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Designing The Future Of Dental Health For Overall Health at DentaQuest



Dan Williams

“Innovate or die.” It’s one of many famous quotes attributed to management guru Peter Drucker. 3M, Apple, and many others serve as examples of innovation rescuing companies from the brink of extinction. But innovation shouldn’t just be a lifeline to a failing venture. It should be part of a company’s DNA that inspires and nurtures a culture and environment for creating products, processes, and business models that deliver new value.

Unfortunately, innovation too often gets swallowed by ongoing efforts to maintain existing product value. How do product leaders protect innovation, and why is innovation something that needs protecting? Who is responsible for innovation – if everyone is, no one is. These are some of the challenges we probe in our discussions with innovation leaders.

This week we sat down with Dan Williams, Executive Director of Innovation at DentaQuest. A little over nine months ago, Dan was brought into what he thought was a dental insurance benefits organization but turned out to be a business that’s evolving into a care delivery model. At DentaQuest, their challenge is to evolve their model and story from the predominant “drill and fill” restorative services culture to a model that’s focused on prevention. More than just a digital transformation, Dan and his team are focused on an entire cultural transformation using design thinking.

In this interview, Dan discusses:

  • Using design thinking to solve the big, looming health issues like diabetes, opioid abuse, etc.
  • The idea that design is really a thinking methodology that designers use to identify unarticulated and unmet need.
  • Person-centered care. Not thinking of design as aesthetics, but rather taking the journey with the patient to understand it from their point of view and why they don’t get the care they need.
  • Designing behavior versus designing technology.

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Podcast Transcript

Dan: Well it’s interesting timing because, I’ve not been with DentaQuest longer than six months. I think as Dan has known about me for a few years, I came out of a technology software product background. Now I find myself in what I thought was an insurance benefits organization, but it really isn’t. It’s a business that’s evolving into a care delivery model.

Right at the time when you join and this is what the aim or focus of the program is, the company is going through some great changes, which I think are really actually positive for going from the model of care in dentistry, which is about restorative services, and so that’s where your benefits piece would come into play in a administrative benefits company to one that’s really focusing on prevention. Creating a prevention model through the clinics that we own and clinics that we manage and deliver these new services through gives us that chance to drive the real prevention model.

We’re just really excited about innovation because not only is it am I working with clinicians and the business heads for driving that strategy. It’s really giving us a lens to look at what does care models for dentistry even by prevention for children look like in the future, which is really hearkening back to the design piece and design thinking.

The folks that I have added so far here at the company are a lot like your own and user centered practices area, user centered design area. I think it’s a rich time for how medical and dental practices are going to be moving forward and how I would hope that the designers like us that are at the centerpiece or at least at the table of discussion. We have a great way that we look at things versus the way a finance officer might look at these things

Richard: Tell us a little bit about that. I like that track of thinking about innovation as it relates to something that we take for granted, which, A, is healthcare. We think of healthcare as a big monster that doesn’t have a lot of ongoing innovation that’s relevant to the day-to-day use of somebody, but specifically around dental care. Because I suppose most people think that if we’ve nailed innovation in dental care, it’s pretty much been done by now. You’re saying, No, we haven’t even touched it yet. We’ve got a whole bunch of good stuff to do.

Dan: What a lot of people don’t realize, and I think A, it’s maybe a branding issue or a discovery issue for so many people is that the genesis of a lot of disease comes from your mouth. 130 million Americans don’t have proper dental care, and of those, about 70 million are children without any sort of care. Of that, about 30 to 40 million of them are people who have caries and disease already and they’re not even into kindergarten and first grade yet.

There’s this whole concern that, well, healthcare is all around keeping your body healthy. I’m learning here in a rapid session is that really what the point is is keeping your mouth healthy, it keeps the rest of your body really healthy. With all this transfer of disease that starts from your mouth ends up being pervasive in later things like arthritis, rheumatoid arthritis, diabetes, heart disease, lung conditions.

It’s really crazy stuff, Richard, to see that we haven’t made that connection yet. There’s a lot of thinking both here in a company like DentaQuest and through accountable care models where they’re trying to put the two together. You don’t have this divorced dental practice from managing medical care and medical costs. I think that that’s a ripe place for innovation, and again, particularly around both education and in guidance and principles for helping people realize that what I just said if you can take care of your mouth, you can take care of a lot of your downstream concerns later on.

Starting it really early with kids is important, but those numbers I threw out to you, it’s frightening how many people discount or dismiss dental care as really important. It’s sort of a, Nah, and that’s because a brand and a visional of [inaudible 00:04:33] people is, Oh yeah, it’s about white teeth and a good smile. It’s not, Hey this is about your disease. This is about your body’s health.

Richard: You’re talking about one of the things that design and user experience design is always up against as a challenge, and that is we have the superficial stuff that people pay attention to like white teeth and a smile. If that’s a part, it’s the way the pixels are, it’s the aesthetics. It’s the real functioning of something, the ultimate value of something in the long run that where the design attention goes, Design with a capital D, if you will.

How do you then balance that out? Because the aesthetics are important; they just aren’t nearly as important as the functional stuff and they get all the attention. How do you as the design guy in this organization balance those things out?

Dan: I guess the good fortune is we have a focus on the right syllable. I’ll say it that way because they have recognized through a lot of clinical practice. The cool thing about DentaQuest is it’s got a foundation in an institute which actually are challenged or I guess addressing the philanthropic and science parts of oral care in dentistry. A lot of that thinking does end up becoming part of the business focus.

The CEO calls it, and you probably heard this, Richard, it’s a double bottom line philosophy where we’re managing the aspects of oral care for all while we’ll keep maintaining a business. That’s really been at the genesis of if we don’t see that the administrative benefits piece of the business really focuses on those critical issues that we just talked about. How to move part of our business to embrace it and support it so that those discoveries and those concerns coming out of the foundation work, out of the oral care centers are in fact brought into the business and become part of our solution and part of our solution space?

It’s a lot about design, it’s a lot about … I’ve had some great conversations with folks around here that don’t think of design, and I think that’s always been a challenge is, Oh, well it’s about aesthetics, it’s about a good smile, it’s about someone feeling good. Having confidence to really take that journey with the patient and understand from a user’s needs point of view, why do they never get good dental care? What happened along the way that they decided this wasn’t important or that mom and dad were working all day? It says my social characters about why people don’t do this as there are physical or fundamental or financial.

That is really the bigger dilemma for me of why medical and the healthcare industry is in the wreck it is because these are very intertwined issues and challenges. They can very much be attacked by design. I almost wish that we at the design community had maybe a bigger seminar on tackling these broader issues that are affecting health. Not just, Well I came up with the newest product to do this or I came up with a software that has a great application to connect me to my doctor.

The bigger fundamental issues are both social and economical and also the person themselves. We call that person-centered care. It’s about finding and fundamentally what’s going on here that affects this so that people get this in their heads that, You know what? If I don’t take care of my teeth, I’m screwed in more ways than not having a nice smile, and then they are dead.

Richard: I really like this idea of a bottom or triple … double or triple bottom line.

Dan: Yeah, a triple bottom line.

Richard: Just to challenge you for a second, when I get to the DentaQuest website, and I’m looking at this.

Dan: It’s terrible.

Richard: It’s not telling the story that you’ve just told me. You’ve just told me something that got my heart racing … What you’re saying is we’re not just a business, we’re a service to society. How do you then transform your organization because you clearly get the message? How does the rest of the organization, how do the practitioners who have been doing it get that message

Dan: Like I said, the impact organization which I’m part of is not even six months old. The CEO came in with this initiative and this goal. He’s brought some like-minded people in. Alison Corcoran who came from Staples and for that Polaroid is trying to champion this brand messaging unification or directive to say, to your point, anybody who looks at this says, Well we’ve got a frumpy medical dental benefits company. Don’t really capitalize on all the great work I have been describing and the foundation and then the institute, but also that we’re trying to lead this change for oral care for all, not, Hey, we’ll pay your Delta Dental bill. That’s what we know you for.

The funny thing is it’s such a great powerful story that this is why I came here. I came here because I felt … Of all of the things I’ve done in my career I said, I really wanted to be part of something philanthropic and something that was really about change. Even though you can look at my career and say, Well, hey, when you were at Motorola, you worked with some of the first phones in the world and you changed the whole concept of what communication is. That was fundamentally earth shattering for a lot of people.

I realized there’s a more fundamental issue, which is the general wellbeing of society is driven by a lot of what you and I do on a daily basis. I think it needed to have more touch points with design, and I was really challenged by that when I came here because the community here is not that at all. It’s a financially driven business organization that now is realizing how important it is in this construct of stakeholders guiding and supporting better care for our society. You can’t just come at it as a bean counter. You’ve got to come at it as a humanist and as a designer and as a person that’s thinking more holistically about what some of these challenges are to providing better care for the community.

There’s a lot to say in that statement, but a lot of it has to do with, to your point, how do you make an organization effective? The good news is we’ve got some help with that. We actually brought in some consultants that have been part of Kaiser and part of the journey over at the Boston Children’s Hospital working with me, working with our current leadership team on what are the transformative steps to a culture to be able to support that. Because without it, you’re the voice in the corner saying, We need to do this.

Actually there are some renegades in the company that are willing to break a piece of it off and say, You know what? The bigger organization is never going to get this or it may take more time for them to get this. Here’s a piece that we can start to champion and guide and manage with some of these new principles. We can start to show that there is impact.

I think along the bottom of the stream is, yeah, how do you change the culture of a business generally driven and measured by financial value and purpose to the larger audience of insurers that really are our customers. I think it’s not the end user per se.

Richard: You’re talking about more than just a digital transformation. You’re talking about an entire cultural transformation.

Dan: Some of that is training. I do a lot of what I call my water cooler conversations about one design thinking is like and people sometimes say” That’s awesome!” and some I would be like, “You don’t know what the hell you’re talking about. See you later.” Maybe you can build a financial model somewhere.

Richard: Tell me a little bit about what this stuff looks like tactically because exactly to your point, a lot of people are saying, Hang on a second. That seems pretty tangible. That doesn’t feel like something I can do anything with.

Dan: A tangible might be just we’re embarking on … I probably can’t say it publicly, but there’s two or three technologies that I’ve helped business leaders look at. One is a chemistry that’s been used to eradicate or stop caries itself. Another is an online social network play for brushing that supports an online service that rather than it’s just about the brush; it’s also about community and a support for care that comes from your community with that community.

Some of these introductions, not just willy-nilly, but driven by some of our larger mission statements or mission goals. A lot of this is driven by the fact that we are trying to eliminate or lower children’s disease, and particularly caries, which is the number one disease in the world that no one talks about. Like, Oh I didn’t know that.

Richard: I didn’t know that.

Dan: Caries is the root of all of the evil that takes place in your mouth, which eventually leads to quite a lot of health problems. It’s a massive issue that starts at early, early ages of one, two years old when they are saying that mothers who have cavities don’t even realize that they can transmit caries to their babies by kissing. Just fractions of details that if you got them all with the right presentation and the right subject underneath them, I think we start to drive that conversation a little deeper. I’m hoping I am a part of it, if we can make that happen. Some small fires, Richard, some things that are outside the norm.

I think their CEO is very passionate about this whole subject and very compassionate about needing to change the models, change some of the financial models, change some of the ways that we do things. If we’re driven a lot by Medicaid in the future in a governing body supporting or managing healthcare for this nation. What does it mean to have to be able to serve a larger audience with less money? How do you use creativity to drive solutions that don’t rely anymore on the pot always being full, but perhaps a pot being very narrow or lower? You’ve got to come up with very creative solutions to be able to deliver the care that you’re providing people.

That’s really what this clinic-based approach was I was telling you a minute ago is about is us getting into the ownership, management and delivery of dental care by what we call our DentaQuest model of care, which is really driven by prevention first, restorative second. That’s a whole flip on today’s drill and fill culture, which is, Hey, I get paid by how many cavities I fill.

That’s a big change in the industry because that’s not always supported by people. A lot of people believe that the model of restore is the biggest best model and they bank on that. I think design thinking, it’s just rich for design thinking, but it’s only one thing. Just think about diabetes. Just think about the big looming issues. Think about the opioid issue. Like why aren’t design communities starting to take this up and drive some of these solutions? I think we’re just starting this conversation, especially in a place like Boston where we’ve got so much medical awareness around us. How much do you think it’s touched by design?

Richard: Well you’ll be delighted to know that Joe Chan, who is the biggest contributor to the Harvard School of Public Health, recently given a donation of around about 400 million to the Public School of Health. Actually hosted a dinner for all of the leaders of the Public Health System at Harvard and all of the associated organizations and schools to talk about design thinking and what design thinking can do. Made a distinction between what design is and what design thinking is, design as aesthetic, really pleasing, interesting, even objectifying things versus actually solving problems.

There is a awareness that this tool or set of tools can be helpful, but I agree with you. The industries haven’t quite found common ground yet where they can work together on these problems. It still feels a little bit like design with a little D is leading the conversation where in fact the design thinking conversation is where and the design doing, as I call it, getting out there, interviewing people, finding out what their real problems are, and then applying the design thinking mentality to those problems. It’s happening. It’s just not happening at a pace that’s reasonable.

Dan: That’s an awesome thing to hear and I wish I had attended it. There are small fires, companies like yours. I had lunch with John Sakai over at Continuum. I’ve known John for many years, and we’ve grown up through the, Hey, what is design? Where it used to be, Hey, it’s industrial design. Oh, then it’s graphic design, it’s user interface design and service design. He says the same thing you’re saying. He said, No, it’s really a thinking and the methodology that designers use to problem solve or not even problem solve; so much as identify the unarticulated need on the unmet need.

That’s not something that’s been able to be talked up very well yet. I think to your point, lot of peoples are just saying, Oh, you’re a design guy. Okay, I think I know what you do.

In effect, I was tickled pink that DentaQuest took this position, appointed me, which was both a guy who had a lot of experience on the physical side of design, but also with theory as well as the thinking part of it and over all the candidates. Believe that that was a change agent for this whole industry and the economy of dental services, which I used to always say, I never see anybody …

Again, I spent so much time over in Kendall Square in my career that I could see it’s not about technology. This is not a technology to solve problems. This is a systematic issue that is going to take a lot of stakeholders around the table looking at these things we’ve been talking about today, the community itself, the economy, the financing models, the policy makers, the government bureaus embodies. When I did some of those medical products, I realized that. I said, If you don’t have a conversation or having engagement with those other people, you can have the best technology in the world, and it will never go anywhere.

Having a seat at the table of a company like DentaQuest which has the conversation with all of those pieces of the pie for moving the needle, I thought was strategic in terms of trying to be impactful in taking design thinking through that lens to be able to start a conversation and apply it. We’ll see if I’m successful.

Richard: You know what? I think this leads into a part of the conversation which I’ve started to realize happens a lot more often and that is as designers, as design thinkers, we have the opportunity to understand human beings and to lead their behavior in a certain direction. That can be used for good and bad.

If you’re Facebook, you’re leading them in the bad direction. You’re taking advantage of people’s desire to be a part of something or to react to FOMO, whatever it is at a physiological level. They are basically getting that little dopamine hit every time a notification goes up, and it’s become abusive. They’re stealing your time and your attention so they can sell more ads.

Then there’s other companies who are saying that this is a very powerful tool. UX is not something to be taken lightly. What’s the ethical conversation here? How can we use that to getting deeper into good behavior. We can guide somebody towards a habit that is healthier, and in your case, I think that’s probably more true than ever. Oral hygiene in general is about habits. It’s like routines and those are things that UX and design can talk. We know how easy it is to change people’s behavior as UX people, but the question remains, what are we going to do with that knowledge?

Dan: That’s a great point for … Again, one of the services and products we’re looking at is in that section of brushing, habit changing. How are you affecting someone’s lifestyle to introduce good brushing? It’s rather simple stuff, but unless you’re … You’re commanding or you’re getting their attention and time for them to apply that knowledge. It’s often a very low detail thing that they think they can get away with or don’t have to spend time on.

When you make it part of a larger story of good health, I think people start to think, yeah, maybe I shouldn’t brush my teeth. Maybe I should see the dentist once or twice a year and take … I think we have this thing. Again, I don’t have … Maybe I do have it. It’s something like, we call it 2 plus 5787. It doesn’t mean anything, but what it means is that you take two hours of the year to address your dental health, and what are you doing with the other 5287 hours, which is just add 365 times 24 is the number of hours.

It’s kind of a way that people think, Yeah, I never thought about that. Yeah because that’s an important thing and I think two hours a year is what it takes to maintain good health, good dental hygiene. It starts to get people thinking about, Wow, I really don’t put a lot of attention after into it, and the little I can do every day by brushing and changing habits and engaging in good practices is something that has a lifetime of benefit. That is and could be very much driven by design thinking.

There is a company down in New York, and you probably know about called quip, and quip is very much driven by just that model that we want to create good habits through great design. They had this subscription model, but when you talk to Simon, who like yourself is from the other side of the pond, he’s very much about creating a good habit and using some very simple, fundamental things. He’s a designer. The two heads of that company are design guys who left Fused, started his business. He and I had some great conversations about what do you think it’s going to look like in the future?

A lot of it’s about really call it would be self-care. Again, one of these things that has to be thought about as we have less money for more people is that you need to help people retrain themselves to be responsible for themselves more. Which is not just for dental health, but for everything. We’re becoming so reliant on everything. You forget about self-reliance, which a lot, probably 80% of good health is based on self-reliance.

To your point, how do you train people? How do you help them help themselves is I think a big design challenge.

Richard: Dan, give us two or three things that are on your to-do list right now. So you can be as tactical as you want.

Dan: One is architecting that model of care to be … that sort of prevention model of care to be rolled out nationally. I’m part of that team that’s looking at not just the clinical aspects of it, but the user centered practices, creating a mapping patient journey for primarily a Medicaid population that has to start at a very early age and takes them through a process and maintains and supports a lifestyle of good care.

Richard: What kind of design assets do you use to do that? Is that a typical experience design?

Dan: I think we’re doing some ethnographic research right now within the Medicaid community, understanding what some of the real needs, articulated unmet needs. Some that just is journey mapping in itself and looking at what are the construct of a patient’s day do they do? Why don’t they get to the dentist? Why don’t they take their child who has a toothache and is not able to get to the dentist because mom and dad work? One is at the school cafeteria as a janitor, can’t take time off from work to take the child there.

What do you do to change the model and bring the care to them? What are we thinking about behind services standpoint that doesn’t matter? One of my programs is called Care Beyond the Chair, and it’s looking at how do you send technology, services, capabilities into the community, which you’ll find in dealing with a lot of what we’re talking about today, Richard, is community-based. It’s not anything to do with, I don’t know where my dentist is. It has to be a community-driven mindset that they don’t need it.

I’ve had a great conversation with some of our clinicians down in Appalachia, in the Carolinas and you know what? People there accept that you’re 30 years old, that you don’t have any teeth anymore.

Richard: That’s kind of crazy, isn’t it?

Dan: No, but just think about it. Think what happens to people’s psyche that through the course of no community intervention, it becomes an acceptable way of living. Then you start to think, Well we’ve got to get in there. We can’t wait for them to come here. A lot of my work is about directing and working with the clinicians.

Richard: That’s awesome.

Dan: One is a teledentistry product, one is local here in Boston, another is down in New York and working with them on trying to take their technology and capabilities and bring them in. One of the challenges is, hey you need a smartphone. Oh, and you need an address too. Think about a person who is so transient that they’re probably uproot their family on average every three to four months. They use not Obama phones; they used pay as you go phones in three month intervals.

That’s thinking about, Okay, what do I need to think about that makes the solution still practical, but it’s in a new construct of not you and I and having the smartest of phones and the longest data rates possible in a snippet that still wants to drive that benefit to them.

Richard: That gets back to your original challenge, which is you’re designing behavior, not designing technology.

Dan: I think it’s marrying them because, again, you’ll never take the designer technologist out of me, but having that history, education and knowledge, I know that that’s not what the problem is. The problem is not that you can’t solve a technological issue. It’s that we need to address the real requirements of delivering technology to a broader group of people who don’t always have the same mental model or capability as what might be the first thing that the designer or engineer thought about as the end user. It’s not that at all, not with the world I’m in right now of the 60 million Medicaid patients, in which half of them are under the age of 10 years old.

Richard: Amazing. I want to reference a book that I’ve been reading. It’s called “The Power of Moments”, and it’s written by Chip Heath and Dan Heath which are the guys that started the Freakonomics series of-

Dan: Oh, Freakonomics.

Richard: They talk about a campaign that was running in India specifically, but in a lot of the developing countries where open defecation was leading to all kinds of disease. People would, as they say, would basically go and shit in the woods, and that would end up in their crops and in their water. Really the people that were trying to solve this problem were shipping in porta potties and essentially taking a technological approach to solving the problem. People were ignoring that. Folks in Malawi would say, Well that thing’s better than my ass. Why would I go and take a dump on that base?

What they realized is that they had to redesign the behavior first so that the technology could actually get traction. It just reminds me of the story. I think that what you’re saying is exactly that is the technology makes sense when you understand why it’s fitting into your routine, your behavior or your habits. Unless the mental model is there, it’s very difficult to make that.

Dan: I think you’re making a point, and if it’s designed, it’s designed for appropriateness. My most recent hire, so a user center designer from Illinois Institute of Technology’s design school, and I know you know those guys really well. She’s Indian and she’s not a few a years out of India, and she’s a breath of fresh air for me because she does exactly what you say. She gives me a picture, a point of view of like here’s what happens in India. It’s not unlike what happens in rural America. You must be thinking, well we get all this technology around us. We’re America. No, there’s a very … I don’t want to say not … not the same concerns, but a lot of the same issues where people don’t have that ideal model that you and I believe is so representative all around America.

Well, take a trip down to Kentucky, there is nothing down there. She is very good because she’s going, You know, Dan, here’s how we used to do it in the village. Here’s what we thought about dentistry. Here’s how we watched services.

Really makes me think that as a rural society, some of these exchanges are going to be very valuable to even our own community. Designers have to leave that. Kind of stop thinking that we’re all a bunch of rich brats from places like Boston and New York and everyone knows what we know and they want what we want. The truth is a third of this country, 130 million people don’t have access to dental care.

Richard: That’s crazy. That’s interesting.

Dan: In America. Here we got the likes of what’s going on and the challenges of Congress to take more money away. It’s like what are you going to do?

Richard: That is crazy.

Dan: It is, it is. I think it’s a great place to try to impact and affect something as important as this through design thinking.

Richard: I love it.

Dan: Would be good to get you guys involved.

Richard: Yeah, we would love that. If you want to meet some of my friends over at Partners in Health and people like that who are also trying to solve these kinds of problems, and obviously different diseases or different indications, but they are solving it with the same kind of uphill battle, if you will.

Dan: I’m really serious, Richard. I think sometimes things start in small fires and whether … I’ve got some folks over at MIT Media Lab. I’ve been talking to some folks there. Now is the time for this. It’s not … I remember when it was a technology issue, or it was the innovation issue. Innovation for what? It’s like this is innovation for sociological changes, but with a backdrop that it’s services and driven by services technologies and the capabilities of things you and I work lifetimes on. That conversation has gotta start somewhere. I don’t know if it’s a TED conference or it’s over at the Media Lab or Harvard.

Richard: I think what we should do is put a small group of people together and see where we go from there.

Dan: That’d be awesome.

Richard: Dan, I really appreciate your time. I absolutely love this. This is something that’s been on my mind for a while, using design thinking as a way to solve bigger problems than just another social app. You’re kind of on the forefront.

Author Richard Banfield

As CEO, Richard leads Fresh Tilled Soil’s strategic vision. He’s a mentor at TechStars and BluePrintHealth, an advisor and lecturer at the Boston Startup School, and serves on the executive committees of TEDxBoston, the AdClub’s Edge Conference, and Boston Regional Entrepreneurship Week.

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