The Irishman bringing consumer tech to US dentistry

by Communications, Dental practice software, IT, Movers and shakers

Toothpic is a phone app that’s accelerating the retailisation of dentistry in the US. Users get a virtual dental check-up within 24 hours via its pool of 400 online dentists in the world’s first large scale teledental service. We caught up with CEO Mark Moore, 30, who splits his time between Dublin and New York.

Mark, who’s using Toothpic?

We thought it would be mostly emergencies and rural patients but actually it’s a broader audience, especially young adults in cities. As a way to find out what to do next to manage your mouth it’s much less hassle than going to the dentist.

In the US it’s normal for insurance packages to include check-ups with x-rays every six months. People often doubt whether they really need to attend and they can check this out with Toothpic. Some people aren’t going at all, and so they might use Toothpic as an on ramp to see what they can expect if they do go in.

So it’s really a screening tool: do I need to go in for an appointment, or can I push out my next appointment, perhaps by doing something different at home with my oral hygiene regime?

How do consumers find out about Toothpic?

We’ve spent much of the last couple of years working on this distribution question. We partner with dental insurance companies to help distribute the service. We run campaigns with those insurers to make their members aware of the service, what it can be used for and when it’s most valuable to use it. Then when a patient needs the service they often remember that Toothpic is available as a first point of contact.

ToothPic users are guided through clinical selfies that OralEye dentists examine

ToothPic users are guided through clinical selfies that OralEye dentists examine

Users get a report with a dentist’s recommendation within 24 hours — is speed of response the USP?

While we commit to a 24 hour response time and many reports are returned much faster than that, it’s not our USP. Our USP is more convenient access to care and care management. We’ve learnt that there are many issues that prevent patients from getting the care they need and so we’re trying to address a number of those, such as cost, convenience and fear. Except in emergency situations, response time is rarely the main barrier to care.

Which part of the US market is the app going to disrupt the most?

Rather than being a disruptor it’s accelerating trends that are already there. Consumers want more information, dentists want to be more convenient, and insurers want to create more personalised products. We’re working with all these stakeholders to make things better, which is ultimately about consumer empowerment. We see consumers making more informed decisions across many other sectors but medical and dental fields have been lagging in this regard.

Is Toothpic purely a referral tool or will there be follow up services like health tips via videos?

Toothpic already does both. So if our OralEye network dentist looks at your photos and sees poor oral hygiene on your lower teeth, for example, she might send a video showing you how to improve your brushing, perhaps with advice on a better toothbrush, and then recommend getting a scale and polish to remove the calculus. We are working on making our content even more personalised.

Tell me about your strategy — you’re based in Dublin, with a New York office, operating in 10 states and rolling out in all 50 in 2018. Why the US, not Ireland, Europe?

When we started nearly five years ago we were too early for the Irish and UK markets. We did work with some very innovative dentists but the US market was further ahead. Telemedicine was gaining mainstream acceptance and the high percentage of commercial insured patients meant that insurers there could be a meaningful distribution channel for us.

You’ve been pitching to insurance companies and tech investors. What’s been the biggest challenge and what’s worked?

One of the big challenges has been for traditional investors to understand the size and scope of the dental market. In particular most investors have had very few dental problems and so can find it hard to believe that there are millions of people with limited access to quality dental care. Dental also struggles to compete with the ‘sexy tech’ trends like AR [augmented reality], VR  [virtual reality] and AI [artificial intelligence].

I found in San Francisco in particular that there’s a lot of investment by trend. We were probably arriving at the tail end of the telemedicine hype, and Teladoc had just gone public, which was good, but everyone was looking at AR, and now it’s AI and bots. But we found a few strategic investors who knew the dental sector and worried about their space being disrupted, so they totally got it.

Insurers suffer from a structural challenge in that their customers are not their users and so to get new innovations deployed requires significant stakeholder management and convincing. I think this is a common issue in consumer healthcare technology in general. Also, their business models are not well aligned with prevention but we’ve seen that when one starts others follow quite quickly.

Who’s your biggest competitor?

There are a few start-ups who are doing different flavours of teledentistry but as a far as we know we are the only ones selling to insurance companies. The others have sold to dentists, and some telemedicine companies have a teledental service on the side, but it’s not their main focus.

Do you exit, and if so when?

I’m sure our investors have their own thoughts on this but given the lack of consumer innovation in the dental industry we see many years of opportunity to grow and improve patient outcomes along the way.

Where will you be in five years? Where do you see the US and European dental sectors in five years?

All going to plan this next generation will see teledentistry not as an add-on to dental care but as the tool they use to manage their care as they change insurer, change dentist and change their oral hygiene habits. Like telemedicine we expect it to become table stakes.

I expect the US will see further consolidation on the dental practice side, consumer dental insurance products and lots more integration between payers, providers and patient services up to and including healthcare and dental management services.

The US has big overheads on the medical side because they have spent the last 10 years trying to come to terms with the Affordable Care Act and Obamacare instead of genuinely innovating. They’re now loosely committed to the outcome-based price model established by Obamacare, and some CEOs are saying they’re not going back because their ships are too big to turn around.

I was at a conference with European insurance agencies last week in Munich and they’re ahead on pricing. For instance, if you follow specific health regimes they’ll reduce your premiums. They’re doing that now in medical, so it will happen in dental.

In the book Homo Deus, Yuval Noah Harari describes a world where our personal AI assistants monitor all the data we produce to alert us to health issues, and AI programs remove human errors from diagnoses. How far do you see this kind of thing going in our lifetimes?

To some extent this is already happening in point solutions but they have yet to be unified under one platform. In the dental sector insurers have enough data to start doing this for many patients. I expect we’ll at least see AI-augmented diagnoses and probably some people will trust a fully AI diagnosis with a fall back to a human-in-the-loop system. I think the main challenge is creating a business model for prevention that aligns the interests of the patient, payer and provider (or AI owner).

The contrarian billionaire Vinod Khosla has some interesting things to say about this, although he has a vested interested in promoting the view that 80% of doctors are soon to be redundant. But AI is already being used in healthcare and at the very least it will continue to make the market more efficient.

It unlocks illiquidity of services, reducing the possibility of risk being unclear, which is good for the consumer because when risks are unclear insurers set prices higher to be safe. I do think the trend of personalisation will continue because AI will enable more and more fine grain data and therefore reward the consumer with personalised pricing.

ToothPic CEO Mark Moore

“Like telemedicine we expect it to become table stakes”

Mark Moore, ToothPic CEO

Author: Zac Fine