Five practices, five objections, one dataset

The five case studies

The cleanest before/after production lift in the file — 87 members, each measured against their own baseline. Highest total-chair-per-fees multiple among the five.

Matched cohort — same 87 members, before vs. after

Membership fees are the floor, not the ceiling

For every dollar in membership fees, $4.50 came through the chair. Out-of-plan production ran 3.1× in-plan — members do not "just get their cleanings." They accept and complete work outside the plan at a rate that dwarfs the discounted services.

Treatment acceptance — three cohorts side by side

Largest matched cohort in the file (138 members), highest member treatment-acceptance rate in the file, highest same-day-completed rate in the file, and 60 same-day enrollments — the volume story.

Treatment acceptance by cohort

Members not only accept at the highest rate — they also complete same-day at the highest rate in the file. Every fifth member visit becomes work-on-the-books that same day.

Same-day enrollment linkage

60 patients said "yes" to treatment and "yes" to the plan on the same visit. This answers the sub-objection "our patients need weeks to decide."

Matched cohort — same 138 members, before vs. after

At Waynesboro, the plan is the mechanism by which patients say yes — the majority of linked enrollments happen the same day treatment is accepted.

Same-day enrollment linkage

This is the practice where the ratio flips. The plan is being used as the mechanism by which the patient converts from case-presented to treatment-scheduled — not just retained afterward.

Cohort behavior — same 65 members

Appointment reliability lift

Members break appointments at roughly half the uninsured rate. This is the practice where the plan most clearly changes the patient's behavior rather than just recruiting patients who already behave well.

Highest post-enrollment $/member in the file, and out-of-plan production runs 2.4× in-plan. The plan doesn't cap revenue; it opens the ledger.

Batten — matched cohort (n = 43)

Batten — where the revenue comes from

Batten — treatment acceptance

Members accept at insured rates — a 21-point premium over uninsured on comparable presented-plan exposure.

The Towne Lake alternative — if reviewers push back on Batten

Same objection, different tradeoffs. Use this if a doctor challenges Batten's n = 43 or the "essentially all new patients" caveat.

Recommendation: lead with Batten. Keep Towne Lake in the back pocket for reviewers who challenge the n or the "no pre-history" caveat.

460 enrolled members — the biggest book in SGA East — but the smallest cohort lift, near-zero same-day enrollment, and the smallest member-over-uninsured acceptance gap in the file.

Why we include this

An FFS dentist evaluating a membership plan has watched every vendor case study cherry-pick the wins. Leading with a practice where the plan under-performed does two things:

1. It buys credibility for cases 1–4. If we would tell them Bluffton, we would tell them if any of the others had gone sideways too.
2. It sharpens the "when to launch a plan" conversation into an operational one, not a philosophical one.

What went wrong at Bluffton

Same-day enrollment linkage

Cohort behavior — 207 matched members

The cohort does show a real lift — Bluffton members are visiting twice as often after joining. But the revenue-per-member ceiling stops at $1,123, roughly half of Batten's $2,131.

Fees-to-chair math — the "floor" is barely a floor

At Bluffton, out-of-plan and in-plan are almost even. Members are getting plan services and not much else. Every other practice on this list has an out-of-plan ratio above 1.5×.

Treatment acceptance

Member premium over uninsured is only 2.7 points. At Statesboro it is 21 points. Whatever is happening at Bluffton is not "membership changes acceptance."

The likely mechanism

Bluffton is capacity-constrained. Hygiene is booked out 112 days (average days-to-future-hygiene-appointment for existing patients, per PlanForward's dashboard) — roughly 4× the file median. When the hygiene chair is booked into the following spring, a same-day enrollment can't get seated, an accepted plan can't be started, and the mechanism that drives lift at Waynesboro or Claxton has nowhere to happen. Bluffton also dropped Humana and Aetna in the measurement window, which likely contributed to the higher pre-enrollment visit baseline (patients who couldn't get in as often before).

Portfolio patterns across the five

For readers who page through all five, the pattern that repeats.

Methodology & open items

From PlanForward's 2026-09-25 response to Amy's 8/24 request, verified against the workbook.

Practices we considered but dropped from the final five

Open items — do not publish without closing

1. Bluffton's 71-day hygiene lead time — root cause. Provider turnover? Hygienist shortage? Deliberate throughput cap? Jarod Howlett (ROD) may know. Without this, the counterexample stops at "capacity-constrained" and does not name the specific operational cause.
2. Sharp Smiles data irregularities. PF is checking. If resolved, Sharp Smiles could be added as a sixth case study for the "we're already FFS" objection.
3. Advanced Dental Center of Summerville — currently unsupported. Revisit Q1 2027.
4. Insured cohort net-production-per-visit for each of the five, if we want to claim "members reach insured parity." v2 currently only supports "members outperform uninsured."
5. Member same-day-completed lag — sign issue. For Statesboro, Miss Lou Stine, and Stonewall, "avg days plan → completed" for uninsured shows negative values, which PF flagged as a timing/order issue in source. Do not quote those specific numbers. Same-day-completed % is unaffected and is safe to use.

Next steps

1. Amy · confirm the objection-to-practice mapping stands (or swap Batten ↔ Towne Lake for Case Study 4).
2. Amy · send Jarod Howlett a short note requesting Bluffton context on the 71-day hygiene lead time.
3. Once confirmed · package each of the five as a standalone 1-page PDF for Growth Manager use (matching the existing Peach brand template used for v1), plus a combined portfolio PDF for reps who want all five in one file. Deliver a companion .xlsx with the raw cross-cohort tables.
4. Decide on v1 · keep 04_case_study_draft.md as a portfolio landing piece that points to the five per-practice case studies, or retire. Recommend keep — the "not a discount card" framing still reads well as a landing page.