Independence Dental Services Offers Customized Support to its Partners

COO Carey Lasher heads operations for a DSO that runs a little differently—all services are a la carte.

DSOPro: Tell us about your career.

I started my career as a dental hygienist in the late ‘90s. My inspiration was my dentist, Dr. Howard Goforth, and his hygienist. Their practice was in Bluefield, West Virginia, a border town near my home in Virginia.

During an appointment we were discussing that I didn’t really know what I wanted to do after graduating from high school. He said, “Hey, have you ever thought about the dental field? We’re always in need of hygienists here. Go to school to be a hygienist.” I thought, Heck, why not? I liked him and his staff, so I started down that path. I really enjoyed clinical hygiene. After doing it for several years, though, I realized I preferred the business side of dentistry. Hygiene was taking a toll physically, so I tried to find different areas to work within dentistry. I ended up doing some management, consulting, helping with de novos, and opening multi-site locations with a small, regionally based DSO.

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I exited the dental field for a while and started a children’s clothing business, which was great for my kids. I also tried pharmaceutical sales, but in the end, I found neither was really right for me. When I returned to dental, I started on the consulting side so I could merge the business side with the hygiene part of it. At one point I thought I would go to dental school. I did all my prerequisites, earning my bachelor’s degree at Virginia Tech. But then I decided to switch career paths, which led me to get my MBA. My goal was to figure out how to treat people the way they want to be treated as patients, which means ethically, and still have a good business model. You don’t have to choose between one or the other. The consulting I did brought that out, and I really loved that part of it.

I joined ClearChoice Dental Implant Centers and eventually became a regional manager for them first in the Mid-Atlantic region and then in the Northeast. We were always very successful. During the years I worked there, we were either the top one or two highest grossing regions in the network. I left shortly after ClearChoice was purchased by Aspen due to the pandemic and needing to focus on home life like many other families. After some time away from the industry I went back into consulting.

I had a couple of larger DSO clients, and a clear aligner industry partner. I was training their sales team essentially how to close bigger deals with clients. I was also helping individual dentists. I partnered with one location that was averaging about $200,000 a month, which is pretty respectable. But now they are trending at about $700,000 net collections a month. I helped them not only close cases, but with throughput, addressing things like how are you going to actually manage that case in the clinic? How are you going to staff properly? What are your workflows? How do you make it efficient without creating overtime? It’s balancing all those factors that play into a well-run business.

I shared ideas, gave suggestions, and with some of them I held their hands through the entire process. I helped train their managers or the leaders of a center, or I helped train the treatment plan coordinators or the trainers on how to effectively manage case acceptance and the throughput in the office.

I joined Independence Dental Services in 2021. I had previously worked with a couple of the people who were starting this new DSO and they thought I’d be a great fit to help them build a newer model DSO where we allow extreme clinical autonomy, moving away from the old viewpoint of how people see DSOs. Sometimes people consider DSOs a dirty word. The newer generation of dentist combined with the pandemic has taught us the benefits of DSOs—the stability and security—and we’re trying to blend the best of both worlds together here with Independence.

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DSOPro: Compare your roles and what was different about them.

At ClearChoice, I started as a patient education consultant. Next, I became a regional manager and my role was driving case acceptance, closing cases, top-line performance, and growing EBITDA. One of the things I’m most proud of is that we trained centers to be able to collect a million dollars in net collections per month at each of our locations in the Northeast. Then we aspired to have each patient education consultant collect a million dollars on their own in a month. I trained the first person to do that. Some people said I was just lucky because that person was phenomenal at what she did. I said, “Let me prove you wrong.” So, I trained another person, then another person. They are probably still using that method today.

Part of the success of that was a result of understanding the operations of the business and how it’s actually applied. It’s hard to put new initiatives or models in place in a dental practice if you don’t understand the dynamics of the dental practice.

I started as a VP of Performance at Independence, which meant I focused on the performance of all the centers and the operation workflow in each. My job was to figure out how to affect change and see the behaviors associated with the metrics to drive organic growth and control the variables.

It’s not always just about numbers, but the numbers tell a story. How do you get that story moving from point A to point B, where you need it to go in order to drive the revenue in a way that is ethically and morally right for the patient as well as your employees, while keeping all stakeholders in mind. You want to treat them fairly. To drive performance requires identifying and mastering the top three key metrics. When you do, you move on to another metric without losing sight of the ones that drive revenue. Some of those are production collection totals, collection ratios, and lifetime value of a patient. You must analyze many different metrics and you need to know which ones are the most important for that timeframe within the business.

DSOPro: What is your focus as the COO?

Ultimately everything that feeds into the business, including performance, procurement, revenue cycle management (RCM), recruitment, compliance, marketing, etc. Any area involved in operating a business aside from treasury management and the accounting portion of it, which our CFO oversees. That means design and focus on the performance of all the centers as well as the operational aspect of business overall, at the enterprise level.

DSOPro: Tell us more about the structure and how the model makes Independence Dental Services different.

Independence started December 31st, 2020, so we opened during the pandemic. One of the benefits of that is we’ve learned to operate fully remotely. We do not have a brick-and-mortar structure for our corporate headquarters. So, we’re able to hire the best talent across the United States and not worry about them needing to be in one geographic location.

Our offices do not pay management fees to the DSO. They have clinical autonomy to operate how they want to operate. If they are looking at expanding, we can help them with expansion. We also offer a sub-DSO model, so if they want to expand their footprint into other locations, we can help them with that as well.

DSOPro: Let’s talk about procurement and sourcing offshore centers. What things are you trying or finding more efficient?

We all know there has been a big staffing crunch that makes it more difficult to get the right people to fit the right roles. There are geographic constraints, or maybe you’re not finding the right person for the budget. Offshore services may offer a solution in some circumstances.

There are different types of offshore services. You have to prioritize what you’re looking for. When we offshore, we look at them as our employees. We don’t consider them just a call center. They are people who help and support us.

We’ve had experience with offshore companies in different countries. We chose the one we have currently for their knowledge and communication skills. Communication is key for effective change or getting methods across in a non-frustrating manner. It matters who you are outsourcing with. It’s been received very well by our corporate staff and our practices absolutely love the help they’re getting. We are seeing less turnover and fewer issues with consistency.

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DSOPro: How does procurement work at Independence?

We have partnered with a third-party consultant who has the knowledge of all things procurement. When we put out our request for proposal (RFP) for a primary supplier or distributor, this consultant helped us and it has paid off tenfold. By going through a third-party vendor we share in the cost of the fees with our practices and with corporate. That’s partly how we avoid charging management fees. Not everyone needs marketing, not everyone needs recruiting, so what we provide is “a la carte.” It’s the a la carte fees that go through their P&L.

This is a different model. Having locations in 14 states, we’re not geographically bound to certain vendors and services. It’s been very beneficial.

DSOPro: How do you manage compliance issues across different states?

I think a pain point for any DSO is taking decentralized processes and trying to make them centralized and standardized. Compliance is one of those areas. How do you keep up and manage all of that? That’s a big opportunity in dentistry. There are a lot of manual processes on the compliance side. Hopefully in the future there will be a software that works in collaboration between states, or maybe different softwares that can be bundled together to make the compliance steps more automated.

Certain licenses must be updated each year; certain facilities inspections have to be done. There are regulatory items that have different timelines and demands. How do you make all that less manual and with fewer layers? Hopefully something will be available within the dental field to address that in the next 5 years.

DSOPro: What things do you like the most about your job?

It’s funny to recall that before I joined Independence, I swore I’d never work for another DSO again. DSOs provide stability in people’s jobs. They give a lot of stability to the industry. There’s a lot of knowledge that can be had from DSOs. I think the mindset has changed.

When I started in the dental space 20 plus years ago, it was taboo for dentists to even advertise, especially in a small community. Back then, and this really dates me, dental advertising was in the Yellow Pages or by word of mouth. Marketing is commonplace now. Some of the DSO titans blazed that trail for a lot of people. I think in 20 years, DSOs are going to be a normal course of business.

DSOPro: How have vendors grown and changed or improved their systems by working with DSOs?

They’re having to grow with that space. When I first started with Independence, several vendors didn’t know how to work with DSOs. They could work with dentists who had more than one practice, but now they’re having to develop and change their internal processes to the DSO model. Today there are e-procurement platforms on the market that match any DSO model, making it functionally easier to align accounting needs with the practice’s supply needs. It makes the process more fluid for everyone and gives more visibility into budget.

We don’t ask offices to change their practice management software systems. Whether they’re using Eaglesoft, Dentrix, Open Dental, or Denticon, normalizing that data is another big opportunity. A lot of vendors, especially software vendors, are making sure they can work with multiple platforms.

DSOPro: What technologies are you leveraging right now?

We use several different types of software. I use technology with caution, though, because often when you want to throw software at the problem maybe it’s a process opportunity that doesn’t require software. Sometimes changing software can create more issues. I think networking with other people in the industry to see what they are using successfully is important before selecting software.

We’re working towards 100% utilization of the Dentira e-procurement platform. We partner with them so our primary distributors and vendors run through that system. Their invoice module links to our accounting software, which makes it simpler and more efficient for our accounting team to pay invoices in a timely fashion and hold vendors to their agreed/negotiated terms.

We’re beta testing and rolling out some other technologies that are related to our RCM and insurance claims management.

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DSOPro: Any advice for people interested in working with DSOs?

Find the right one for you. There are different types of DSOs and it is important to compare the different models. They each have their own visions and values, and you should find the right fit for you and your belief system. We’re not all created equal, but we all do have a common cause—we can really help more people get access to care.

People looking to get into the DSO space, whether as a team member or dentist, should network outside of their local chapters. Going to some of the conventions and dental meetings can help support that path. We often only lean into the people we really know, but sometimes outside voices are important.

Two good resources are the Association of Dental Support Organizations (ADSO) and Women in DSO. I am on the advisory board for Women in DSO. There is a high percentage of women working in the dental industry. If you want to learn more about DSOs, it’s a great place to start. Women in DSO is a great organization for networking, not just for the DSO space, but also if you are interested in working for a vendor or service organization that supports DSOs. 

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About Carey Lasher RDH, MBA


Carey Lasher is the Chief Operating Officer for Independence Dental Services, a national DSO, focusing on revenue drivers for organic growth and providing best practices for operations. Her first degree as a dental hygienist sparked her love of science leading her to receive her BS in biology from Virginia Tech followed by an MBA with Distinction from Liberty University. Carey started her career in dental hygiene followed by operational, sales, management, and leadership roles. She was previously President of Highwater Partners, a leading business consulting firm, and held a leadership role for ClearChoice. Carey is an award-winning clinician and business leader with over 25 years’ experience in the dental industry. She has developed high-performing teams, builds high-functioning systems, and delivers profitable businesses.

Independence Dental Services

Independence Dental Service Organization was founded in 2020 and currently has 50+ locations in 14 states. To learn, more write to or visit

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