Tips To Increase Adult Orthodontic Patient Starts

Alison Werner
Hello and welcome to the Orthodontic Products podcast. I’m your host, Alison Werner. In this episode, we’re gonna talk about increasing adult patients as share of chair. And with us to break down this topic is Oliver Gelles, chief marketing officer at OrthoFi, the software and service solution that provides patient onboarding and includes insurance, patient billing, and collection services. Oliver has over 20 years of experience in the orthodontic industry and is a frequent speaker on patient acquisition. Oliver, thank you for joining me.

Oliver Gelles
Thanks for having me, Alison.

Alison Werner
Great. So to get started, I know OrthoFi has some great data around adult orthodontic starts and I know there’s some misconceptions around trends there. So what are you seeing?

Oliver Gelles
Yeah, I’ve been on the circuit a little bit recently because I think that in the last few years, we’ve had such a roller coaster ride with COVID and then what I call the year of confirmation bias with the 20 plus percent growth year in 2021 and then a correction in 2022 and then some economic tightness and softness that people experience, especially in the back half of last year, which we’re seeing continuing into this year.

And so, you know, for the audience out there, first of all, the 21 % growth that, that everyone experienced in 2021, much of that was fueled by anomalous factors, stimulus, nowhere to spend the stimulus, and then really a surge in adult treatment demand.

They surged from what was 25% of the cases to almost 35% within our cohort group. And so they represented a disproportionate aspect of that growth. And then of course, when the economy comes back and tightens, that’s usually the first place that that happens. That said, the 3.5 % shrinkage in starts last year is not entirely attributable to just the economy.

I think that that’s lazy. And I think that what we’ve been doing is slicing and dicing the data to understand like more of a root cause. And so what we’ve seized upon is this. So when you look at the starts, you know, the child starts actually were flat or increasing the overall, you know, uh, exams were, you know, a little bit down, but not as down as the start. So we lost some case acceptance, the adult demand was a little down, which is pretty indicative of economic tightness.
We’ve seen that in other times like 2008, 2009. So their exams were down 4% for adults. Adult fixed treatment was also down 4%, which is what you’d want. If the phone rings 4% less at the time, you would expect a 4 % drop in adult fixed appliance starts. The outlying factor, though, is that adult aligner starts were down almost 11%.

Oliver Gelles
And so what accounts for that seven point delta? And there’s really only one distinguishing factor between aligner treatment and adult fixed appliance treatment. And I think we can all agree that aligners didn’t spontaneously become less popular, less marketed or any of that. So it wasn’t the demand for that solution. It was because orthodontists routinely are still requiring the lab fee as a minimum down.

And so during a time of economic tightness, the worst thing you can do during that time is to require an adult who, you know, by the numbers only 4 out of 10 have a thousand dollars to put towards treatment to put 1,500 down. So we self -inflicted the equivalent of a 2 % impact on starts. So if you think about what I said, 3 .6 % drop in starts. 2 out of that 3 .6, so more than half, was attributable to that seven-point delta with adults. So that’s self -inflicted.

Alison Werner
Okay. So let’s talk about who these patients, these adult patients are. In large part, we’re talking about Millennials and Gen Z. So if you’re going to go after these adult patients and figure out a way to rebound here, what do you need to know about this population and their decision making?

Oliver Gelles
So there are a lot brighter folks than I about actually seizing on the behavioral trends of millennials. Tracy Martin in particular has made a career out of really educating the industry of millennials and she’s forgotten more about millennial psychographics than I’ll ever know. But I do think that it’s worthwhile to be a student of that game. What I can add to the picture is this, which is what everyone on the call needs to remember and know is the adult target and the adolescent target are very different in these two important ways.

Number one is they were not planning on this treatment. The parents of an 11-year-old have likely been in OBS or at least seen their kid knowing that their kid has some malocclusion or some crooked teeth or buck teeth. And they’ve known that they were going to have to be saving for this. So they’ve been preparing for this expense.

And so you can sometimes get a higher down from a family that’s been saving. For adults, many of them make the decision very spontaneously. It’s far more whimsical. You know, they have a life event, they get divorced, they have a wedding they’re going to be going to or be in. Their friend just got aligners or got them off and they’re motivated in that moment. So they don’t have a bunch saved up and all the FRED savings date data shows that people had lots of savings and lots of cash back in 2021, but it not only has snapped back, it’s actually snapped back lower than before. So people have even less sitting in their bank accounts ready to write a check on. So that’s one of the reasons why of all your targets, you can’t ask an adult for a high down. That’s just not a great idea. So that’s one important thing.

And then the other thing is they’ve been living with this malocclusion for likely 10 to 15 to 20 years. And so they can live another year with it. So we got to be really great at getting that same day contract from them while their attention is in this place right now before they get distracted with other expenses and other things. And so if you don’t get an adult to same day start, you’re probably not going to get them for a while.

But you need to be patient and stay with them using automated pending technologies like OrthoFi has, but there are other technologies that do this and stay with them so that when the thought comes back up, you are just in time, you’re in their inbox and ready to remind them that they deserve this treatment and that it’s a great time to get a great smile.

Alison Werner
Well, and another reason for targeting this adult population and getting them to that decision is because adults are going to make up a larger portion of cases going forward based on the demographics, right?

Oliver Gelles
Yeah, I mean, this is another thing that a lot of orthodontists are either sleeping on or burying their heads about. So we are in one of the greatest specialties and industries in the world for many reasons. But one of the reasons is that we’re very lucky is that we have birth rate data, which essentially is the equivalent of total addressable market data that tells us how many targets are we going to have for the largest part of our market, right?

So we know how many 11 year olds there are going to be because we have the birth rate from 11 years ago. And so what’s super interesting is the birth rate actually peaked in 2010 and it has been declining ever since. So it makes sense that in 2021, we had a nice number of kids. The bad news is, is that by the data, not only are there gonna be less kids this year to treat, there’s going to be less kids for the next 10 years to treat. So if you want to grow your practice, it’s not going to be by treating more kids unless you’re going to be stealing them from your neighbors and getting a market share play. You’re going to need to treat more adults if you want to increase your total volume of starts.

Alison Werner
Okay, so with all that in mind, what are the best strategies for winning these patients over and building a long -term relationship? And you talked a little bit there about dealing with their financial situation. So what else should doctors know?

Oliver Gelles
Right. So from a conversion workflow, I think one of the most important things in general, but especially for adults. So it’s almost like all these things are important to convert kids, but acutely important for adults. Right. The first thing is really lean into the pre -suasion aspect. Right. The job to convert the patient does not begin when they walk through your door. The job begins from the first call.

How you establish rapport, how you establish reciprocity with that patient, make them feel like a patient even before they walk in. We have lots of data connecting their engagement with intake forms, which is why we have mobile friendly intake forms, using technology, making them feel like they are part of the practice, high impact appointment reminder calls with video texts, like investing time and energy in the pre-suasion so that they’re already pretty warm when they come in and then having a great playbook to do same -day conversion. So a lot of practices have leaned into same -day starts. If you have not, now is the time because this target needs to be converted that way. And then of course have great technology that follows them immediately after and doesn’t let a lot of dust settle on that opportunity .

You have a very short window after the exam, but then in the middle have to have flexible terms. You can have a nice fee. If you’re doing the best technology in your neighborhood, I say this all the time. I want you to have the highest fee. I also want you to be the most affordable. And the only way to have both of those be true is by being flexible in our form of flexibility. We feel is the best. And that is the open choice concept where the adult patient designs their payment plan based on what they can do. And what that ends up doing is it blends growth and cash flow and risk. And that’s the ultimate formula that we see.

Alison Werner
Okay. Now you mentioned, you know, the fact that a lot of orthodontic practices have aligner patients pay that lab fee upfront. And I know that OrthoFi recently entered into an agreement with Align Technology that will allow OrthoFi clients to spread those Align lab fees over 10 months. Can you talk a little bit more about what that means in practice and how practices can kind of implement that?

Oliver Gelles
Absolutely. Now I will say like OrthoFi already did a pretty decent job of helping them to balance that anyway, because we have carrot and stick incentives for patients to put higher downs that then create a blended balance cashflow that’s really healthy. So we already were doing a pretty good job of solving for this, but it always did feel like, trust me, it’ll happen. It’ll work itself out. And some did and they, and they’ve, profited and thrive from that and some, you know, have hesitated.

Even within our own customer group. Some, you know, lean into the system and some not. But now I’m excited because we actually have a real solution where I can tell you that your cashflow is going to be fine because if you are a qualifying practice, meaning that you’re in good standing with Align, it’s, you know, it is only to sole proprietor practices. So DSOs likely have a different, you know, different arrangement.

But if you’re in a sole proprietor practice and you’re in good standing with Invisalign, you will likely qualify for what’s called the FPT -10 program, which like you said, Alison, very simply is imagine that if you click your clincheck and approve it, you will get the first of 10 invoices over the next 10 months that through ACH, and it does have to be ACH, but there’s a huge ROI for that, that you will automatically be on a 10 month installment program.

So what we’ve seen by running all the modeling numbers is that the average practice would see, even if they didn’t increase their volume of Invisalign at all, they would see roughly a $45,000 cashflow benefit over the first 12 months, which is the equivalent of getting a zero interest small business loan.

That’s pretty nice as a benefit. But I am also telling everybody, don’t use it to go buy a boat, right? That cash is, I want you to reinvest it in the business. And if you have designs to increase your mix of aligners in your practice, and you, let’s say, want to go from 20 % mix to roughly 40 % mix, this is the vehicle to get there. And if you do that, that $45,000 is actually more like over $70 ,000 that you would have as an advantage versus just trying to climb up the ladder yourself.

Alison Werner
Now for anyone who’s interested, I know that you’re going to be going deeper into this topic, or our topic, which was adult starts. And you’ll be leading a mini masterclass as part of the AEO’s Lunch and Learn program in the exhibit hall with consultant Tracy Martin, who you mentioned is really enmeshed in the Gen Z millennial behavior. So if you really want to dive in deeper on that, go check this out on Saturday, May 4th at 11:50 a .m. in the exhibit hall. What else should potential attendees know about this session?

Oliver Gelles
Yeah, we’re going at this as hard as it can possibly go. And for any of you on that has heard Tracy’s content in particular, it will make you uncomfortable. It is definitely cutting-edge stuff. There are a lot of, you know, staid notions in our industry that she’s going to challenge hard. And, you know, for me to be saying that being I usually am that role is saying something, but it will be very, you will not want to miss it. You will hear stuff that you are not hearing in other halls.

Alison Werner
Well, Oliver, thank you so much for taking the time to speak to me. I know we’re going to have you back again soon to talk on other topics, but I really appreciate you kind of delving into this. And I hope everybody goes and checks you out at the AAO and maybe gets a little scared, but it’s for a good it’s for a good reason.

Oliver Gelles
Thanks, Allison. Really appreciate it.