well, well, well beyond just your years at Smile Doctors. We’ve had the pleasure of working with Jacqueline to implement digital strategies, but she does more than just digital. She’s working with the practice groups overseeing how things like traditional and digital get rolled out at the local level, so she’ll have some perspectives that even I wouldn’t have if I were talking to you all about this, so really excited to dive in with her here.

Jacqueline, I want to kick it off with our first question and it’s really just posing a very broad question to you that will help us narrow in for this conversation and then I’m going to make our faces vague and turn off the screen which is, collaboration across the practice groups and affiliated practices has got to be one of the hardest things to do when you have 260 locations and growing. Tell our listeners what you think the biggest challenges and hurdles have been in developing a centralized and engaged marketing function.

Jacqueline: Sure. I’m sure as many of you may know, one of the biggest challenges, really, is the fact that there’s a lot of different perspectives and a lot of people with opinions and in order to grow and to scale there’s got to be some process put into place that allows you to do that at the larger-scale level and so one of the biggest challenges that we face is rolling out change.

Change management is really important and it is something that most people inherently are afraid of and so in order to address that, we really have to think with a people-first mentality, meaning not just our patients, although that always needs to be at the forefront of any communication that we’re putting out there, but also team members. I don’t just mean our doctors, I mean the people inside the practices who have to implement the change, who have to try new systems, who have to go from using one type of technology to another type of technology or go from no technology to a different type of technology. So it’s really understanding from the jump, what it is that people are going to be afraid of and try to remove those barriers as you’re communicating that change so that you get the adoption necessary to truly implement across the system.

Lauren: I love that. I talk about, when we’re marketing to patients all the time I talk to my clients about removing the barrier of the patient whether it’s insurance, or payment structures, or bedside manner and you’re saying the same thing applies when you’re working with the internal team, what are they afraid of? What is stressing them out and how do I address that and get ahead of it?

Jacqueline: 100%. At the end of the day, the people inside the clinic are the people that are speaking every day to your patients. It’s the people that your patients in the community or your prospective patients get to know and so those are going to be either your biggest cheerleaders or your biggest detractors so it’s much better to get everybody bought into something before you roll it out than rolling it out and making them feel [inaudible 00:07:12]

Lauren: Jacqueline, this may be a loaded question, but any tips or tricks that groups that are unsure how to start this could deploy at that level? How do you communicate? What are some channels that you have found to be effective to make that happen?

Jacqueline: Sure. There are plenty of communication apps out there that are easy to start and test and you can even use for free, but the truth is just having very organized communication, regardless of the tool that you use to do that, really helps. We create documents and we have cadences for when our clinics hear from our marketing team versus when they hear from our operations team so that they know what to expect when that communication is coming down, but there’s a few things that I lean into and I’m a little bit of a softy when it comes to quotes, but I always go back to the Abraham Lincoln quote that said, “If I have an hour to chop down a tree, I’m going to spend the first 45 minutes sharpening my ax.”

I try to apply that across the board to anything that I’m doing and that includes communicating out to the field organization, meaning I really want to think through anything that I’m going to share with them to make sure that I’m trying to account for any pushback I may receive before that even happens. So, again, regardless of the platform you use to communicate, it’s really about how you communicate and make sure that you’re not overwhelming them with the number, the volume, and the type of communication that you’re putting out there.

Lauren: One final thought on this topic before we discuss may be some challenges in the marketing space, but I’m sure a big part of getting buy-in is having a shared vision. Give us some thoughts on how you help the groups realize that we’re all working towards a common goal and how are you communicating KPIs at a global level, but also metrics that matter maybe to that individual practice so they can see the progress?

Jacqueline: Sure. One thing that we’re very careful about is when we talk to the field organization about KPIs and metrics, we don’t typically talk to them in terms of production or revenue because it takes away from the focus on patient care so we really talk about new starts versus existing patients, and the balance of their schedule and so we try to put it in terminology that means something to them so that they’re working hard to do that.

Again, it’s really all about treating our team members just the same way that we would want our team members to treat our patients. If we can look at things at the centralized marketing level and then turn that communication into something that’s applicable for them, they’re more likely to adopt it.

When we talk about that, we talk about new case starts, and that is our primary focus, and so we help them by being able to look into what their schedules look like, having a field marketing organization that has a limited number of trade areas that they’re responsible for so they can dive into that local level and roll that up back up to the centralized level.

Lauren: Awesome. I’m going to have maybe a few more pointed questions on that topic when we get into the marketing, but before we dive that deep, I think something else that people really want to get a feel for, whether they’re in your vertical or other high growth verticals is, I would love your perspective on, I’m going to use the word consolidation lightly, but essentially affiliating, bringing these groups in and helping them so that they can focus on care is happening at a breakneck speed. Do you think that’s something that’ll continue? Do you see that within your own organization or just within the groups that I know you have friends and colleagues at other groups too, is that something you think is here to stay?

Jacqueline: I think there’s going to be some ongoing growth in consolidation. I think it’ll slow down a little bit. We saw a lot of extensive growth throughout COVID-19 and I think part of that was the ability for an independent practice or organization to keep their team together and weather the storm where we have an organization that allows us to take on some of those challenges and they can focus on patient care, we have the technology to be able to allow them to do that, and so we saw a lot of additional growth throughout COVID-19. I think that’s going to continue, I think there’s a need to focus on patient care.

I think, in general, as a consumer, people are looking for more of that one-to-one care and if doctors, regardless of the vertical they’re working in, want to provide that, they’re going to need help managing the other areas of their business that don’t really directly allow them to have that relationship with their patients.

Lauren: Yes, totally agree. So with the scalability or the scaling and consolidation comes the need to have smarter marketing programs, so I know we talked about new patients starts, let’s dive into where I know both of our hearts lie, which is on the marketing side. In your experience, both agency side at other organizations and at Smile Doctors, what do you think are the pillars of success in marketing specifically? [crosstalk] certain tactics or certain channels? What have you seen as the must-haves?

Jacqueline: Sure. At the end of the day, driving leads is the job of marketing. Anybody with any marketing background gets into the debate about lead generation versus sale completion and who’s responsible for what. At the end of the day marketing’s role is to drive qualified leads to your organization, whether that’s at the local level or the brand level.

In order to drive leads, you have to focus on more than just the lower funnel. I know a lot of times we get caught up in KPIs and digital tactics and how are we going to drive one extra lead to get one extra sale, and all very important things. However, if you are not balancing that with your storytelling and providing prospective patients with the reasons to believe in your brand, then you’re missing an opportunity for the long tail.

The short tail really is that lower funnel and being able to activate against the people that are coming in that are raising their hands, but the long tail is creating that awareness, creating that consideration, and being an organization, a brand that people come to when they’re ready to come into your funnel. I think in this space there’s a lot of opportunities because there’s had to be a lot of evolution in a lot of other verticals, historically, that have propelled marketing as consumption habits change and I think with the evolution that has occurred in healthcare, a little bit prior to COVID but exacerbated by COVID-19, I think we’re starting to see that happen more rapidly in the healthcare space.

Lauren: When you think about your marketing channels and tactics, and even your budget, Jacqueline, and you think about the need to do both to capture existing demand but to focus on also telling your brand story, do you think about those as two separate initiatives that need to run parallel? Do you budget for them? Do you ensure that you’ve properly fund both? Tell me a little bit about how you think about fitting them into a marketing budget or a marketing plan.

Jacqueline: Yes. You have to look at that holistically because every tactic should work with another tactic in order to– one plus one can’t equal two in the marketing space, you have to really figure out how one plus one can equal three or can equal four. So when you think about telling your brand story, that has to be something that occurs across all tactics, across all channels, across all local trade areas. However, you’re building your marketing plan, but not every channel, not every tactic needs to tell the story in the same way. You’ve got to have an overarching strategy that applies across the board and that’s part of your planning process, and then it’s, how do we activate against that to make sure that we’re meeting people where they’re looking for us?

It is a dance, it’s a delicate dance and it’s a balance that you have to find, and not every situation allows for you to have the same balance of storytelling and activation. In your paid search initiatives, you’re not going to have as much of an opportunity to tell your brand story, but you may have an opportunity through public relations to have one of your doctors interviewed to be able to lean into what your brand story is, which may ultimately help drive SEO once you link that on your website and people and people start looking for the article. Again, you just have to be mindful of the whole picture no matter what you’re trying to achieve in a given moment.

Lauren: We had a question come in that was based on the comment you just made. Caroline, thank you for sending this question out to Jacqueline. She wanted to know if you think video is essential to telling the right stories, or how do you think video fits in?

Jacqueline: I think that video plays a huge role in that because people like to see things sight, sound, in motion. It’s easier to tell your story when you can do that in video hence why we’re here today and not just doing an email chat. I think in our space especially because primary research has become such a bigger thing for patients, prospective patients to do going into the healthcare space these days, educational videos are important, but also human interest videos are important. People like to know that they’re being treated by, seen by, interacting with people who are like them. There’s a lot of storytelling that you can do within the vertical through video, and we lean into it very frequently.

Lauren: Tell me this, I find this to be a big challenge in this space and this is not isolated to just the Ortho and dental vertical. This is every single high-growth group that I’ve ever come across. How do you scale something like video or creative when you have branded and non-branded practices and local groups? Any recommendations there?

Jacqueline: Sure. It depends on if you’re talking about something that is highly produced and curated versus something that is a little more organic and user-generated, and we use a combination of both. We do have a very fleshed-out list of practices. Some of ours are branded, some of ours are non-branded and they’re all going through some transition processes they affiliate, so we go through that too. But we have an asset management tool that we work with that allows us to have a primary video or a primary asset and interchange logos and/or pieces of information in those videos so that if one of our non-branded affiliations wants to take a piece of content that we have created for the brand that they’re able to do so by just searching, replacing a logo and so it’s training your field marketing organization on how to use different tools, but we make that available.

We actually lean into quite a bit of user-generated content from our doctors and our team members out in the field and we tap different groups of doctors who are interested and/or Excel in different things. I have a group of doctors that I tap into when I need quotes for a press release because they’re very responsive and usually that’s something that you have about 24 hours to respond to before the opportunity goes away. Then we have doctors that have huge social media presences and love creating TikTok videos and educational things and those are the doctors we tap into for that kind of activity. It truly is getting to know your organization and leaning on your local teams to get that content for you when you need it.

Lauren: Yes. That’s fantastic. I don’t know if you’re willing to share what the asset management tool is that you use but maybe something you could recommend to other groups who aren’t sure where to start would be check out this tool.

Jacqueline: Sure. There are lots of tools out there and it really depends on what your needs are as an organization. Right now we are leaning into a product called Brandfolder. It’s strictly a creative asset management tool that allows us to communicate with our field organization and quickly edit assets that are built for the brand but are usable for non-branded affiliations.

Lauren: Awesome, thanks for the recommendation. Hopefully, everyone can check that out if they aren’t sure where to go. I have one final question and then I want to move on to technology. You mentioned very early on that a lot of where we are today was accelerated by COVID-19. When that happened, a lot of the world shut down and then there became this pent-up demand on the patients’ side to a degree. What did you all do when the world reopened? I think some of it still exists today to make sure that you were there and present and able to provide care to those patients. What marketing strategies and what communication strategies did you find effective?

Jacqueline: Sure. The great thing is that our doctors were really involved in our addressing of the situation. I want to take a step back and talk about what we were able to do when the pandemic very quickly shut things down without a lot of notice. In our industry specifically, there was this slower evolution into telemed that a lot of people, a lot of doctors were resistant to and our doctors too.

As COVID-19 presented itself, we were able, because we were already in the exploration phase in the space, to really pull together very quickly a remote care program that allowed our doctors to treat patients remotely. I know that seems strange because we specialize in things like braces and Invisalign. We were able to quickly lean into technology that allowed us to do digital scans from home, that allowed our doctors to do a lot of virtual appointments where they worked with patients and responsible parties to make adjustments to their braces to make sure that they are continuing to see progress in their treatment path.

By doing that we became a very trusted resource to a lot of our patients and were able to get a lot of referrals as things started opening up because people were so happy with the fact that they didn’t have to stop treatment. Once everything shut down they could have virtual appointments with their doctors. From there, our growth accelerated again and we were able to treat even more patients, we were opening hours, extending days of operation. Also, a lot of our doctors continued their virtual appointments for existing patients. If patients weren’t comfortable coming in, or if a doctor said, “Hey, I could work a few more hours, but I don’t want to be in clinic,” we were able to extend that and make that available to our patients.

Lauren: That’s a great segue. I was going to ask, what, if anything, in the tech adoption, have you seen carried over from or was triggered by COVID-19 but is really here to stay because I think people think that there’s going to be a before and an after and there’s probably just a before and then a now. It’s never going to change, it’s never going to go back to the way it was before. It sounds like the ability to provide virtual care is here to stay. Anything else that you saw change, whether it’s on the delivery of marketing messages or at the point of care that started because of COVID but is really part of the ongoing strategy today?

Jacqueline: I will say that we’ve seen a lot more adoption of online appointment scheduling. It was interesting just coming from retail and consumer goods and knowing how easily people adopted online shopping in that space. Then to come into the healthcare space and see that maybe people still would rather call their clinic and schedule their appointments, we’ve seen a lot more adoption of our schedule online features. We were fortunate in that we have several practices that treat military and so we had already piloted our remote care program before COVID had started and so it was just something that we were able to roll out because the pieces were built.

We do a combination of aligner treatment and braces treatment. We are seeing a lot more interest especially from adults in the aligner care space really leaning into the virtual appointments and not trying to lose the additional disruption in their life by having to schedule appointments and go into clinic. I think that’s going to continue in our space and I know we’re not just talking in the dental space, but we’ve seen a lot of evolution in adult treatment because a lot of people said, “Well, I saw myself on camera for the whole year and I realized that I wasn’t loving my smile and so I decided to get into aligners and do this as an adult because I stopped wearing my retainer after high school and I don’t know what happened.” We’re seeing a lot more people lean into that virtual appointment and that’s not slowing down.

Lauren: Thanks technology in that way too. Thanks for exposing that opportunity. We’re talking about care and I would love to also get your thoughts on technology and patient engagement. Once someone is a patient, in terms of how you communicate with them, talk to us a little bit about that, how you’re digitally communicating. I think this even dips back a little bit to our prior conversation, how you roll out a universal communication strategy that is still personalized and localized based on practices.

Jacqueline: Sure. For us, adopting the right CRM database has been a game-changer. Obviously, there’s a lot that we have to think through when it comes to HIPAA and Dental Board compliance, and making sure that as we’re communicating with patients in a digital way, we’re still respectful of everybody’s rights and the compliance that’s put in place. It took a lot of work between marketing and legal in our different associations and organizations. Our whole CRM database, existing patients, and most of them prefer to communicate with us via text.

We have a lot of adoption of virtual appointments but even those that are coming in clinic, they like to be able to just text the clinic and get a response back on, “I need to change an appointment,” or, “what was my appointment time,” or just having that two-way communication and there’s a lot of backend work that has to go into that to be compliant. That is another space where our existing patients, SMS texting is is what they want to do, they don’t want to call.

Lauren: I love that. I text my dentist’s office, so I’m one of those. That is a welcome change that may have been an outcome of COVID, it may have been already in the works, but glad to see it here. Speaking of CRM, I think it’s interesting you brought it up, there’s so many uses. When I think of CRM, from our perspective as a digital marketing agency, I also see it as one of the key elements to being able to track ROI. Talk to me a little bit about how you all are able to look at a marketing activity, be it online, offline, in office, whatever it is, and try as best as possible to determine how that marketing activity is generating new patients.

Jacqueline: Sure. We take a little bit of a different perspective because ROI is very important but again, it’s not something that we typically communicate down to the local level. We really do our best to try to apply the dollars that we spend in marketing to the four wall budgets associated with each of our practices, and truly get down to a reasonable cost per lead. We try to, not just in our media spend or in our marketing spend, but holistically as we’re spending as an organization, what does it cost us to generate one lead and make sure that we’re we’re mindful of that.

Obviously, you have to measure ROI to make sure that you’re not top line spending through the roof. When it really comes down to the bottom line is what does it cost for us to bring one additional patient into the fold? The CRM database allows us to make that match back from when we started communicating to when a patient signs a contract, and tie that all the way back.

Equally as important is we have this bank now or this analysis of who are the type of people who are coming in and not just taking an appointment, but actually contracting service? Then we can pass that information back to our partners like Cardinal and build lookalike models in our different marketing channels to make sure that we are going after people who are more likely to convert once they come into the clinic.

Lauren: I actually got two questions. I will pose this to you, but any CRM recommendations for people that haven’t started that CRM process yet? I think something I’ve learned along the years too that I would love for you to share is that implementing CRM is not a 30-day project, it’s [unintelligible 00:29:54] Just scope the expectations for some people listening in on what type of time commitment it’s going to be, but that it really is worth it.

Jacqueline: Yes, it is a very heavy lift from the start. Once you do it, it is worth it because you will start seeing a stronger return on your spend almost immediately. You’ll have the one-to-one communication with existing patients, with future patients. It really is a game changer and it’s something that I think for a long time— even though I was agency side, I did work with several healthcare partners then. I think there was always this hesitation in the healthcare space to really lean into CRM because in most cases when you’re treating patients you don’t want to see them more frequently. The healthier person doesn’t need to come in as frequently. There was a little bit of a question, why do we need this? Why do we need to lean into this and spend the money there? It truly does help to build that pool of responses.

A lot of our patients come from referrals from our existing patients. If we know who those people are, we know where we’re getting referrals from, we know who we can tap into if we want to run a program like a refer a friend or something like that. We personally lean into and leverage Salesforce. It is a best in class program and one that I’ve worked with in several verticals. It is not the cheapest solution out there, but it’s probably the best solution out there right now.

Our onboarding process once we had a data clean up, which also takes some time, is probably about three months. If you are planning to onboard a CRM database and truly build out patient journeys end-to-end communication, it’s something that’ll probably take about 30 days to prep for and then another 90 days to implement.

Lauren: Yes. I think then you’ve got the ongoing adoption too. It becomes this never ending investment from a time perspective. 90 days is impressive, I have to say. [crosstalk]

Jacqueline: Correct. We’ve had the benefit of being able to integrate it with several existing technology. That is one thing that I think is a learning opportunity that we’ve had that I would share with this group in that if you’re going to take on a big tech challenge like onboarding a CRM database, it’s the perfect time to do a full audit of your entire tech stack. Because the worst thing that can happen is for you to try to integrate a very tech forward partner into several systems that don’t have those integrations. Then you have to build custom APIs, which add so much time to the process and are usually broken and need to be repaired. I know personal in the tech space, the word customization makes me shudder.

Lauren: It just means complexity and maintenance and a lot of other considerations. It sounds nice on paper. I’ve got a couple questions. I want to move on to a block of questions around branding, but a couple pointed questions about marketing came in. Let’s see if you have thoughts or opinions on these. The first question from Marisa, she wanted to know, do you find certain channels to be more or most effective at yielding an engagement or a response? This is probably talking mostly about your bottom funnel, but any channels you would say you really need to look at being here if you aren’t already?

Jacqueline: Yes. The answer is yes but there’s elements to that answer that are very dependent on what you do. I can use an example from our experience working together, Lauren. We lean very heavily into paid search and paid social, and that’s because we have the targeting capabilities to do that with the data that we have access to.

That said, I will say, depending on the creative we’re running and the type of message we’re running, one works better than the other. Perfect example, we just ran through our Q3 analytics this morning. At the end of Q2, Facebook was actually our best performing channel for driving leads, but we were running a pretty strong offer and we had some very engaging creative. We changed our offer and we turned our message more into the services we provide and a little bit less of a discount in our messaging. We actually are seeing a lot more engagement in search right now. It really is dependent on so many things working together. I would never just say spend your first dollar in this channel. It’s really, look at what you’re trying to get out of something and what the best channel to do that is.

Lauren: I love that you said, have the option to be fluid because it may not just be this static, this is always the best and this is always second best and this is always third. Someone just asked while you mentioned the word offer, how did you go about picking an offer? How do you guys decide that? Do you do it based on the competitive landscape or do you really just think internally about what’s best for your organization and hope that that resonates with the prospective patient?

Jacqueline: We have a combination of both. Obviously as we bring new practices into our fold, we do a whole audit of what works for them and what doesn’t, because we don’t just see ourselves as one way communication out to our affiliations. This really is a two-way relationship. If we’re going to be most successful in supporting them, we have to understand if they were a practice for 10 or 15 years before we came onboard, something was working for them.

We try to continue to learn and educate ourselves as we continue to grow as an organization, but when it comes to specifically designing offers, we know what time of year people are more likely to engage with our different types of services and products that we offer. We do have co-op partnerships and relationships with different brands in the space.

We work with Invisalign for all of our aligners. There are times when Invisalign is running a promotion and we need to lean into what they’re doing. We do that from time to time, but we also continue to research. We review the offers that we’ve had in market historically and try to understand which ones tend to drive more leads, but which ones– sometimes the one that drives the most leads is not the one that drives the most conversion. It’s really dependent on, do we need to drive more people in or do we need to convert more people and how do we go about doing that?

Lauren: Yes. There’s a time in place for offer. It’s not per of your evergreen strategy, but it is something that you use to pulse marketing activity.

Jacqueline: Correct.

Lauren: Awesome. One other marketing question, and then we’ll talk about branding, someone, Marta, asked in our chat, would you recommend distributing budgets for all locations at the local level or at the brand level? I think this is one of like the million dollar questions in multi-location multi brand. I know that there’s no right or wrong answer, but any tips for how you think about budgeting across such a large group [crosstalk] everyone, you’re helping every practice equally, but also harnessing the power of the fact that you’re one organization and you can buy at a larger level?

Jacqueline: Sure. That’s exactly that. When there is an opportunity for us to create a benefit for our practices by centralizing activity, we do that. When there’s a benefit for the practices to own that, we leave it in their hands and in a very example is we manage the digital activation across the entire system. We plan it and place it locally by location. We organize it and put it together because it is more efficient and effective for us to look at it holistically, to negotiate it holistically.

Then in the same vein, I will never know if in Albany, Georgia billboard A versus billboard B is a better look for that clinic. That local practice is going to have better insight into what’s going to drive better there. That’s in their hands. We really do spend a lot of time prior to the new year doing annual planning. I lock arms with our director of field marketing and she and I go through what’s the brand approach, what’s the local approach? How do we share this budget and bring this to life?

Lauren: That’s awesome. I agree. I think there’s no right or wrong answer to that question. I think every brand is going to have unique scenarios, whether it’s contractual obligations on spending or it is efficiencies of the buy. There’s probably a lot of things to consider there.

Jacqueline: Yes.

Lauren: Talking about branding and jumping into a little bit more, and you opened up very nicely by saying there’s a time and place for bottom and then there’s the branding element. You all have a unique value proposition. How do you tell that story and build loyalty? How did you look at your landscape and say, “This is the value?” And you have two layers. You have the value that you bring to the patient as an organization and the value that you bring to a potential affiliated practice too.

Jacqueline: Correct.

Lauren: For groups that are still working through their messaging and their positioning in their marketplace.

Jacqueline: Yes. It’s a loaded question, but I do believe that, first and foremost, you have to do your research. We have commissioned several research studies and ongoing research studies to understand what’s important to the consumer in our space. One of the reasons, for example, that we changed our approach to offers is because we realized that that consumer responsible party cares more about how what we offer fits into their budget than how much the discount we’re going to offer is.

We just changed the way that we communicate that in a very subtle way. Just like you have to understand the consumer, you have to understand the potential practice that’s going to affiliate and do your research there as well. Preparation is always my– I try to keep things simple and try not to use a lot of marketing terms when I think about these things. At the end of the day, it’s preparing yourself ahead of going to market so that you’re making the smartest decisions with the best information you have available to you at that time.

Lauren: I know from working together with your organization that in the digital space there’s a lot of ways you continue to refine messaging strategies. Any tips or tricks for how to do that whether it’s through creative or messaging testing, or running polls or anything like that you guys do on a regular basis?

Jacqueline: Always be testing.

Lauren: Yes. We do too.

Jacqueline: Always take a small portion of your budget and test something. Now when you do that you cannot test so many things that you don’t understand what’s driving what. In the social space, as an example, you have an opportunity to run dynamic creative up to five ads at one time and it’ll auto optimize to the ones that are performing best. Why not take advantage of that? Even if all you are doing, if you’re keeping the same image and just changing the tagline or changing the call to action or keeping the same tagline and call to action and changing the image, whatever it is that you’re doing, you’re always giving yourself an opportunity to learn about what is creating that engagement and ultimately that conversion.

Lauren: One of the questions we had around branding and I think this is very unique in areas where consolidation is occurring and those groups are adopting the new brand names. They’re adopting the brand Smile Doctors where they previously had a local brand. Talk about that transition. What has made that easier? What have the challenges of that been? Any tips that you have for groups that are taking that approach to consolidation.

Jacqueline: Smile Doctors has changed our approach to that a couple of times because again, listening to the feedback is very important. What we have learned is in the local community, the doctor’s name is what’s important. The doctor has that relationship. When we do onboard an affiliation with a very large presence with a very well known doctor, we are very careful about the way we go about doing that. We do not force a holistic change over to now your Smile Doctors and here’s all our brand colors and everything that you have to do in-clinic and externally.

We’ve actually adopted an approach where we are applying powered by Smile Doctors to their existing assets and allowing them to live in conjunction with us because the truth is we are their support services organization. We are not taking over as a big corporation coming to push everyone out. We are coming onboard to allow them to be more focused on patient care and in order to do that, they need to retain their name in the community. That has been our approach is that we become a partner of theirs as opposed to taking over and pushing their name out.

Lauren: Do you all do anything, this is my own curiosity too, do you do anything that brings the local dentist or the local leaders together on a semi-annual, annual, quarterly, just to even collaborate with each other and exchange ideas? How do you guys foster that type of environment?

Jacqueline: Our doctors have a doctor meeting twice a year, they all come in. We have an agenda different organizations are focused on in different meetings. They also have their own community. We have weekly calls that the doctors get onboard with. We have different doctors who are on many internal boards. We have a group of doctors that are marketing board and they hop on more of our marketing calls and we have doctors that are more involved in the operation. Those that want to integrate more into the system, we bring them onboard because they have a perspective that’s unique to them.

Lauren: Awesome. I love that. Then I think the final question on branding and not everyone may view this as a branding element but I think it’s extremely important. You mentioned referral programs and that’s great. How do you build brand loyalty? What do you think are the pillars of doing that? I think there’s a word of mouth component and then there’s also, how is your brand represented in the digital space? Talk to me about how you generate reviews, how you generate loyalty, what programs you have for that.

Jacqueline: We work with a review management technology partner that has been really great at allowing us to do two things. Obviously, it’s pushing reviews, positive reviews out. In doing that they have an automated program that we established that as someone is leaving their appointment they’re receiving a text message to review us based on their experience. That’s great for creating that awareness and having those reviews in market.

The other thing it does is if there is a challenge it also gives us insight that we may not be getting from that local team as to challenges we’re having at specific clinics if we’re not getting good reviews in those places. It works as a positive double-edged sword for us in that we’re putting word of mouth out there in the digital space, but we’re also getting feedback if there are challenges that we’re maybe not exposed to at the centralized level.

Lauren: Yes. Is that something that you guys essentially push to own at a national level is the generation of those reviews? Because I think to your point, then you can roll out strategic responses, coach teams on how to handle those things, so that’s great.

Jacqueline: Absolutely. We do leave it in the hands of the local teams to respond to the reviews. Obviously, we write scripts and we give them guidelines, but having that local community engagement is important. We make sure that it’s our local practice directors that are responding to those. It’s been great since we’ve implemented it.

Lauren: I always tell groups when they’re just getting started or if they’re mature in their footprint but not in their marketing that being in those local searches is perhaps one of the most important things you can start doing. If your budgets aren’t there to support social or pay search, get yourself in that map, get yourself listed on Google and focus on your reviews because that’s going to be one of the most important things. I have a question that was based on the brand conversation we just had. Caroline asked, do you see groups or affiliated practices that will do that kind of powered by Smile Doctors and then fully adopt? Do people go through an evolution?

Jacqueline: Yes. Honestly, for us, it really depends on the doctor. A lot of times we see the migration from powered by to full on Smile Doctors when the well-known presence in the market that doctor is either retiring or taking on a different type of role within the organization and we’re going to bring a new doctor in. That’s our nature. We look for natural opportunities to do those integrations. Otherwise, it just feels weird and forced. We’ve learned that if we force that there is a loss of trust in the community, and we don’t want to create that ever.

Lauren: Yes. Becca asked a sub-question which was, for the groups that do decide to take the Smile Doctor’s brand out of the gate, what do you think is the driver of that trust and loyalty, like they’re ready to do that right away? What do you think gets them to that point so early on?

Jacqueline: Those are fewer and further between for us, but a lot of times those are multi-doctor practices that maybe are newer doctors that don’t have an established presence already and so they’re leaning into us even more to have that bigger brand presence. Now, the interesting thing is those that truly do adopt and embrace the full-on Smile Doctors brand, they are some of our most fun clinics. You see that in the reviews too.

Lauren: Yes. That’s great. They get the added benefit of any national branded media that y’all are putting out there, so that’s great. I have one question that is a little bit specific to some of your channels. I will allow you to answer this with whatever comfort level you feel, Jacqueline. This question is around, how do you benchmark your cost per lead across channels, and does it differ greatly across channels, which I think you said it does but how do you monitor that?

Jacqueline: we have a holistic cost per lead that we aim to hit on a monthly basis across all channels. We know, for example, that when we launch a new program, that our cost per lead is going to start high because there’s a lot of machine learning that needs to happen in some of those low funnel channels in order to bring that cost per lead down. We are very flexible in that but because we layer in things like our direct mail, and our local store marketing, and all of those pieces totally wrapped into that we set KPIs in the digital space for where we want our cost per lead to be. Sometimes we hit it, sometimes we don’t. Sometimes when we don’t hit that cost per lead in the digital space, it doesn’t mean that we don’t hit our holistic cost per lead.

Again, it’s such a hard question to answer because we truly believe in the full-funnel approach to marketing and we have the freedom within our organization to be able to look at it in that way where I’ve worked with many other organizations where every channel has a set KPI and it gets evaluated on a regular basis. I feel like that approach can be very limiting because you start to pull tactics out of the mix which you may be improving one piece of the channel, but long term you may be actually hurting the program because they all need to work together in order to drive that lead.

Lauren: Do you have a tool for attribution? Essentially, that’s what attribution is. It says one patient touched six channels so they each deserve credit rather than just the last touch. How do you think about attribution?

Jacqueline: We currently do not have a formal attribution model in place. It’s not to say it’s not on the roadmap, it’s just not in place yet. [crosstalk] Now, I’ve worked with so many retail partners that the attribution model is important and I could spend another hour talking about the differences between MMM and MTA, and which is more important and how they work together. Again, I’ve never been a fan of last-click attribution because that’s always going to get attributed to search, people are always going to do a last search before they make a decision and I feel like if you were to turn off all your other channels and only work in search, you’ll have a really low cost per lead, and you’ll have very low volume leads. That’s just what’s going to happen. [crosstalk]

Lauren: -reach is restricted by the demand, you’re not generating anything. [crosstalk] Two closing questions for you. We have about five minutes left, and I’m keeping an eye on the chat too so if anything else comes through we’ll add it. Looking ahead, so thinking about what’s coming next, most of what we’ve been talking about is what’s gotten you to this point, how have you been so successful, but when you personally look at your marketing plan going into 2022, are you exploring any new channels, any innovations? What are you looking at as the next place to go?

Jacqueline: Absolutely. One challenge that every vertical’s going to have to solve for is this emphasis on privacy and some of the data restrictions that are going to start happening in channels like Google and Facebook and so we are actually partnering with your team and with Google to do some beta testing on local activation to navigate around some of those privacy channels. It’s really going to be about getting creative and making sure that you’re addressing some of those things [sound cut] to evolve and continues to focus on consumer privacy.

Lauren: Absolutely. We saw it with the iOS updates, we’re seeing it with the change from cookies, so it’s not going anywhere. It’s just how we react to it. It’s great that y’all are thinking ahead on that front. Closing question, where do you see your industry, the orthodontic and dental industry, in the next five years? Do you think probably five years ago we didn’t think virtual care was a thing that would ever exist but here we are and it exists. Any visions that you have for the future?

Jacqueline: I think we’re going to continue to lean into virtual care. I have a little bit of an unpopular opinion, but I think there’s going to be some boomerang from some of the Do It Yourself space as well. Especially in our industry, I think people like to think that they can do things on their own but there’s some things that a true trained specialist really needs to guide you through and I think there’s going to be some boomerang effect.

Lauren: It’s like everyone went to online shopping and then you’re like, “Wait, I want to go to the mall again,” right?

Jacqueline: Yes.

Lauren: Well, amazing. Jacqueline, I can’t thank you enough for joining us. We’re right at time so I don’t want to pose another question to bring us over but for everyone listening, this is going to be sent out in a recording in about 24 hours so be patient, you’ll get it in your inbox. If you don’t see it in 24 hours, please, please, please feel free to find myself, Alex, our CEO, you’ve received a couple of emails, find me on LinkedIn, and we’ll make sure that you get it. Jacqueline, thank you so, so much. It was a pleasure to get to chat with you outside of just our client relationship. Hopefully we’ll get to have you back here again soon.

Jacqueline: Thank you, Lauren. Appreciate it. Thank you everybody for listening.

Lauren: Have a good one.

Jacqueline: Bye.

[00:56:27] [END OF AUDIO]

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