Executive Summary
Current position: SGA has an active Advanced Care program with a working eligibility framework and ROI model. A ROD-flagged list of 27 candidate practices exists for the 10/1 push, superseding an earlier 13-practice model — 2 of the 13 have since dropped off the current list (unconfirmed why).
Biggest opportunity: The model's own credible case — 15% full-arch conversion — shows $1.3M net / 125% ROI, proven achievable at Riverside Dental (16 FA cases YTD, the network's benchmark).
Biggest threat: 78% of the 27-practice candidate list is overall Growth-Readiness RED, and 67% fail the eligibility framework's own #1 disqualifier — no dedicated lead manager / slow lead response. Broad AC investment into this cohort by 10/1 risks funding the exact failure mode the framework exists to prevent.
Strategic recommendation: Don't launch all 27 by 10/1. Split into a small ready-now tier and a remediation tier; treat 10/1 as a wave-1 checkpoint, not a full-cohort launch date.
Top 5 Priorities
- Confirm the ready-now cohort and close the financial-modeling gap on the 16 unmodeled practices (by 7/15)
- Resolve the Total Care Dental / Community Shores Dental discrepancy with RODs
- Pilot AI-driven lead-response automation vs. hiring on the 5 storefront-ready / ops-weak practices
- Re-score Gate 3 (Lead Response) at the 45- and 90-day marks
- Report actual numbers to leadership at each checkpoint, not projections
Expected outcome: A credible 10/1 milestone built on practices the data says are actually ready, plus a tested remediation path for the rest — instead of a broad launch the org's own gates data says isn't operationally supported yet.
Current Footprint & Headroom
Candidate pool: 27 practices (ROD-confirmed, SEMrush AC Health Flags, as of 2026-06-18) — supersedes the 13-practice ROI-modeled cohort per direction from the growth team. Total Care Dental and Community Shores Dental appear in the original 13 but not the current 27 — flagged for RODs to confirm.
11 / 27
Have a modeled financial case
ROI model vs. SEMrush AC list, cross-referenced
18 / 27
Gate 3 (Lead Response) = RED
Growth Readiness rollup, 2026-06-27
21 / 27
Overall Growth Readiness = RED, 0 Green
Growth Readiness rollup, 2026-06-27
5 / 27
Storefront health = GREEN (SEMrush)
SEMrush AC flags, 2026-06-18
The 5 storefront-GREEN practices (Dr. Bill Dorfman, Dakota Dental & Wellness, Innovative Dental, Peninsula Center MV, Peninsula Center LA) are all overall-RED on Growth Readiness. Marketing Foundation (20% weight) isn't the bottleneck for this cohort — Ops & Lead Management (30% weight) is failing almost across the board.
Deadline alignment: 10/1 already matches the existing audit-priority dashboard built in tools/advanced-care-dashboard/.
SWOT
| Strengths | Eligibility framework + ROI model already exist and are actively used. 11/27 candidates have real financial modeling done. |
|---|---|
| Weaknesses | 67% fail Gate 3 — the framework's own #1 disqualifier. Financial case covers under half the candidate list. The credible 125% ROI case explicitly assumes "dedicated lead manager" capability — the exact thing most of the 27 lack. |
| Opportunities | The 5 storefront-strong/ops-weak practices are the fastest plausible "quick win" cohort — remediate ops, not marketing. Riverside Dental is a ready-made proof point for RODs on the other 16 un-modeled practices. |
| Threats | Framework states a 60–90 day minimum remediation window; today (7/1) to 10/1 is 92 days — mathematically tight-to-impossible for practices currently below threshold. Portfolio sensitivity shows a -$315K net loss at 20% lift if ops gaps suppress incremental case volume below the 30% base-case assumption. |
Financial Case
| Scenario | Practices | Annual Spend | Net (12mo) | ROI | Confidence |
|---|---|---|---|---|---|
| Base case (blended, 30% lift) | 13 modeled | $1,038,000 | +$46,500 | 4% | High sourced |
| Downside (20% lift) | 13 modeled | $1,038,000 | -$315,000 | -30% | High sourced |
| Upside (40% lift) | 13 modeled | $1,038,000 | +$408,000 | 39% | High sourced |
| Credible case (15% FA conversion) | 13 modeled | $1,038,000 | +$1,302,000 | 125% | High model's own recommended lens |
| Heavy tier only (base case) | 4 | $432,000 | +$192,900 | 45% | High only tier solidly positive in base case |
| Standard tier only (base case) | 5 | $390,000 | -$81,600 | -21% | High negative |
| Pilot tier only (base case) | 4 | $216,000 | -$64,800 | -30% | High negative |
| Remaining 16 candidates (unmodeled) | 16 | ~$1.28M | Unknown | Unknown | Low — do not use for decisions order-of-magnitude extrapolation only |
The 125% ROI case is the one that gets shown to leadership — but it explicitly assumes exactly the operational capability that's currently missing in 67% of candidates.
Risk Analysis
| Risk | Prob. | Impact | Mitigation | Early Warning |
|---|---|---|---|---|
| Ops — lead management gap (18/27 Gate-3 red) | High | High | Remediate before spending AC media on Gate-3-red practices | Weekly Gate 3 pull (already automated) |
| Financial — portfolio downside if lift underperforms | Medium | High | Fund Heavy tier first; hold Standard/Pilot spend pending ops confirmation | Monthly Dental Intel production vs. baseline |
| Talent — dedicated lead manager availability | High | High | Pilot AI-driven lead-response automation before an 18-person hiring wave | Gate 3 flip rate on pilot practices |
| Timeline — 92 days to 10/1 vs. 60–90 day remediation floor | High | High | Treat 10/1 as wave-1/wave-2 cutover, not hard deadline for all 27 | Bi-weekly eligibility re-score |
Decision Memo
Recommendation: Launch a small, verified-ready tier now; run an ops remediation sprint on the storefront-strong/ops-weak group in parallel; defer the rest pending re-scoring. This is two problems bundled into one ask — marketing spend vs. lead-ops capability — and they need two different interventions.
Why not the alternatives
- Fund all 27 by 10/1: 67% fail disqualifier #1; remediation floor exceeds the runway; portfolio sensitivity shows real downside if ops gaps suppress lift.
- Fund the original 13 as-is: 2 of the 13 have already fallen off the RODs' current list; several Standard/Pilot-tier practices are net-negative in the base case.
- Wait entirely for Q1: the ready-now tier (Heavy tier +$192.9K net even conservatively) is real, low-risk, available upside — holding it hostage to the slower 16 wastes it.
One metric to watch
Gate 3 status across the 18 currently-red practices
One thing to stop doing
Treating all 27 as one homogeneous marketing-spend decision
First investment — with a caveat
Pilot AI lead-response automation before hiring 18 lead managers (untested hypothesis)
90-Day Plan
| By | Actions |
|---|---|
| 7/15 | Confirm ready-now cohort (start from Pryor Family Dentistry and Smile Gulf Coast — the only two candidates both Gate-3 non-red and financially modeled). Pull ROI data for the 16 unmodeled practices. Resolve the Total Care / Community Shores discrepancy with RODs. |
| 8/15 | Launch AC media for the confirmed ready-now cohort. Start the AI lead-response pilot on the 5 storefront-green/ops-red practices. Re-score Gate 3 across all 18 red practices. |
| 9/30 | Full eligibility re-score across all 27. Promote anyone who's cleared 80%+ into Wave 2. Report real numbers to leadership ahead of the 10/1 checkpoint. |
Brutal Honesty
- The premise "push more practices into Advanced Care" assumes the constraint is marketing spend. The data says the constraint is operational. Additional media budget doesn't fix a lead-manager gap — it likely makes the downside worse.
- A skeptical controller's first question: why fund Standard/Pilot tier at all when the base case shows them net-negative? Honest answer — only Heavy tier is unambiguously good conservatively; everything else rides on the FA-conversion upside case materializing.
- Most likely failure mode if the org proceeds unchanged: a batch of practices spending $4.5K–$9K/month on leads by 10/1 with no one positioned to respond — literally the framework's documented "common failure point."
- Assumption most likely to be wrong: that Gate 3 status accurately reflects real lead-manager presence at each practice. It's a proxy metric — worth a spot-check with 2-3 RODs before it drives launch/hold decisions.
- The AI-lead-response pilot idea is mine, not sourced from data. It fits SGA's stated hiring philosophy and the framework already lists CRM/automated SMS follow-up as a must-have, but nothing confirms it closes the gap as reliably as a human hire. Pilot before betting the remediation timeline on it.
Board Summary — Ranked Priority Actions
- Confirm the 2-practice ready-now cohort (Pryor Family Dentistry, Smile Gulf Coast) and clear them for immediate AC launch.
- Pull financial models for the 16 currently-unmodeled candidate practices — close the data gap before committing spend.
- Launch an AI-driven lead-response automation pilot on the 5 storefront-ready/ops-weak practices as a faster, cheaper alternative to an 18-person hiring wave.
- Resolve the Total Care Dental / Community Shores Dental discrepancy with RODs.
- Fund Heavy tier practices first — the only tier solidly positive in the conservative base case.
- Hold Standard and Pilot tier spend until ops readiness (Gate 3) is confirmed, not just marketing readiness.
- Re-score Gate 3 across the 18 red practices at the 45-day mark (8/15).
- Run a full eligibility re-score across all 27 by 9/30, ahead of the 10/1 checkpoint.
- Communicate 10/1 internally as a wave-1/wave-2 cutover date, not an all-27-live deadline.
- Spot-check Gate 3 data accuracy with 2-3 RODs before it drives further launch/hold decisions.