Mashura · Vet InventoryLive
Cubex
Usage-based subscription. We map and enrich product data across many animal-health locations and systems.
HeyDonto · AI Technology
Confidential · Authorized recipients only
Go-to-Market Strategy · Dental
Connecting Dental to the Rest of Healthcare
Two motions, one semantic engine. The enterprise API that turns the largest installed bases into platforms, and the exchange that lands the way dental buys.
01 Section One · Enterprise Direct
Axiomera Dental API
Direct enterprise data-transformation engagements. Patterson, Vyne, and the large installed bases we turn into governed FHIR platforms.
02 Section Two · The Exchange
Conduit
The standards-based dental interoperability exchange. Per-location platform plus per-episode transactions, DSO pilots, and the OHIA credibility moat.
VMC MAR COM Inc. DBA HeyDonto
Knoxville, Tennessee · Berlin · 2026
The Structure
How dental goes to market
Dental is one market with two very different buyers. We meet each on its own terms, and both run on the same semantic engine underneath.
Every dental practice management system speaks its own private language, and almost none of them expose a usable API. That single fact created the entire opportunity, and it also shapes how the market is sold. A solo practice or a mid-market DSO buys a product it can turn on. A national distributor or a revenue-cycle organization buys a platform it can operate. These are not the same sale, so we do not run them as one.
Section One
Enterprise Direct · The API
Large, direct enterprise engagements sold on our data-transformation layer, Axiomera Dental — the motion we launched first. We turn a partner's own installed base into a governed FHIR platform they operate and brand. Custom platform-license and revenue-share terms, C-suite sales cycles measured in months. Patterson and Vyne are the flagship motions.
Section Two
Conduit · The Exchange
The standards-based exchange that connects dental to medical, payers, and federal networks, built on top of the API layer. It lands the way dental buys: a platform fee per connected location plus a transaction fee per episode. Sold through DSO pilots, specialty workflows, and the clearance-dependent medical wedge, with OHIA conformance as the credibility moat. This is the long, compounding go-to-market.
The relationship between the two
We launched Enterprise Direct fourteen months ago. Axiomera Dental is the intelligence and API layer, and Conduit is the standards-based exchange we built on top of it since. The dependency runs one way: the exchange is only possible because the API layer already turns any PMS into a live FHIR endpoint.
The rest of this document is in two parts. Section One is the Enterprise Direct playbook for the handful of very large accounts that buy the transformation layer itself, the motion we started with. Section Two is the full Conduit go-to-market we built on top of it, the motion that scales through pilots, network effects, and the standards moat. High-level financial projections live in the investor deck; this document is the strategy, with the current-state numbers threaded through.
Full financial projections and valuation framing are presented in the HeyDonto investor deck and are not restated here.
01
Section One · Enterprise Direct
Axiomera Dental API
The data-transformation layer, sold direct to the largest installed bases — the motion we launched fourteen months ago. We turn a partner's own enterprise into a governed FHIR platform they operate and brand, the engagement that made Conduit possible.
A Different Buyer
Why the enterprise motion is separate
A handful of organizations do not want a product to turn on. They want to own a platform. That is a fundamentally different sale, and it earns its own go-to-market.
The Conduit motion in Section Two scales through pilots, network effects, and the standards moat. It is built for the many. The Enterprise Direct motion is built for the few: national distributors, revenue-cycle organizations, and the very largest installed bases, where the buyer is not a practice adopting a workflow but an enterprise turning its own data into infrastructure. These deals are larger, slower, and sold at the C-suite over months, with custom platform-license and revenue-share terms rather than a per-location list price.
What we sell here is Axiomera Dental, the intelligence and API layer itself. The HeyDonto Synchronizer turns any on-prem PMS into a live, standardized, bidirectional FHIR endpoint, and a cloud agent does the same where only a partial vendor API exists. Once a partner's installed base sits behind one governed FHIR contract, the partner can operate it, brand it, and let approved vendors build against it, integrating once instead of practice by practice.
What we provide
Standardized FHIR access
The only FHIR authorization available in dental today. We ingest the entire PMS schema, every table, relationship, and historical record, and expose one governed FHIR R4 contract, read and write, the same shape regardless of source system.
Why it is different
Read and write, in real time
On-prem access has traditionally not existed in this industry at all. This is not a nightly export or a batch job. Change data capture runs continuously and writes land back in the source PMS in well under a second, in both directions.
Proof already delivered
Source · Native
Eaglesoft
Governed
FHIR
Destination · Native
Dentrix Ascend
A dental-industry first
We took data out of Eaglesoft in its native standard, converted it to FHIR, and delivered it into Dentrix Ascend in its native standard. The first time dental data has moved this way, and something no other company in the dental industry has shown. Once a PMS is behind a standardized endpoint, moving data between platforms stops being a custom integration problem and becomes a routing problem.
Axiomera Dental API · Live & Billing Today
Already running the layer
Current customers running on the data-transformation layer right now.
Mashura · Dental InventoryLive
Zimbis
Usage-based subscription. Standardizes and enriches product data across hundreds of dental locations.
$45/loc/mo · 1,000+ locsLive
Air Clinic
Real-time read and write to the practice system through one API, across 1,000+ live locations. $4M to $5M ride-up potential.
$35/loc/mo · DSO AnalyticsLive
Clarifi Health
One standardized, cross-system data layer so DSO analytics work on any practice regardless of software.
10,000+
Locations live across these groups today
$7.6M
Current API-direct ARR, run-rate at end of Q2 FY26
Cubex, Zimbis, Air Clinic, and Clarifi are live and billing on the Axiomera Dental layer today, together running more than 10,000 locations and carrying the $7.6M current API-direct ARR run-rate. Cubex and Zimbis (Mashura) together carry $9M to $12M ARR ride-up potential as locations and monthly usage climb. Ride-up figures are potential at full rollout, not current run-rate.
Flagship Engagement One
Patterson Companies
The largest dental distributor, turning its own closed installed base into a Patterson-branded, Patterson-operated FHIR platform. The template for what the enterprise motion looks like at full scale, and the single largest line in the dental picture.
Valuable Eaglesoft data is locked inside 22,000 on-prem locations, and Patterson wants to turn it into a platform others can build on. Axiomera Dental deploys inside Patterson's own enterprise. Patterson hosts the model and carries the compute, which turns Eaglesoft from a closed, site-local system into a Patterson-branded FHIR API across the installed base. Because Patterson carries the infrastructure, the engagement lands for us as a pure-margin, zero-cost-of-goods recurring line. It was built over months of direct work with Patterson's technical, leadership, and executive teams, including a full-day working session we hosted with their senior leadership in Minneapolis.
22,000
Locations across the installed base
8–10
Users per location
$15
Per user per month
$31M
ARR at full rollout
- What we do
- Run inside Patterson's own enterprise, which hosts the model and carries the compute, and turn Eaglesoft into a Patterson-branded, Patterson-operated FHIR API across the installed base.
- How it maps
- The on-prem synchronizer pulls the data and our models map it into governed FHIR, so any approved vendor integrates once against one API instead of practice by practice.
- Why zero COGS
- Patterson carries hosting and compute inside its own enterprise, so every dollar of the recurring line lands as pure margin for us. There is no infrastructure cost sitting against the revenue.
Why Patterson is the template
One distributor turns its entire installed base into a platform, and every vendor who wants to reach that base now reaches it through us.
It is the clearest expression of the enterprise thesis: sell the transformation layer once, to the organization that already owns the distribution.
Flagship Engagement One · Economics & Terms
What the full rollout looks like
The economics are simple to build and large at scale. A per-user recurring line across the whole installed base, carried at zero cost of goods, reaches $31M ARR at full rollout.
The model is a single recurring line multiplied across the installed base. Every user at every location pays a flat monthly rate, Patterson carries the infrastructure, and the revenue accrues to us at full margin. The build-up below shows how the $31M ARR figure is reached, and why it is a ride-up rather than a number that appears on day one.
| Driver | Assumption | Contribution |
|---|---|---|
| Locations | Full Eaglesoft installed base | 22,000 |
| Users per location | Typical practice staff on the system | 8 to 10 |
| Rate | Per user, per month | $15 |
| Cost of goods | Patterson hosts and computes | Zero |
| ARR at full rollout | Per-user line across the base | ~$31M |
The path to full rollout is a phased deployment across the base rather than a single switch. Revenue rides up as locations are activated, so the $31M is the destination, not the starting run-rate. That ride-up is exactly why the engagement is a strategic anchor: a single relationship that scales into the largest recurring, zero-COGS line in the dental portfolio.
How far along we are
Execution, not discovery
This is one of the deepest enterprise relationships in the portfolio. The commercial work is largely done: terms, conditions, and pricing have already been negotiated. What remains is execution, not discovery.
- Structure
- Platform-license plus revenue-share. A per-user recurring line across the installed base, with Patterson carrying hosting and compute, which is what makes it zero-COGS for us.
- Terms & Pricing
- Already negotiated. Terms, conditions, and pricing have been worked through with Patterson, at redline with Business and Legal. The commercial shape is agreed; the document is in final markup.
- Teams Engaged
- We have worked directly with Patterson's technical team, leadership team, and entire executive team. We brought them out to Minneapolis, Minnesota, for a full-day working session and went through the plan with every person on their senior leadership team.
- Private Equity
- We have also been working with Patterson's private equity, so the relationship reaches beyond the operating company to its ownership.
- What Remains
- This is an active, advanced strategic engagement at the final stage before execution. Until the terms and conditions are executed, it is not a signed contract, but the commercial work is behind us.
How to read the $31M
The $31M is ARR at full rollout, a ride-up potential, not current run-rate. It is what the engagement becomes when the full installed base is activated under executed terms, and it is presented here to show the scale the enterprise motion reaches, not to book revenue that has not yet been signed.
Patterson is an active enterprise engagement with terms, conditions, and pricing negotiated and at redline, not a confirmed customer or executed agreement. Location counts, user assumptions, per-user pricing, and the $31M ARR-at-full-rollout figure reflect the proposed structure and are ride-up potential, not current run-rate. Only executed agreements are treated as executed.
Flagship Engagement Two
Vyne Dental
A large dental revenue-cycle organization where the connectivity already exists but the meaning does not. We wrap the integrations in place and standardize the semantics, with no replatforming.
Vyne runs more than 120 existing integrations across PMS platforms, clearinghouses, payers, and internal systems. The connectivity is there. What Vyne wants is to take those 120 integrations and harmonize them, and to standardize them to FHIR for interoperability, so the data across all of them means the same thing and can move cleanly between systems. Axiomera Dental wraps those integrations in place, inside Vyne's own AWS, with no rebuild and no move off their infrastructure.
- What They Want
- Take their 120 existing integrations, harmonize them, and standardize them to FHIR for interoperability, so a data point means the same thing everywhere and moves cleanly across systems.
- What We Do
- Wrap those integrations in place and make the data mean the same thing, standardized to FHIR, with no rebuild and no moving off their existing AWS.
- How It Maps
- Our models read each feed, work out what it means, and align it to one shared FHIR vocabulary the whole business can trust.
- Commercial Shape
- Usage-based, deployed inside the customer's own cloud. No replatforming is the entire value proposition, which shortens time to deployment.
- Status
- Still scoping and pricing the project. A large enterprise engagement in active conversation, not a signed agreement.
The contrast with Patterson
Patterson
A closed base we open
Patterson is a closed installed base we open.
versus
Vyne
An open one we harmonize
Vyne is an open but inconsistent one we harmonize.
Two shapes of the same enterprise motion, which is why the playbook has to flex to the account rather than force one model.
The Playbook
How the enterprise motion runs
Few accounts, enormous coverage, long cycles. The enterprise motion is a small number of very deliberate, C-suite engagements, not a volume pipeline.
Everything about this motion is the inverse of Conduit's. Conduit wins through many small, fast, self-reinforcing deals. Enterprise Direct wins through a handful of large, slow, high-conviction ones. The buyer is a distributor, a revenue-cycle organization, or a national installed base owner, and the person in the room is a CEO or a head of platform, not a practice manager. The engagement is measured in months and built on a bespoke integration into the partner's own environment.
What the enterprise motion looks like
Target the installed-base owners. Distributors, RCM organizations, and the largest DSOs that own distribution rather than adopt it.
Sell the transformation layer, not a workflow. The product is the governed FHIR platform itself, which the partner then operates and brands.
Deploy inside the partner's environment. On-prem synchronizer or in-cloud wrap, so the partner keeps hosting, compute, and control.
Custom terms. Platform-license plus revenue-share, or usage-based, negotiated per account rather than list-priced.
Prove once, reference forever. A delivered Eaglesoft-to-Ascend transfer is the proof point that de-risks every subsequent conversation.
How it reinforces Conduit
Same engine underneath. Every enterprise deployment extends the installed base that already sits behind a governed FHIR endpoint.
Embedded distribution for the exchange. A partner's installed base, once opened, becomes reachable by Conduit without individual sales.
Reference weight. The largest distributor in dental operating our layer is the strongest possible credential for the Conduit motion.
Margin profile. Partner-hosted deployments land as high-margin recurring lines that fund the broader build.
One story to investors. Two motions, one semantic core, compounding on each other rather than competing for resources.
The Enterprise Thesis
Sell the transformation layer once, to the organization that already owns the distribution, and let them turn their installed base into a platform we power underneath.
02
Section Two · The Exchange
Conduit
The dental interoperability exchange. A standards-based platform that connects dental practice management systems to medical EHRs, payers, and federal data infrastructure, sold the way dental actually buys.
Strategic Positioning
What Conduit is, and what it is not
Conduit occupies a position no one else holds: the interoperability layer that connects dental systems without competing with any of them.
Conduit is not a dental PMS, not a medical EHR, not a payer platform, and not a clearinghouse. It is the exchange that connects all of them. That distinction is the whole strategy, because it means Conduit never competes with the systems it connects. It makes each one more valuable, which turns would-be competitors into distribution partners.
Underneath, every exchange is powered by Axiomera, our semantic intelligence engine. Conduit does not simply move data between systems, it translates data across incompatible formats, binds clinical concepts to the right ontologies, and emits a complete audit trail at every hop. A crown coded one way in one system and another way in the next are recognized as the same procedure, mapped to the standard the rest of healthcare uses, and reconciled across locations, each step carrying a confidence score and a full record of how it got there.
The Problem
Dental is shut out
Physicians cannot send referrals to dentists electronically. Dentists cannot return clearances in any standard way. Records cannot move between PMS platforms without fax or re-entry. Dental data is absent from consumer health apps, federal warehouses, and longitudinal records.
The Insight
Zero systems on FHIR
Not one dental PMS speaks a standardized health-data language. Where an API exists at all, it exposes a handful of fields. Once every system sits behind one governed FHIR contract, moving data between them stops being an integration problem and becomes a routing problem.
The Position
The neutral middle
Conduit is the standardized layer in the center. Vendors, DSOs, payers, and medical systems connect once and reach the entire network in both directions. The audit trail Conduit produces is the deliverable that gets the work reimbursed.
The Product Surface
Four exchanges, one engine
Every Conduit deal is some combination of four exchange patterns. Each is a job that moves by fax and phone today, and each becomes structured, reimbursable data on the platform.
Referrals & Clearances, Real Time
Medical to Dental
Why
A transplant, cardiac, or cancer team needs a dental clearance before it can proceed, and today it moves by fax and phone.
What
We carry the request out and the signed clearance back as structured data with an audit trail.
How
The model reads the dentist's findings and maps them into the exact FHIR fields the medical record expects.
Records Across Incompatible PMS
Dental to Dental
Why
A dentist refers to a specialist, but their two software systems cannot talk to each other.
What
We move the record, imaging metadata, and treatment history between them.
How
We translate each office's private codes into one shared meaning both sides can read.
Prior Auth, Claims, Payer Responses
Authorizations & Claims
Why
Prior authorizations and claims bounce between the practice and the insurer in mismatched formats.
What
We route the request and the response between them.
How
We map the practice's data into the payer's format, X12 or FHIR, and back.
FHIR APIs, TEFCA and QHIN
Patient Access
Why
Dental records are shut out of the national health-record system.
What
We publish them to open APIs and networks so patients and apps can reach them.
How
We standardize each practice's records into FHIR resources anyone authorized can pull.
Why the audit trail is the product
CMS's 2023 expansion made the documented care-coordination chain itself a reimbursable artifact. Conduit produces that chain natively.
Every exchange emits a complete FHIR AuditEvent trail and flows through the full authorization sequence, so every connected practice is CMS-ready by default.
The Regulatory Tailwind
The CMS mandates are the tailwind, and there are several
A big reason we are entering this space now is that federal policy is actively pulling dental into standardized interoperability. This is not one rule; it is a stack of mandates, each of which points at exactly what Conduit produces.
The audit trail, the FHIR APIs, and the electronic authorization flow are the deliverables these rules require.
| Mandate | What it requires | Why it points at Conduit |
|---|---|---|
| CMS 2023 Inextricably linked |
Medicare dental coverage when the dental care is tied to a covered medical procedure. | The documented care-coordination chain becomes reimbursable, and that chain is exactly what Conduit produces. |
| CMS-9115-F Patient Access API |
FHIR patient-scoped APIs, now extending to dental. | Conduit publishes dental records as standardized FHIR resources patients and apps can reach. |
| CMS-0057-F Prior Authorization |
The 2027 rule brings electronic prior authorization to dental. | Conduit routes prior-auth requests and responses through the full electronic authorization sequence natively. |
| CARIN BB Blue Button oral |
Standardized dental claims and EOB exchange. | Conduit already speaks the standardized claim and remittance formats these flows depend on. |
The full authorization sequence, by default
Underneath every exchange, Conduit runs the full authorization sequence these mandates assume: eligibility (270 and 271), prior authorization (278), the FHIR AuditEvent log at every handoff, the claim (837D), and the remittance (835). The chain is complete and documented by default, which is precisely what turns the work into something that gets paid.
The Commercial Model
How Conduit lands and earns
Conduit prices the way dental buys, a platform fee per connected location plus a transaction fee per episode, and on medical-to-dental workflows it lands on both the dental and the medical side.
The model is deliberately simple, and it maps directly onto how organizations already think about cost. A connected location pays for access. Every episode that moves across the pipe carries a small transaction fee on top. The recurring line gives us a predictable floor per account, and the transaction line scales with the value the network actually delivers. Critically, a medical-to-dental workflow has two connected locations, the medical clinic and the dental office, so both are billed.
$495/ loc / mo
Recurring · Platform Access
Platform access at $495 per location per month is the standard rate. Enterprise and DSO deals are custom-negotiated above or below it depending on volume and commitment.
Both Sides Billed
On any medical-to-dental workflow we bill the medical clinic and the dental office. The oncology, cardiology, and kidney clinics on the medical side are connected locations too, not just referral sources, so they carry their own platform and episode revenue.
Per Episode
$20
Inbound referral
$15
Record transfer
$5
Prior-auth or claim
Outbound sending is free by design, which is what powers the network loop.
The Loop
Free outbound sending means every connected practice introduces Conduit to every practice it sends to. The receiving side experiences the value, then converts to paid for unlimited access. Adoption compounds instead of being sold one account at a time.
Clearance
On the medical side, each clearance loop is a reimbursed per-episode exchange, covered under CMS NCD 260.6, so clearance-dependent accounts scale with clearance volume on top of platform access.
Conduit · Signed Pilots
Three signed pilots, three shapes
Executed pilot agreements. First invoice September 2026, ramping through Q1 FY27 as they convert.
Per-Location DSO
U.S. Oral Surgery Management
Multi-location oral surgery DSO. Proves the per-location platform-fee model at scale and delivers the first reference logo.
Per-Location OSSO
OMS360
Oral surgeon support organization, PE-backed. Same per-location model as USOSM. Proves the model repeats.
Per-Episode Clearance
Kidney Transplant
Reimbursed under CMS NCD 260.6. Proves the episode model and opens the federally reimbursed medical market.
The three signed pilots are three different shapes on purpose
We did not sign three versions of the same deal. Each pilot proves a different way the model earns, so the reference set covers the full commercial surface rather than one repeated motion. Two revenue lines run on every pilot: recurring platform access at $495 per location per month, and per-episode transactions on top.
| Pilot | Shape | Unit economics | What it proves |
|---|---|---|---|
| U.S. Oral Surgery Management Signed |
Per-location DSO | $495 per location per month, plus clearance and referral episodes on top | Proves the per-location platform model at scale and delivers the first reference logo. As a specialist DSO it is a net receiver of referrals and record transfers, so episode revenue rides on top. |
| OMS360 Signed |
Per-location OSSO | $495 per location per month, plus heavy inbound referral volume | PE-backed oral surgeon support organization. Same per-location model as USOSM across its OMS network, with heavy inbound referral volume since surgeons are net receivers. Proves the model repeats. |
| Kidney Transplant New |
Per-episode clearance | Per clearance episode, reimbursed under CMS NCD 260.6 | Not location-based. Each candidate needs a mandatory clearance loop. Revenue scales with clearance volume, and roughly 90K sit on the kidney waitlist nationally. Proves the episode model. |
The first two are the DSO beachhead. The third is the wedge into clearance-dependent medicine, and it matters out of proportion to its size because of who sits behind it.
Recurring figures are illustrative at the standard $495 per-location rate; enterprise and DSO deals are custom-negotiated and transaction volumes vary by site. First Conduit invoice is expected in September 2026, ramping through Q1 FY27 as signed pilots convert. High-level ARR projections are in the investor deck.
The Wedge
Clearance-dependent medicine
The fastest path into the medical side of the exchange is captive, recurring, federally reimbursed demand. A few concentrated buyers cover most of the market.
Clearance-dependent medicine and multi-location dental share one problem: a mandatory exchange between systems that cannot talk. In clearance medicine the buyers are extraordinarily concentrated, which means a handful of wins cover most of the market. We lead with transplant clearance because it is a hard gate to being listed, it recurs at annual re-evaluation, and it is explicitly covered by federal reimbursement. And on every one of these workflows we bill both ends, the medical clinic that orders the clearance and the dental office that performs it, so the medical side is a revenue base in its own right, not just a referral source.
The Wedge
Transplant clearance
A hard gate to being listed, recurring at annual re-evaluation, explicitly covered by CMS NCD 260.6. The single sharpest entry point into the medical side.
The Concentration
Two operators, ~80%
DaVita and Fresenius control roughly 80% of US dialysis, the pipeline that feeds transplant clearance. Few logos, enormous coverage.
The Accelerant
A former operator
A well-placed former operator compresses the enterprise sales cycle in these accounts by months, not quarters. Sourced through an expert network, converted to a monthly advisory retainer.
Clearance-Dependent Verticals
Where the concentrated demand sits
The clearance-dependent verticals below are all mandatory exchanges gated on a dental clearance. Treat every name as a go-to-market target, not a customer.
Solid organ transplant
Roughly 90K on the kidney waitlist
Dialysis and kidney care
Roughly 808K ESRD patients
Head and neck radiation
Extractions before radiation
Stem cell and bone marrow transplant
Conditioning gate
Cardiac surgery and valve
The endocarditis pre-op gate
Antiresorptive therapy
MRONJ pre-therapy screening
Where the buyers concentrate
2,657
DaVita sites · roughly 281K patients
2,600
Fresenius sites · roughly 190K patients
~250
Transplant centers · programs are the clearance gate
~80% of US dialysis
Those two own roughly 80% of US dialysis, the pipeline that feeds transplant clearance.
Oncology & cardiology
A handful of networks and PE-backed platforms own most of community oncology and valve or cardiac surgery.
The Medical Motion
Put a former operator in the room. Lead with the reimbursed clearance loop, target the two or three operators who own the pipeline, and let concentration do the work that a large field sales team would otherwise have to.
TN Spotlight · Proving the wedge at home · East Tennessee
Covenant Health, the home-market proof
The clearance wedge is a national thesis. Covenant Health is where we prove it, in Conduit's own backyard, with a warm relationship at the top and the region's only transplant program as the clinical anchor.
How to use the relationship
Rivers has a relationship with the President and CEO of Covenant Health, and the instinct to look at kidney care there is right. But the way to use that relationship is not the obvious one. Covenant is the largest health system in East Tennessee, with strong nephrology and a large chronic-kidney and end-stage population, and it is the region's most trusted brand. What it is not is a dialysis operator. The outpatient dialysis clinics around Knoxville are run by the national operators, and the transplant program belongs to a separate academic center. So the play is not signing a dialysis chain through Covenant. It is standing up a working, local clearance model with a trusted system and its physicians, and proving it in the home market.
Three separate players touch one kidney patient
Kidney care in this region is split across three organizations that do not share a digital pathway. That fragmentation is precisely the problem Conduit exists to solve, and seeing it laid out locally is the clearest possible illustration of the national opportunity.
01 · Manages
Covenant Health
The patients & the physicians
Nephrologists diagnose and manage CKD and ESRD; its hospitals treat the sickest. Owns the physician relationships and the patients, which is exactly the access Conduit needs. Does not own the dialysis chairs.
02 · Dialyzes
Fresenius · DaVita · DCI
The outpatient chairs
National operators run the centers where patients dialyze three times a week. Fresenius even operates a unit on the Fort Sanders campus. This is where the recurring, captive population actually sits.
03 · Transplants
UT Medical Center
The clinical endpoint
The region's only kidney transplant program, roughly 60 transplants a year and about 1,300 since 1985. Clearance is the gate to being listed here, which makes it the natural anchor for the whole workflow.
The gap Conduit closes
Today the dental clearance runs on fax and phone between whichever nephrologist or transplant coordinator is involved and whatever local dentist the patient can find. There is no shared digital pathway between the three players above. Standardizing that handoff is low-risk, high-visibility, and directly reimbursable under the CMS inextricably-linked dental benefit.
Who Covenant is
10
Hospitals across the system
130+
Locations, 11,000+ employees
25
County East Tennessee footprint
$1.68B
Revenue, 2023 annual report
Headquartered in Knoxville, Conduit's home market, and led by Jim VanderSteeg, President and CEO. A not-for-profit, community-owned integrated system and the region's largest employer. Employed and affiliated nephrologists manage kidney disease across its hospitals and clinics, then refer patients out for dialysis and, when appropriate, for transplant evaluation.
Sizing the Local Opportunity
Small local dollars, outsized strategic value
The point of Covenant is not the local revenue. It is the reference. That said, the local market is real and worth counting, because it is what the pilot runs on.
Covenant operates none of the dialysis centers directly, but its footprint is dense with them. Across the Knoxville metro there are roughly thirteen centers, and across the full twenty-five county region the count runs to an estimated thirty. Fresenius is the dominant local operator, with DaVita and the nonprofit DCI filling in the rest.
Knoxville metro operator mix, by identified centers
8 FMC3 DaVita2 DCI
Beyond the metro, dialysis extends across the footprint through Oak Ridge, Maryville, Morristown, Sevierville, Lenoir City, Newport and more, bringing the regional estimate to twenty-eight to thirty-two centers. Counts compiled from CMS facility data and public directories; approximate and current as of the latest listings.
The patient backlog, and what it is worth
Using national averages of roughly 68 patients per center and a 30 percent clearance backlog, at a base of $1,500 per clearance in reimbursable dental treatment routed to local dentists, the region sizes as follows. These are the dental dollars that flow to the practice network, not Conduit's fee.
Metro~13 centers · ~884 patients
Region~30 centers · ~2,040 patients
Conduit's own local revenue
Conduit prices per dialysis location, plus UT Medical Center as a premium hub account because it is the clinical endpoint every clearance feeds. The local dollars are modest by design; this is a proof program, not a revenue play.
| Scope | Sites | @ $299 | @ $399 | @ $499 |
|---|---|---|---|---|
| Knoxville metro | 13 | $47K | $62K | $78K |
| 25-county region | 30 | $108K | $144K | $180K |
| Region + UT hub ($5K/mo) | 30 + hub | $168K | $204K | $240K |
Fees are illustrative planning inputs, not quoted rates, read as annual recurring revenue. UT Medical Center priced as a premium hub at $5,000 per month as the region's only transplant program.
How to play the relationship
Frame it as a local proof of concept, not a revenue play. Ask Covenant to help stand up a pre-transplant dental clearance pilot with its nephrologists and a handful of local dental practices.
Bring in UT Medical Center's transplant program as the clinical endpoint, since that is where clearance actually gates listing and where the workflow finds its anchor.
Use the result as the reference for the national operators and the value-based kidney care platforms, where the real scale lives.
Keep the dialysis operators in view. Because Fresenius and DaVita run the local chairs, a Covenant pilot naturally introduces Conduit to those operators' local medical directors, a warm path into the national accounts.
Why Covenant is worth doing
A live clearance exchange with a respected local system becomes the case study Conduit takes to the national operators and their private-equity owners.
The home market de-risks the national motion, and it starts from a warm relationship at the CEO level rather than a cold call to a dialysis chain's corporate office.
Covenant Health, UT Medical Center, Fresenius, DaVita, and DCI are named for market context only and are not Conduit customers or partners. Local patient and center counts are estimates from public directories and national averages, not audited figures; fee and dental-treatment values are illustrative planning inputs. Sources: Covenant Health public reporting; CMS facility data; local operator directories; UT Medical Center Center for Transplant Services.
The Beachhead
The DSO wedge and the full workflow catalog
DSOs are the beachhead, but the catalog reaches far beyond dentistry. There are 127 scored workflows, and every medical-to-dental one is billed on both sides, dental and medical, so the addressable base is much larger than a dental-only count suggests.
The DSO segment is the natural landing zone for the per-location model. Mid-market groups running multiple PMS platforms feel the interoperability pain most acutely, they have the operations leadership to deploy quickly, and they are a compounding beachhead: 58% of new dentists now join DSOs, up from 22% in 2018, so the addressable base grows every year on its own. Every location added compounds on the $495 per-location platform line, with episode revenue on top.
Why the addressable math is bigger than dental
On any medical-to-dental workflow, we are not just billing the dentist. We are billing the medical office too. A cardiac clearance runs between a cardiology clinic and a dental office, and both sit on Conduit. So the oncology clinics, cardiology clinics, and kidney clinics on the other end of every clearance are billable locations in their own right, on top of the dental sites.
127
Scored workflows in the pipeline, and growing
67,600
DSO beachhead dental locations
2 sides
Billed on every medical-to-dental workflow
$495
Per location per month, plus per-episode
The medical buyer the dental-only view misses
Three medical verticals are addressable locations in their own right, each billed alongside the dental office on their respective clearance and coordination workflows.
Oncology Workflows
Oncology clinics
Roughly 1,900 community oncology clinic sites nationally, plus radiation oncology. Chemotherapy, radiation, CAR-T, and bone-agent clearances all bill the oncology clinic and the dental office.
Cardiology Workflows
Cardiology clinics
More than 2,500 cardiology practices nationally. Valve replacement, valvuloplasty, anticoagulant review, and CV-risk clearances bill the cardiology clinic and the dental office.
Kidney Workflows
Kidney clinics
7,556 dialysis centers and 1,000+ nephrology practices nationally. ESRD oral care, transplant clearance, and dialysis coordination bill the kidney clinic and the dental office.
How the pipeline is prioritized
Every workflow is scored 1 to 5 on ten weighted criteria, thesis alignment, market demand, revenue, clinical impact, procedure value, build reusability, regulatory tailwind, network effect, time to value, and competitive differentiation, plus a pattern-extension bonus. Once a pattern ships, its siblings become configuration exercises: after Oncology goes live, Chemotherapy clearance is the same FHIR pattern with a different code, not a new build.
The Build Pipeline
What is live, what is next, what is queued
The pipeline is sequenced by a 10-criteria scoring model, not by guesswork. Five workflows are live today, and the remaining backlog is ranked and ships in batches of roughly five per month after stabilization.
| Workflow | Stage | Category | Score |
|---|---|---|---|
| Dental Implant Referral | Live | Dental-Dental Referral | 4.63 |
| Oncology Dental Coordination | Live | Medical-Dental Clearance | 4.83 |
| Renal/ESRD/Dialysis Oral Care | Live | Medical-Dental Coord | 4.49 |
| Endodontic / Root Canal Referral | Live | Dental-Dental Referral | 4.41 |
| Orthodontic Referral | Live | Dental-Dental Referral | 4.31 |
The highest-scoring workflows in the backlog
Ranked across all 127 workflows on thesis alignment, market demand, revenue, clinical impact, regulatory tailwind, and network effect. The top of the list is dominated by medical-to-dental clearances, the workflows that bill both the medical clinic and the dental office.
| Rank | Workflow | Category | Score |
|---|---|---|---|
| 1 | Head & Neck Cancer Dental Clearance | Medical-Dental Clearance | 5 |
| 2 | Solid Organ Transplant Dental Clearance | Medical-Dental Clearance | 5 |
| 3 | Dental-Medical Imaging Interoperability | Imaging Exchange | 4.49 |
| 4 | Cardiac Pre-Operative Clearance | Medical-Dental Clearance | 5 |
| 5 | Chemotherapy Dental Clearance | Medical-Dental Clearance | 4.95 |
| 6 | Radiation Therapy Dental Clearance | Medical-Dental Clearance | 4.95 |
| 7 | Cardiac Valve Replacement Dental Clearance | Medical-Dental Clearance | 4.85 |
| 8 | Oncology Dental Coordination | Medical-Dental Clearance | 4.83 |
| 9 | Transplant Pre-Workup Clearance | Medical-Dental Clearance | 4.65 |
| 10 | High-Dose Bone-Modifying Agent Clearance | Medical-Dental Clearance | 4.65 |
| 11 | Dental Implant Referral | Dental-Dental Referral | 4.63 |
| 12 | Valvuloplasty Dental Clearance | Medical-Dental Clearance | 4.62 |
| 13 | Bone Marrow / Stem Cell Transplant Clearance | Medical-Dental Clearance | 4.62 |
| 14 | Oral Health Integration into Primary Care | Medical-Dental Coord | 4.59 |
| 15 | Medical↔Dental Claims & Patient Access | Payer / Claims | 4.52 |
| 16 | Provider Directory / Referral Routing | Patient Access / Admin | 4.5 |
| 17 | Medicare Inextricably Linked Documentation | Payer / Claims | 4.47 |
| 18 | Endodontic / Root Canal Referral | Dental-Dental Referral | 4.41 |
| 19 | Diabetes / Periodontal Co-Management | Medical-Dental Coord | 4.41 |
| 20 | Dental Access to Medical Allergy Data | Data Exchange | 4.41 |
The Full Catalog
All 127 workflows, by category
All 127 workflows fall into nine families. The four marked "bills both sides" are where a medical clinic and a dental office both sit on the exchange and are both billed, which is where most of the addressable value sits.
Workflows by family
Medical-Dental Clearance
13 workflowsBills Both SidesOncology, cardiology, transplant, and stem-cell clinics, each billed alongside the dental office.
Cardiac Pre-Operative Clearance5
Chemotherapy Dental Clearance4.95
Radiation Therapy Dental Clearance4.95
Solid Organ Transplant Dental Clearance4.85
Cardiac Valve Replacement Dental Clearance4.85
Oncology Dental Coordination4.83
Head & Neck Cancer Dental Clearance4.8
Transplant Pre-Workup Clearance4.65
High-Dose Bone-Modifying Agent Clearance4.65
Valvuloplasty Dental Clearance4.62
Bone Marrow / Stem Cell Transplant Clearance4.62
CAR-T Therapy Dental Clearance4.17
DRC, Military Health Dental Readiness3.99
Medical-Dental Coord
31 workflowsBills Both SidesPrimary care, endocrinology, OB-GYN, ED, nephrology, and specialty clinics on the medical side.
Oral Health Integration into Primary Care4.59
Renal/ESRD/Dialysis Oral Care4.49
Diabetes / Periodontal Co-Management4.41
Medical ED-to-Dental Appointment Routing4.34
Dental ED Diversion4.31
Obstructive Sleep Apnea (OSA)4.19
Osteoporosis Med / MRONJ Risk Workflow4.18
Pediatric Preventive Coordination4.14
Anticoagulant Med Review Before Dental Surg.4.11
Immunosuppression Review Before Dental Tx3.98
Oral Cancer Detection Coordination3.81
Oral Surgery Coord Around Medical Treatment3.75
Pregnancy / Prenatal Dental Referral3.63
ENT Referral from Dentist (Suspicious Lesion)3.53
Oncology Referral from Dentist (Susp. Lesion)3.53
Tumor-Related Dental Ridge Reconstruction3.52
Airway / Myofunctional / Sleep Med Coord3.5
Rheumatology / Autoimmune Med Coord3.4
Cleft Palate / Craniofacial Team Coord3.36
Jaw Fracture / Oral Trauma M-D Coord3.35
Hospital Dentistry Coordination3.35
Hypertension / Cardiovascular Risk Referral3.33
Skilled Nursing / LTC Oral Health Referral3.33
Dental Splint Coord (Covered Med Conditions)3.18
Home Health / Med-Complex Dental Referral3.05
HIV / Immunocompromised Patient Coord3.05
Bariatric Surgery Pre/Post Dental Coord3.05
Substance Use / Meth Mouth Referral Coord2.72
Nutrition / Feeding Difficulty Referral2.7
Speech Therapy ↔ Dental / Ortho Coord2.7
Behavioral Health / Dental Anxiety Coord2.5
Data Exchange
11 workflowsBills Both SidesDental access to allergy, labs, INR, problem list, and A1C from the medical record.
Dental Access to Medical Allergy Data4.41
Dental Access to Lab Results (Procedure Risk)4.41
Dental Access to INR / Bleeding Risk4.41
Dental Access to Active Problem List4.34
Dental Access to A1C (Diabetic Patients)4.34
Dental Access to Medication Data4.26
Dental Return: Clearance Decision to Medical4.26
Dental Return: OAT Compliance Data3.94
Dental Return: Treatment Summary to Medical3.89
Dental Access to Sleep Study Results3.84
Dental Return: Oral Infection Status3.66
Imaging Exchange
6 workflowsBills Both SidesDICOM, CBCT, and panoramic image exchange between medical and dental.
Dental-Medical Imaging Interoperability4.49
DICOM / CBCT / Pan Image Exchange4.21
Medical Imaging to Dental Transfer3.68
Dental Imaging to Medical Transfer3.68
Dental Imaging Metadata Provenance3.64
CBCT / Pan Imaging Center Coordination3.49
Dental-Dental Referral
32 workflowsDental-BilledGP-to-specialist referral, records, and coordination across dental practices.
Dental Implant Referral4.63
Endodontic / Root Canal Referral4.41
Orthodontic Referral4.31
Failed Implant / Implant Revision Referral4.18
Oral Surgery Referral4.14
Periodontal Referral4.01
Retreatment Referral (Endo/Surgical)3.77
Specialist-to-GP Treatment Summary Return3.53
Oral Appliance Therapy Referral (Dental Net.)3.5
Orthodontic Retention / Long-Term Follow-Up3.43
Emergency Dental Referral Between Practices3.42
Hygiene-to-Periodontal Escalation3.35
GP-to-Specialist Treatment Plan Review3.35
Post-Surgical Follow-Up Return to GP3.35
Perio Maintenance Co-Management3.35
Pediatric Dentistry Referral3.33
Prosthodontic Referral3.31
Oral & Maxillofacial Pathology Referral3.25
Hospital Dentistry Referral3.22
Multi-Specialty Dental Case Coordination3.21
Complex Restorative Tx Planning Referral3.17
Dental Anesthesiology Referral3.12
Oral & Maxillofacial Radiology Referral3.11
Dental Trauma Referral3.09
Pathology Result Return to Referring Dentist3.07
Second Opinion / Case Review Referral3.07
Sedation Clearance (Dentist↔Dental Anesthes.)3.07
TMJ / Orofacial Pain Referral2.97
Special Needs Dentistry Referral2.94
Orofacial Pain Referral2.84
Oral Medicine Referral2.77
Dental Public Health / Community Referral2.77
Patient Access / Admin
16 workflowsCross-SideProvider directory, records transfer, closed-loop referral, and the audit trail.
Provider Directory / Referral Routing4.5
Cross-PMS Patient Records Transfer4.37
Closed-Loop Referral Confirmation4.24
Network-Aware Dental Referral Routing4.02
New Patient Chart Import / Export3.99
Patient Access API for Dental Records3.95
Patient Access API for Dental Claims3.95
Referral Status Notification Workflow3.89
AI / Developer API Dental Data Access3.84
DSO Intra-Network Patient Transfer3.82
Patient Consent / Authorization for Records3.77
Patient-Requested Records Release (Dentist)3.72
Referral Leakage Tracking3.72
CARIN Blue Button Dental EOB Profile3.66
AuditEvent / Compliance Trail3.63
HTI-5 Dental Certification Readiness3.1
Payer / Claims
10 workflowsCross-SidePrior auth, claims, Medicare inextricably-linked documentation, and EOB return.
Medical↔Dental Claims & Patient Access4.52
Medicare Inextricably Linked Documentation4.47
Medical-Dental Claim Coordination4.27
FHIR-to-X12 278 PA Translation4.15
Medical PA for Linked Dental Services4.07
Dental Prior Authorization3.99
KX Modifier / ICD-10 Support Workflow3.6
Dental Claim Submission3.41
Dental Claim Status3.39
Dental EOB / Remittance Return3.26
Lab / Manufacturer
4 workflowsDental-BilledCrown, bridge, denture, and aligner or manufacturer lab coordination.
Crown / Bridge Lab Coordination3
Dental Lab Prescription / Case Transfer2.96
Denture / Partial Lab Coordination2.77
Aligner / Ortho Manufacturer Coordination2.72
Public Health / Pop
4 workflowsData FeedOral-systemic risk, payer risk adjustment, DSO analytics, and public-health reporting.
Population Health Oral-Systemic Risk Feed3.71
Payer Risk Adjustment Dental Data Feed3.57
DSO Analytics Data Feed3.42
Public Health Reporting / Dental Public Health2.73
The catalog is 127 scored workflows and growing, across nine categories. Scores are the weighted output of the ten-criteria prioritization model. Stage reflects the current build pipeline: five workflows live, the remainder ranked in the backlog. Medical-side site counts are illustrative estimates of the US addressable base, not committed pipeline; on medical-to-dental workflows both the medical and dental locations are billable, so the addressable count is the sum of the two sides.
The Alliance
Founding member of the Oral Health Interoperability Alliance
Conduit sits at the top of the alliance driving dental interoperability standards, and we are demonstrating conformance live, not on a slide.
The Oral Health Interoperability Alliance is the multi-sector coalition writing the standards that will govern how dental data moves. It brings together more than fifty industry participants alongside federal observers, and its purpose is to make dental a first-class citizen in national health-data exchange, the same way medical records already are. This is the body that decides what conformant dental interoperability actually means.
HeyDonto is a founding member, and Conduit is positioned at the top of the alliance. We are not a passive participant waiting for a standard to arrive. We are helping author it, sitting on the architecture steering work, and shaping the specification that the rest of the industry will eventually have to meet. Being a founding member is what lets us be first, and being first is the entire moat.
What it is
The standards body
A multi-sector coalition of 50+ industry participants plus federal observers, writing the specification for how dental data moves across the health system.
Our role
Founding member, at the top
HeyDonto is a founding member and Conduit sits at the top of the alliance, helping author the standard rather than waiting to comply with it.
The federal weight
Federal observers
Federal agencies observe the alliance, which is what gives the standard its credibility and ties it directly to the CMS mandates pulling dental into interoperability.
The demos: proving it live, with zero validation errors
The way we turn founding membership into a defensible position is by demonstrating real conformance, publicly, ahead of everyone else. The alliance runs Connectathons, live interoperability demonstrations where systems have to prove they can actually exchange conformant data, and this is where Conduit shows it works.
The Connectathon Result · Zero validation errors
Conduit completed the OHIA 2026 US Realm Dental Connectathon with zero validation errors across every pipeline stage. Not a claim of conformance, a demonstrated one, in a live multi-party test. That is the difference between saying you meet the standard and proving it in the room.
The demo roadmap continues from there: full conformance testing, a live medical-to-dental referral exchange as the working reference, and then helping ballot the guide into an official HL7 standard. Each demo is a credentialing moment, and each one widens the gap between Conduit as the first live, conformant exchange and everyone else still working from the spec.
The Moat
From founding member to the first live system
The defensible position is not the standard itself, which anyone can eventually claim. It is being live, conformant, and referenceable first, on top of a semantic layer a spec does not give competitors.
Membership alone is table stakes. The strategy is to convert our founding role into evidence by being among the very first systems to demonstrate full conformance, then to help ballot the specification so it becomes an official, freely available standard, at which point our head start as the only live and referenceable exchange becomes the moat.
Near-Term Milestone
Conformance testing
Among the first systems to demonstrate full conformance. The most important near-term alliance milestone and a credentialing moment for the product.
Turns Membership Into Evidence
Pilot launch
A live medical-to-dental referral exchange. The pediatric pilot is the pairing that turns alliance membership into a working, demonstrable reference.
Makes It Official
HL7 ballot
Balloting makes the dental referral guide an official, freely available HL7 spec after a second conformance round. Once it ballots, any vendor can claim conformance, so being first matters.
Why first-mover is the whole game
Conduit already covers the alliance's core priorities on the chosen standards: FHIR R4, SMART on FHIR, CARIN Blue Button, TEFCA, and QHIN. The audit trail is the deliverable, so every connected practice is CMS-ready by default.
Once the guide ballots, the moat is being live, conformant, and referenceable first, with a semantic translation layer a spec does not hand to competitors.
FHIR R4SMART on FHIRCARIN Blue ButtonTEFCAQHIN
Execution
The twelve-month plan
One pipe, four quarters. Ship the dental-to-dental catalog and extend it into medical clearance, and be the first conformant exchange when the standard ballots.
Q1
Jul – Sep 26
Anchor and first revenue
AnchorLead DSO conference, mid-July.
ProductImplant and Endo live, DSO pilot onboarded, kidney transplant pilot live mid-quarter.
StandardsSeptember conformance testing.
RevenueFirst invoice, DSO platform fee.
Q2
Oct – Dec 26
Catalog expansion and pilot ramp
ShowsGreater New York Dental Meeting, late November.
ProductPerio and Ortho live, pediatric coordination live, dental-to-medical query.
StandardsOctober pilot launch, pediatric exchange.
RevenueRecognized ramp, pediatric pilots two and three.
Q3
Jan – Mar 27
Clearance and DSO closes
ShowsYankee, Chicago Midwinter, HIMSS.
ProductOral Surgery live, medical-to-dental clearance.
StandardsJanuary HL7 ballot submission.
RevenueTwo to three mid-DSO closes, ARR step-up.
Q4
Apr – Jun 27
Full catalog and scale hardening
AnchorADSO Summit, mid-June.
ProductFull catalog plus clearance, scale hardening.
StandardsFirst conformant system.
RevenueManage the year-two cash trough as the base compounds.
A DSO-buyer conference every quarter
The event calendar is not incidental, it is the pipeline engine. Every quarter has an anchor show where DSO decision-makers gather, and BD uses these to book discovery and qualify, not to present.
Jul '26
Anchor Q1
Dykema DSO Conference, Denver
1,500+ DSO CEOs, COOs, CFOs, PE investors
Oct '26
Confirm
ADA Scientific Session, Indianapolis
Clinician-heavy, formerly SmileCon
Nov '26
Q2
Greater New York Dental Meeting
Largest US meeting, vendor and tech
Jan – Feb '27
Q3
Yankee · Midwinter · HIMSS
Regional plus health-IT bridge
Jun '27
Anchor Q4
ADSO Summit, Chicago
DSO C-suite, planned by DSOs for DSOs
The BD Motion
How we build the pipeline
Three engines drive Conduit adoption, and they compound. Direct DSO sales seed the network, the network refers itself, and embedded distribution reaches practices we never have to sell.
Engine One
Viral referral loop
Free outbound sending means every connected practice introduces Conduit to every practice it sends to. Receiving practices experience the value, then convert. Every practice onboarded through a DSO is also set up on its own account to seed the loop.
Engine Two
DSO onboarding
Each pilot converts to a production subscription, and every location added compounds. Pilot case studies are the primary sales asset for the next DSO conversation, so BD keeps a parallel pipeline running throughout, never waiting on pilot results before continuing outreach.
Engine Three
Embedded distribution
Conduit connectivity embedded in a PMS or distributor channel gives every practice on that platform access to the network without individual sales effort. This is where Conduit and the Enterprise Direct motion in Section One reinforce each other.
Pipeline Discipline
Every deal moves through a defined stage gate, and the weekly rhythm is fixed: a Monday pipeline review with every active deal updated, and a weekly CEO partnership briefing with deal-by-deal status. The one rule that governs pilot agreements is that case-study rights are authorized in the original SOW, never renegotiated after the pilot, because the case study is the conversion asset for everything that follows.
- Warm Only
- Alliance relationships are approached only through the alliance context, never cold. That single discipline protects the most important go-to-market accelerant we have.
- Existing Accounts
- Active customers and strategic engagements are managed through account expansion, not treated as fresh prospects.
- No Competitor Contact
- Interoperability competitors are not contacted under any circumstances.
- Government
- Federal agencies are engaged only through formal alliance participation or introduced channels, never direct BD outreach.
The Moment
Why this is the moment, and why no one else is here
Momentum is already on the board, and the differentiation is not something a competitor replicates on a slide.
Momentum already on the board
Revenue starts this fiscal year. First invoiced platform-fee revenue at the end of Q1, ramping as pilots convert.
Third pilot just finalized. Kidney transplant clearance goes live mid-Q1, opening a concentrated, federally reimbursed medical market.
CMS mandate tailwind. The 2027 prior-authorization rule brings electronic prior auth to dental, and Conduit's audit trail is exactly what it requires.
First live standards-based exchange. Conformance in September positions Conduit as the first conformant system in dentistry, ahead of the ballot.
The beachhead compounds. A majority of new dentists now join DSOs, so the addressable base grows every year.
Why the position is defensible
No direct competitor offers a comparable standards-based dental interoperability exchange.
PMS vendors and clearinghouses are proprietary or X12-only, with no cross-PMS clinical exchange.
Medical HIEs and QHINs have no dental PMS connectivity or dental-specific ontology.
Point-to-point integrations are brittle one-offs; Conduit scales through the network.
Analytics platforms work inside systems; Conduit moves data between them and complements them.
The combination of PMS connectivity, medical and payer connectivity, patient access, and a semantic layer sits behind alliance founding membership and a patent portfolio.
The Plan, In One Sentence
Ship the dental-to-dental catalog and extend it into medical clearance, and be the first conformant exchange when the standard ballots, all inside twelve months.
Two Motions, One Core
The dental strategy, whole
Enterprise Direct and Conduit are not competing bets. They are two ends of the same market, connected by one semantic engine and reinforcing each other at every step.
Dimension
Enterprise Direct The API
Conduit The Exchange
Buyers
Distributors, RCM organizations, national installed bases
Medical clinics (oncology, cardiology, kidney), dental practices, specialty groups, and mid-market DSOs
Biggest buyers
The single largest distributors and installed bases
The medical side. Oncology, cardiology, and kidney clinics are billed on every clearance and coordination workflow, alongside the dental office, so the largest addressable base sits in medicine, not dentistry
Product
The data-transformation layer itself
The standards-based exchange
Pricing
Custom license plus revenue-share, or usage
$495 per location plus per-episode, billed on both the medical and dental side
Motion
C-suite, bespoke, months-long
Pilots, network effects, standards moat
Volume
Few deals, enormous coverage
Many deals, compounding
Where it is now
Live and billing for fourteen months; flagships in redline or active conversation
Signed pilots live, first invoice Sept 2026
Flagships
Patterson (~$31M ride-up), Vyne Dental
USOSM, OMS360, Kidney Transplant
The moat
The only bidirectional full-schema FHIR access in dental
First live, conformant, referenceable exchange
Who actually buys Conduit
The name says dental, but the biggest buyers are medical. Every clearance and coordination workflow connects a medical clinic to a dental office, and both are billed. The oncology, cardiology, and kidney clinics on the medical side are the largest and most concentrated part of the addressable base, which is why the exchange is a healthcare play, not a dental one.
How they compound
Every enterprise deployment opens an installed base the exchange can then reach. Every exchange reference makes the enterprise conversation easier. One semantic engine sits under both, so the harder we push on either, the stronger the other becomes.
Full financial projections, ARR forecasts, pilot unit economics, and valuation framing for the combined dental business are presented in the HeyDonto investor deck and should be read alongside this strategy. This document is confidential and provided for informational discussion purposes only.