2nd Place Winner! Improving Access to Oral Healthcare

Competition Winner

This entry has been selected as a winner in the
Transforming Health Systems: Gamechanging Business Models competition.

Sarrell Dental is a non-profit organization that provides dental and eye care to underserved communities. Sarrell collaborates with community partners to make sure that each and every child has access to quality oral healthcare. Since 2004, they have seen over 400,000 patient visits, and have been praised nationally for their innovative model for oral healthcare reform.

Organization Name

Sarrell Dental & Eye Centers

Organization Website

About You

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About You

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Innovation

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Name Your Entry

2nd Place Winner! Improving Access to Oral Healthcare

Explain what the "innovation" is about, e.g., is it the idea and/or the model you use to accomplish the idea, or your understanding of the target population, etc.?

We are a federally qualified 501(c)3 non-profit, however, we do not rely on cash donations or grants to operate. We have opened 14 state-of-the-art offices and a mobile dentist bus with cash from operations. We carry a $2M line of credit with no balance. We employ 56 licensed Alabama dentists and 44 hygienists. We are the high paying dental employer in our state. We are operate like a hospital, with a CEO for the business side and a Chief Dental Officer on the clinical side. Nearly 70% of our 225 person staff (no volunteers) have a bachelor's degree. About 30% have an advanced degree.

Most important, we are eliminating cavities in the poorest counties, in one of the poorest states in the US. In 2005, our reimbursement per patient visit was $328. In 2012, our reimbursement per patient was an industry low $125 per patient visit. In 2012 only, we saw over 130,000 patient visits. This includes general dentistry, pediatric dentistry and using oral surgeons all who are paid excellent salaries.

We received national recognition and praise by PBS Frontline and The Center for Public Integrity in their June 26, 2012 one hour documentary, "Dollars for Dentists." This documentary can be found on the PBS Frontline website or at www.sarrelldental.org. Our segment begins at 26 minutes.

We have experienced over 400,000 patient visits without a single patient complaint to the Alabama Board of Dental Examiners.

We are a national model, not only for our good works, but because we have done so without incurring long term debt or using cash donations or grants.

Describe how your innovation model is distinct from any other organization in your field?

We have been told by many, from the Robert Wood Johnson Foundation to The Pew Center for the States to various USA dental school faculty, that we are the first in the USA to successfully execute a highly successful, growing, sophisticated, self sustaining non-profit dental practice in the USA. This is a model that is new to dentistry that has empirical data to support its amazing patient outcomes.

What type of operating environment and internal organizational factors make your innovation successful?

Our clinical data speaks for itself. Under the leadership of Mr. Parker, we have been able to recruit top, young, business talent to our organization. We compete successfully for the brightest young talent out of undergraduate, MBA andJD programs. The average age of our managers is 26, and the best want to compete with the best. While there are many charitable opportunities available, Sarrell's high paying, career-building positions offer a unique career opportunity. At Sarrell young, talented leaders are promoted based on ability. They work with us because they can make a good living and help the many, underserved American children, who lack access to dental care. It is a rewarding experience to grow a non-profit, make a meaningful contribution, and serve less fortunate children.

How do you make sure you constantly innovate in light of (potential) external challenges, or your growth plan?

We invest in our patients, our people and our infrastructure. We have a Community Outreach person in every area we have an office. We have a Hispanic outreach team specifically targeted to that segment. They screen children for dental issues in schools, day cares, Head Start programs and at community health fairs, free of charge. We also provide dental education at the aforementioned events.

We pay industry high wages for our state. This allows to attract the best in class of clinical and business personnel. We receive about 20 unsolicited resumes a day and are now able to reject 2-3 dentists a month, who apply with us. We have a waiting list of oral surgeons wanting to work part-time with us.

Last in IT, we have purchased a state of the art, VDI system from Cisco and Citrix.

Business Model

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The systemic challenge you are trying to overcome (select one)

Bring accessible healthcare to communities in emerging markets

Health area (target market) where the need is [select only one]

Other specialty care

Categories along the health continuum you are covering [select all that apply]

Prevention, Detection, Intervention, Follow-up, Long-term care.

Please describe in more detail: what problem are you trying to solve in the organization's specific context?

Only 60% of America's Medicaid-eligible children see a dentist regularly, due to a lack of access to care. In Alabama, 66 out of 67 counties have a shortage of dentists, according to federal guidelines. The dentist shortage, compounded by those dentists not wanting to see Medicaid eligible children, further exasperates the problem. Due to the poor US economy, we have ever-increasing Medicaid roles and more children going unseen, and Sarrell Dental has experienced 31 consecutive quarters of record patient growth, serving over 130,000 patient visits in Alabama only during 2012.

Stage that best applies to your solution [select only one]

Scaling (growing impact on a regional or global scale)

Core strategies of your business model [select all that apply]

Approaches to behavioral change at the individual level, Patient-centered design, Redesign of the public healthcare system for more efficiency (in terms of processes, structure etc.), New/redefined roles for healthcare service provision, New approaches to distribution of health products and services, New financing strategies for health.

If other, specify here:

Most relevant tools you are using to implement the strategies outlined above [select only two]

Technology, New skills, Education/training.

If other, specify here:

Please describe your solution in more detail

By using a motto of "treat every child as your brother, sister, son or daughter" we have created a patient-centered model, where the child truly comes first, not just in words but deeds. As an example, our larger offices are open 8-6 daily, utilizing an 8-5 and a 9-6 shift to stay open 10 hours a day. Over 80% of our patients are not old enough to drive, so they arrive, in general, via transportation provided by an adult. If a patient shows up late for an appointment at 6pm (closing time), if the dentist is still present, we turn back on the equipment and treat the child.
On the business side, we handle all non-clinical functions, freeing our dentists and hygienists to provide world class care. All personnel, financial, support functions (IT, etc), are handled by business side personnel.

What are your vision and overall objectives?

Our vision is to provide quality oral healthcare to communities that have an underserved population. We believe in treating every patient with dignity and respect, and it is our goal to eliminate the access to care problem in every community that we open our doors.

What is your value proposition?

Traditional non-profits often fail to achieve their objectives because they rely on donations and volunteer efforts. While these may contribute to the overall good in some scenarios, we believe a complete business model that focuses on organizational efficiency, accountability, and hard work will be more effective in creating a long-term, sustainable solution. By combining a talented workforce, proven business principles, and clinically-focused dentists, we can achieve what other non-profits and governmental entities have not.

Who is your customer(s)?

Sarrell treats the dental and optical needs of lower income children in underserved communities that might otherwise not have access to dental care. Generally, these are Medicaid and SCHIP eligible patients ages 1-20.

What approaches to you use to reach your customers?

Sarrell operates 14 clinics in underserved communities as well as a state-of-the-art mobile dental bus that travels to areas where dental care is not otherwise available. This dental bus has two fully-functional operatories and digital radiograph equipment linked to electronic health records.

Our Community Outreach personnel provided dental education and screened over 50,000 Alabama children in 2012.

What are your primary activities?

We provide dental education, screenings and comprehensive dental work (everything but orthodontics) to under served Alabama children between ages 1-20. We do so without the need for cash donations or grants. We grow organically using best demonstrated business practices and have created a new, effective and proven dental model. The first self sufficient, not for profit, dental model of this kind in the USA.

Who are your peers and competitors? What problems could these players pose to your success or growth?

Competitors are: for profit Medicaid dental providers, FQHC's, dental schools and private practice dentists who see Medicaid/SCHIP patients. However, we feel we have no competition because of the lack of access to care in Alabama and the USA. The majority of Medicaid/SCHIP children still cannot access a dentist for their needs. With Medicaid roles growing, the need will only worsen.

What other challenges - individual, organizational, or environmental – are you currently facing or might hinder future success of your business, and how do you plan to overcome those?

The single biggest hinderrance to our growth out of Alabama is individual states' Dental Practice Acts (DPA). Most do not allow non-profit organizations to operate, even though we use only fully licensed dentists. In fact, We had to change, via Sarrell Dental legislation, the law in Alabama in 2011. Even though most dentists in Alabama do not see Medicaid patients on a regular basis. This was a battle covered numerous times by prestigious journals such as The Non Profit Quarterly (type Sarrell Dental in the search box on their website), PBS Frontline (see PBS Frontline website) and many other publications (search Sarrell Dental).

Dentistry is about 20 years behind the medical field, as far as consolidation and the use of alternative providers (i.e. nurse practioners). DPA's must change.

Briefly describe your growth strategy going forward

We are currently poised internally to expand our model to other states. At this point we are seeking partners to help us accelerate our growth and optimize community impact before we open our next office.

What dimensions for growth are you currently targeting for your innovation [select all that apply]

New regions(s).

What makes your business "ready" for growth?

We have developed our infrastructure, particularly in IT and management know-how, to be scaleable. We currently have no long-term debt and have a large, sustainable, growing record of growth.

What are your key growth objectives?

To expand our services outside of Alabama. Particularly into nearby states where we can manage our culture, business and clinical practices to ensure continued our proven track record in serving children who need our care the most.

What is your timeframe for growth, in the short and mid-term? What are the growth milestones and key activities going forward?

We are ready, willing and able to expand at the moment. The ONLY resistance we receive is from dental trade organizations, both on the state level and nationally.

Organization Country

United States, AL, Anniston, Calhoun County

Social Impact

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What has been the impact of your solution to date?

We have had over 400,000 patient visits in Alabama alone. Medicaid dental utilization in Alabama has risen over 5% since Sarrell began operations, and in many of the 14 areas where we operate clinics, Sarrell is the only full-time Medicaid dental provider.

What methods for quantification of social impact are you applying (if at all)?

We look at the number of patients treated, cost efficiency of dental care, patient satisfaction, community feedback and awards, and we use advanced data analytics to track more complex operational measures.

Could your solution work in other geographies or regions? If so, where?

Our solution is readily expandable to almost any other state in the union. The infrastructure upgrades we have made to allow video conferencing, remote digital imaging, and EHR (to name a few) have placed us in a optimal position to expand. The states most favorable to our expansion are those with the greatest need for Medicaid dental care and with community health providers open to partnership and collaboration.

What is your projected impact over the next 1-3 years?

If we expand out of Alabama, we can conservatively impact over 100,000 patient visits over the next 3 years.

Organization's Country of Operation

United States, AL, Anniston, Calhoun County

Type of Organization

Non‐profit/NGO

Sustainability

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Elaborate on your current financing strategy

Sarrell operates primarily on Medicaid/SCHIP reimbursements and does not solicit cash donations or grants.

Share of revenue generation in total income of organization (in percent)

99.9%

Direct sales to patients or other beneficiaries (in percent)

99.9%

Of the possible sources of these sales listed below, check all that apply to your current strategy

Licensing fees, e.g., for technology/franchise model (in percent)

0%

Of the possible sources of these licensing opportunities listed below, check all that apply to your current strategy

Service contract with organizations, e.g., government, NGOs (in percent)

99.9%

Of the possible sources of the service contracts listed below, check all that apply to your current strategy

Regional government, National government.

Explain your revenue generation strategy in more detail

We survive primarly on Medicaid and SCHIP reimbursements for the dental work we perform. We do not rely on cash donations or grants for our operations.

Share of philanthropy in total income of organization (in percent)

0.1%

Philanthrophy strategies you are using

Single strategy.

Explain your philanthropic approach in more detail

If someone asks to donate cash, we generally accept it. In the past, we have accepted used equipment but as we have grown, we have found it generally not to be the quality we use. What we accept is generally used only short term or for spare parts.

Expand on your selections; explain how you will sustain funding over the next 1-3 years.

We will continue to utilize our self-sufficient non-profit model. To expand, we would consider accepting cash or grants from acceptable donors.

Year of launch of the organization

2004

Years in Operation

Operating for more than 5 years

Has the organization received awards or honors? Please tell us about them

Sarrell Dental has received numerous honors and awards, including Alabama Head Start's Corporation of the Year in 2010 and 2012, National Children's Oral Health Foundation Affiliate of the Year in 2010, Outstanding Website Award by the Web Marketing Association in 2011, and Outstanding Organization by the NFL Alumni Atlanta Chapter every year from 2006 through 2012.

We want to hear about your “Aha!” moment. Share the story of where and when the founder(s) saw this solution’s potential to change the world.

As a fledging non-profit, with no fulltime dentist, we convinced a retired corporate CEO, Jeff Parker to join our organization. We were able to phase out reliance on cash donations and grants, we instilled best demonstrated practices, hired new staff and changed the culture. Since 2004, we have seen over 400,000 patient visits without a single patient complaint filed with the Dental Board.

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40 weeks ago 2nd Place Winner! Improving Access to Oral Healthcare has been chosen as a winner in Transforming Health Systems: Gamechanging Business Models.
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