How To Build a High Trust Healthcare Brand in India
Amar Singh has built one of the largest dental chains in India, in just 10 years
Forget sterile waiting rooms and foreboding drills. At the forefront of India’s dental care landscape is Clove Dental, a retail chain changing how India experiences dentistry. Clove has expanded to more than 400 clinics across India in just ten years and treats 40,000 patients per month. In this interview I spoke with Amar Singh, Clove's Founder and CEO, to understand the unique challenges they’ve had to overcome.
The dental care landscape gives us a window into the systemic issues plaguing Indian Healthcare. Why do patients lack trust in the medical system? How do we incentivize doctors to think about long term outcomes for patients? Amar shares how his team has solved these problems using a unique combination of technology, quality control, and the right incentives.
Below, I’ve broken up our conversation into five sections, including summaries of Amar’s thoughts and many of his direct quotes.
Dental hygiene and lifespan
AS: “What do we know about the link between dental health and overall patient health and lifespan?”
Amar: “Periodontal Medicine is a new paradigm in dentistry. The proven periodontal - systemic link underscores the connection between oral health status with multiple systemic diseases. New research published in the past few years links chronic inflammation in the gums with elevated inflammatory response throughout the body. Poor periodontal health greatly increases the risk of chronic diseases like heart disease, diabetes, arthritis and even Alzheimer's disease. It affects pregnant women, resulting in preterm labour, premature birth and low birth weight babies.”
Bacteria from your mouth can also travel to your lungs, triggering respiratory problems like pneumonia and bronchitis. This is especially concerning for people with weakened immune systems or pre-existing respiratory conditions.
Research links here and here for readers interested in learning more.
The challenge of changing consumer behavior
AS: “Given the importance, how do you get patients to think about their dental health early and often?”
Amar “For most consumers, the dental care journey is reactive. It starts with a visible problem or tooth pain, meaning that they see discoloration or they see plaque, or they see bleeding, or they see a missing tooth, and that bothers them. Or in more serious cases they have a specific pain in their tooth or jaw.”
Naturally, awareness of the long term implications on health is low. Because most people wait until they feel pain, the problems go unnoticed for a long period of time. By the time a patient walks into a clinic, drastic measures (like a root canal or even reconstructive surgery) are required to solve the problem.
Amar: “It’s a hard problem. We continue to nudge patients towards preventive care by offering annual plans or membership plans that lowers the friction of regular check-ups and maintenance. We suggest members also purchase plans for family members. On top of that, we digitize everything and use technology to drive follow ups.”
The challenge of building retail healthcare in India
AS: “Many companies have tried to build in the retail healthcare space and failed. Most investors complain of high CAC and low retention. How have you overcome these issues?”
Amar: “Let’s consider where most patients start their care journey. You need to see a dentist urgently because you have a bothersome amount of tooth pain. So you then start looking for a doctor or a dentist, and your typical questions are, who's close by? Who is a good dentist? Who's not going to rip me off? Oftentimes in dentistry people are not asking the question, ‘Who is the best in the country?’ like they would in cardiology or nephrology.”
For dental care, much like primary care, patients look for convenience, proximity, and upfront pricing as much as they look for quality. Therefore, growth relies on expanding to new locations so that Clove can be proximate to more target consumers.
Amar: “If you give patients easy access and quality, you can drive traffic, retain patients, and build a valuable business.”
Patient trust in healthcare providers
AS: “How do you solve the trust deficit with dentists?”
Amar: “First, there is low awareness of the 8 dental specialties, each of them requiring three years of an MDS degree. There's no organ in your body that has eight subspecialties. Your lungs don't have eight. Your heart doesn't have eight, but your teeth have eight different specialties. And the reason for it is because of the complexity of a fairly small area in your body- a highly nerve sensitive, highly utilized part of your body. So there's a huge gap in how consumers perceive the complexity of dental problems and the reality.”
Because there is so much complexity and patients often wait for symptoms to develop to the point of severe pain, they are surprised by radical treatment paths like root canals, implants, and crowns (and their associated costs). They feel they are being taken advantage of, when in fact, there is no other option- the patient has waited too long to take action.
Amar: “The other issue is that some dentists do overprescribe. We have the problem of commercialized healthcare in India where most doctors work on a fee-for-service basis.”
Clove has solved for this issue in two ways:
First, all doctors at Clove are full-time employees and paid on an 80% fixed income basis, even if they are underutilized. They don’t get upside from overprescribing procedures and so naturally they default to what's best for the patient.
Second, Clove has a strong audit system to ensure doctors are focused on quality.
Amar: “After a treatment is recommended, we anonymize the patient’s record and send it to another doctor in our system. That doctor goes through a checklist to make sure that the diagnosis was correct. We also ensure that billing was done appropriately for that treatment. Without a system like this, there's no way you can guarantee consistency of treatment quality. We are monitoring 40-50% of live cases at any given point in time. And of course, we have strict standards on the quality of doctors we bring on. We have standards on equipment and materials that we use. And we have consistent pricing. We audit all of this regularly.”
Other unique challenges in Dentistry
Amar: “One interesting problem we had to solve was maintaining cleanliness of the facilities. Every time a chair is used, it gets contaminated because of blood and saliva. Your doctor puts their hands in your mouth, there's blood coming out or saliva, and then they're touching the chair. As per protocol the dental chair needs to be sterilized, usually by a dental assistant. Now, that individual has to do this same job ten times a day, six days a week, 20 days a month. That gets really monotonous, and it’s easy for the dental assistant to skip out on the cleaning.”
To solve this, Clove has automatic sterilization chairs known as DORI, which are self cleansing. This process is monitored using the installed cameras that use computer vision and AI to monitor whether or not the chair has been sterilized after every appointment. This ensures a 100% sterilization rate.
Amar: “The average dentist in India does not possibly have the means or ability to set up these systems in every room. That’s one way we’re able to differentiate our experience and build trust.”
Another thing Amar mentioned was Clove’s internal certification system.
Amar: “We only hire specialists. 70% of our dental network is people holding MDS degrees. Beyond that, we do further accreditation. No matter which doctor we hire, we have to certify that doctor internally and approve them for a certain kind of procedure. We may hire an endodontist, and even though he's a qualified endodontist, we will not let him do RCTs until he has gone through our internal screening process. We are guaranteeing quality by hiring the specialist, but then further validating their skillset with an internal accreditation.”
In conclusion
Amar’s journey while building Clove provides fascinating insights into consumer behavior and how retail healthcare brands can successfully scale. The team at Clove deeply understands the nuances of dental care and the patient journey.
Clove has tackled multiple hurdles on its path to success:
Shifting patient mindset: Moving patients from reactive, pain-driven care to proactive, preventive habits by experimenting with membership plans and digital nudges.
Building trust: Combating the trust deficit in healthcare by addressing the information gap around dental specialties, tackling overprescribing, and implementing rigorous quality audits.
Scaling retail healthcare: Understanding the importance of proximity and transparent pricing in influencing patient choices
Embracing technology: Automating chair sterilization with tools like DORI
Clove's success isn't merely measured in terms of clinics opened or patients treated. Amar and his team have completely reshaped the patient experience, instilling trust in a historically low-trust, low NPS category. By prioritizing preventive care, ethical practices, and transparency, Clove has paved the way for a more responsible and patient-centric healthcare model.