TechTalk: Global Smiles: How a Healthcare Startup Is Transforming Dental Care for Americans

Juha Mikkola:

Fritz, thanks for having me. I'm super excited.

Fritz Spencer:

Well, I'd love to get us started and I'd like to know if you could quickly give us a brief background on yourself.

Juha Mikkola:

For sure. Yeah, I mean I think going back in time, I've always been very entrepreneurial. I remember my first business, if you can call it that, was probably middle school when my family would visit Florida on vacation, I would fill up a suitcase of Matchbox cars and bring it back to Helsinki Finland where I'm from and sell it to the other kids in my class because the same models weren't available in Finland. So I didn't realize back then that that was being an entrepreneur, but I guess it was. And then I just always found that to be really exciting. I don't know what kind of drew me to it, but as I went through college, I actually ended up starting my first company, which was a Floorball hockey company. So we were promoting this type of indoor hockey that in Finland and Sweden is a professional sport.

I loved playing it back home before I moved over to Toronto and really loved playing the game. So I thought instead of learning a new sport, maybe I'll just teach everybody else to play the sport that I was good at. Turned out to be a crazy journey for almost 10 years. We got over a hundred retailers on board, a thousand schools I drove to personally in a minivan to teach the teachers how to play the sport and it was really, really fun.

But I knew I needed to transition into something maybe a bit more sustainable because it was a true passion project. And that's really where something that maybe I'm the most proud of came from. My wife and I co-founded a coding school called Wyncode Academy, which was the first coding educator down here in South Florida. And it was an amazing journey getting to Miami in 2014 when tech was not a thing here and just seeing how far it's come now, it was incredible. We graduated almost a thousand students and got acquired three years ago by BrainStation, which is the global leader in our space. And now I'm onto my next project working on Usko Health and our goal is to try to bring the secret that people in Miami know about, which is medical tourism and going abroad for amazing deals on high quality dental and try and make that more accessible to all Americans.

Fritz Spencer:

Great. I'm so glad you covered Wyncode too because it's such a big organization down here and the fact that you were able to accomplish such a big goal in what you might call a tech desert is a very profound accomplishment. So thank you for doing that here, especially in our hometowns. And let's go ahead and hop right into Usko. So you mentioned a little bit about, medical, dental tourism. What is it exactly, what was the problem you saw and how are you solving it?

Juha Mikkola:

Yeah, I think the problem in general, big picture is the cost of healthcare in the US is out of control. As a business owner, I saw it every single year when our healthcare premiums for employees were going up. Personally, I feel it, I have two kids. It's just obviously getting more and more expensive, and as a country, we spend more on healthcare than any other country in the entire world. And we decided that there is a solution to this. It's just a lot of people don't know about it and that's actually going abroad. For high quality care, you're not giving up anything on the quality side, but you can save a lot of money by doing it.

The inspiration was really talking to people in Miami from so many different walks of life, people just starting their careers, people who didn't have a lot of money. And I always remember this hotel owner I talked to who is ridiculously wealthy and he is like, I went to Columbia to have... Our kids were born there because his wife's Colombian. He is like, it was cheaper than my deductible and we had an amazing experience. It was just totally worth it. I'm like, man, everyone at different parts of the economic spectrum are doing this. And I thought, why is it kind of limited more to Miami? It's because people have friends, they have connections to Latin America in particular from here. It seemed really exciting to try to bring this over to just general Americans as an option. And dental is in general one area where people are very under covered. You have 25% of people don't have any type of dental insurance, and when you look at some of these survey results, like nine out of 10 Americans, even with coverage are saying they're putting off some type of dental care because of the costs.

So it's a really, really big problem. And if you could save on a bigger dental procedure, something that might cost $40,000 in the US if you have to do full dental implants, obviously not everyone's in that extreme case, you could do something like that for under 20 grand in Colombia with the same brands and the same materials. So just try to make it transparent, make it really easy to compare options, vet the network of dentists that we work with and make it smoother. I mentioned our biggest goal is to make it easier to actually book a dental appointment abroad than it is to do one here at home.

Fritz Spencer:

I know that there's nothing that I fear more than making a dental appointment myself. So tell me more about that process. I mean, you mentioned kind of who's involved, but what are your customers, what were they looking for? What was the feedback that you've maybe gotten from them in what you guys are doing really well and maybe what you guys need to work on and more about the platform itself? Is it a platform? Is it a program? Tell me more about the tech.

Juha Mikkola:

Yeah, yeah, for sure. No, I appreciate that question. And I think one of the biggest things that we did, this is a pivot, so we were not building this originally. After the Wyncode experience, I was working on a personal data marketplace and we couldn't get the traction. So with this idea, we took a very different approach, where validation from day one and we were able to close our first $30,000 client patient in first 30 days. So we knew we were onto something with this idea. And you mentioned what's the feedback from customers. We're living by that. We're like, we've got to get this customer feedback every day. The previous idea we were trying to build maybe something really large and we needed to get it so far until it even was relevant to customers. Here it's like we're addressing a need right away.

And what we've done is really use technology in a space that it's not being used a lot today. And that's basically being able to make it easy to compare and collect a bunch of quotes for the same thing that you need. So as a patient, what you do is you go on our platform, you're going to upload some photos of your teeth, you're going to upload a panoramic x-ray, and then that gets sent out to our network of dentists. They can log in, see the information, they spend the time to actually create an assessment and a treatment plan for you. They'll price it out and then you're able to log in and see all of these different options and understand because dental is not actually a commodity, especially for bigger procedures. There's a lot of ways to get to the same end result. Everybody wants a healthy, beautiful smile, but there's many ways to do that. So this gives you an opportunity to get a bunch of dentists all over a minimum 20 years’ experience looking at your case and coming back with pricing and options.

And to be honest, I think this is something we could even apply to us dentists in the future because right now if you want to get multiple quotes, it's almost impossible. You got to go visit all these dentists, so you got to get X-rays done over and over again. It's not easy. So we're trying to make that standardized process so that you can see options and then make the choice that's best for you. It's really about consumer choice.

Fritz Spencer:

Wow. Yeah, that's so interesting. That's exactly how it works. When you go to buy a car for instance, they're going to shop you out. You're going to get an instant response from 18 different banks that all want to loan you. It's almost that same concept I feel like. And yeah, it's unheard of to be able to go to more than one dentist to quote a price that you're going to go to whoever's in your network, whoever your insurance program recommends who's closest to you, and it's probably going to end there. You're going to have no idea whether or not you're getting a good deal or not. And I guess forcing the dentists and providers to give you a competitive quote gives you a better chance at getting a real value for your dollar, especially when it comes to insurance in America. Now, that's one thing that I wanted to hop to is how does that work for insured people in America if they're going abroad to get procedures?

Juha Mikkola:

Yeah, it's really interesting. Right now we're not yet facilitating insurance reimbursements, but individuals are doing it directly. So what I'm hearing from our patients, and this is definitely a goal for us to make it super simple through the platform in the future, is that a lot of insurance companies, if it's something that's functional for your bite or something that you need done for your teeth, they will actually reimburse it and they actually reimbursing something done abroad cause you still have a deductible as a patient. Now your deductible is 50% of what it was, and the insurance reimbursement is 50% of what it was. So basically everybody wins. It's almost like capitalism at work, everybody's searching for a lower price and they're able to find it, and now even the insurance company's happy. So for the most part, it works even if you are an insured patient.

And the difficult part is that a smile is not just functional. So there's the functional part and then there's aesthetic part, which is almost more important for a lot of patients. And insurance typically doesn't cover that part. So when you're thinking like, okay, maybe you need a dental implant functionally, but maybe you want to also do some crowns and you want to do some veneers and do all this stuff, you'd usually go out of pocket for that. And the dentists here know that, they know it's not covered. They're going to charge you a lot for that because it's something you want to just do aesthetically. Makes even more sense to go abroad for that part because now it's your own dollars and you're going to be able to make them go so much further.

Fritz Spencer:

Right, yeah, for those elective surgeries. So you mentioned capitalism and I want to talk about your capital structure. Have you been doing fundraising? Is it all bootstrapped by you and your partners? I'm not sure if you have partners. Tell me a little bit more about the capital structure.

Juha Mikkola:

Yeah, it's interesting. I mean, when we built Wyncode, we were bootstrapped. So the story there was like we sold our condo in Toronto and luckily it had gone up in value and we used that as our seed money to start the company, moving to a city where we knew nobody and we're like, let's hope this works. And it was definitely an exciting way to do it. And I always remember we had students who were going through the interview process and the first three students who confirmed with us actually confirmed for the second cohort. And I couldn't tell them that we didn't have a second cohort if the first one didn't run because we didn't have enough capital. So I was like, I hope we get some people for this first class. Luckily we did. We were able to help those students who came for the second one, but that's literally how tight it was.

With this company, I think it was helpful to have had a successful exit with a company in the past. And then we raised money for that initial idea that I mentioned that we kind of pivoted away from. And then as a founder and as CEO, I had to make the hard choice when the other idea wasn't getting the traction we wanted, what do we do? Do we just keep going and try and try again? We tried so many different angles and we weren't getting the traction. Eventually we decided we got to pivot with the resources we have. So it's been a lot more, even though we had a bit of capital left, it's been a lot more bootstrapped. Our team is tiny. We're just making it work. We got to sell every day.

In many ways, I really like that because with your back against the wall, it definitely keeps you very focused on what matters. And I think that that's a good thing for a founder and a small team to really know this month we just got to sell this much and we got to hit this goal no matter what. And it keeps you taking those phone calls at 9:45 at night like I did from a patient last night.

Fritz Spencer:

You hear about almost in every startup about a pivot, and it's more often than not that some of the most successful companies come out of a pivot. Can you tell me more about that decision that you had to finally make and maybe all the things that might've led up to that?

Juha Mikkola:

It was hard because I really believe in the original idea, and it's something I had been thinking about for five years, even during the Wyncode years to be like, man, I wish there was something that allowed me to... The idea was I wanted to target people who are paying online for coding schools and invite them for pizza at our campus because I knew I could close all of them. I'm like, why can't I give those people the money instead of just trying to blindly do this through Google and existing ads, really a way for people to opt in and share, these are the things I'm into, pay me the money and I'll tell you what I'm into and I'll come check it out. And now that was the idea and I still like it, but I think when we saw we got to a couple thousand users, to get brands interested, you have to have so many more in the way that data is handled today.

And there's a lot of things changing with data, which I think will make it better, but right now our data's everywhere. It's not owned by us, it's not controlled by us, and frankly, most people don't care. And that makes it really, really hard. And I think maybe I was too optimistic about that changing sooner. I think one day it will change, but not yet. So there was a point where it was like, do we keep going? We had more ideas of how we could try to get that consumer traction. And I still remember lying on the floor in the condo staring at the ceiling and being like, what am I going to do? Are we going to go a totally different direction here and do we have the runway to even get enough traction for something new? And it was a very hard decision, but eventually I thought this is the best thing to do for the company.

And it was a big pivot. We were unable to use anything of what we had done before. So I think that was one of the hardest parts. And glad you brought up stories out there that there are a lot of pivots that are companies you'd never think that they did something completely different before, which is a nice story for us to remember too and keep pushing with what we're doing. But I don't think there's ever a easy decision around that. But it was still clear for me. I knew we had to do something and this was kind of our last shot at doing it. So that part was, I think, relatively clear.

Fritz Spencer:

I'm glad to hear that and I'm glad to hear that you mentioned the runway didn't end. And speaking of the runway, what is next? What are you guys taking off to next?

Juha Mikkola:

Yeah, no, I mean right now with Usko Dental, we're fundraising. So with anything, we are not yet at a break-even point. We're not actually far away from it, but we are definitely fundraising, having investor meetings, which is really exciting. It's a totally different part of the business because we're also selling, we're building the platform, we're trying to improve our technology. There's a lot going on every day, but it's very fun and I think it's great to get feedback from investors that the direction we're going is really good and we can kind of look at our unit economics of what it costs to acquire a patient and understand how much we're getting back from that patient. And all of that points to a very strong business. It's just a matter of letting us get to where we need to be to get the scale that makes sense and can support a proper startup team.

So that's definitely the focus right now. And just looking for partners that can share in the vision and see that consumer choice extends way beyond US borders. This is really something where it's so simple and easy for people to save money, and already I think Columbia alone, a million Americans are going every year. So it's not a small market anymore, and the growth is 25%, 30% a year.

Fritz Spencer:

Wow. Yeah, I don't doubt it at all. Living down here in Miami, you hear about these kinds of happenings every day, and I want to mention that if you ever need a partner to help you crunch those numbers, you definitely know who to call.

Juha Mikkola:

Love it.

Fritz Spencer:

Your friendly EisnerAmper accountant.

Juha Mikkola:

Love it. That's awesome. For sure.

Fritz Spencer:

Well, Juha, I want to thank you so much for having this conversation with me today. It's been an absolute pleasure.

Juha Mikkola:

Love it. Thanks so much for the opportunity. This is great.

Fritz Spencer:

And a special thanks to our listeners as well for tuning into TechTalk, the very entrepreneurs and innovators who turn to EisnerAmper for accounting, tax and advisory solutions to help propel their success. And don't forget to subscribe to EisnerAmper's podcast to listen to more TechTalk episodes, or visit eisneramper.com for more tech news that you can use.  

Transcribed by Rev.com.