Healthcare Interpreting in the US and Beyond With Marco Assis

SlatorPod - Propio's Marco Assis on Healthcare Interpreting

In this week’s SlatorPod, we’re joined by Marco Assis, CEO of Propio Language Services (Propio), a US-based interpreting and language technology company.

Marco begins with his unusual route into the language industry where he spent most of his career in finance and M&A before taking over Propio from its long-term owners in 2017. He talks about Propio’s highly specialized healthcare domain and outlines the similarities and differences between servicing public vs. private sector clients.

The CEO shares his experience teaming up with private equity and what Triple Tree Capital Partners brings to the table in terms of operations. He also gives listeners a behind-the-scenes glimpse at recruiting, training, and working with translators and interpreters. Marco gives his take on the competition from in-house services at major hospital systems and insurance companies.

He then talks about the motivation behind building proprietary technology and launching the mobile app platform Propio ONE. The pod rounds off with Propio’s plans for 2022 with Marco announcing the launch of the company’s first international operations hub in Mexico.

First up, Florian and Esther discuss the language industry news of the week, with machine dubbing startup Deepdub raising USD 20m in a series A round led by Insight Partners. Meanwhile, Florian unpacks a CNET article on the “dying art of subtitling,” where he points out that subtitling is actually thriving despite subtitlers being hard to source.

Esther talks about “Why Eye-Tracking Matters in Machine Translation Post-Editing,” where eye-tracking has been found to be a promising tool for MT error identification and fair post-editing pricing models. Florian shares the latest on SlatorCon Remote March 2022 with Deluxe CEO Cyril Drabinsky and Straker CEO Grant Straker joining the 20 speaker lineup.

Transcript

Florian: Tell us more about your professional background and what took you to the language industry? 

Marco: I have an unusual background. I am originally from Brazil and spent most of my career working in various roles in finance and M&A. I grew up in Rio de Janeiro where I got my degree in economics and started at Shell and was able to have my first experience traveling and working in different countries, cities, and cultures. I always had the entrepreneurial bug and dream to start something on my own and be free from the traditional way companies think and operate. I decided to leave Brazil in 2014 and to make a long story short, after studying and visiting multiple places and working in Panama for two years in the Latin America operations for Puma Energy, I was fortunate to meet the prior owners of Propio in 2017 and entered the language services industry in the United States.

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Esther: Tell us a little bit more about Propio in a nutshell. What are your key services? What tech do you use? What do you see as your value proposition? 

Marco: Propio is a full scope language service company highly specialized in the healthcare domain so our core business consists of remote interpreting, over the phone, and video remote. Due to our nationwide footprint access to global talent and strategic partnerships we also offer in-person interpreting as well as translation, localization services. Our value proposition and how we differentiate ourselves is very important and starts from the principle that it is possible to provide high-quality services at fair rates. We do not abide by the same premium services, premium costs. We try to prove it wrong every day. Our technology is 100% proprietary, cloud-based, and we take a security-first approach to everything we do. 

Esther: Tell us a bit more about some of the other key clients’ segments that you work with.

Marco: Propio is going to be 24 years old and we have a track record working with the most diverse sectors. We have a footprint in government and the public sector. We service states, counties, and cities. We also have a diverse client base from insurance, education, social services, which allows us to offer the full range of scope to all clients.

Florian: Why the language industry? Was it just about the entrepreneurial side or were you attracted to the language services as a business? Just tell me a bit more about that. 

Marco: My native language is Portuguese. I lived in different countries. I am fluent in Spanish but even though I speak different languages, I could not interpret myself and so it was a coincidence in that sense but it was a happy coincidence. I entered the United States and worked with the prior owners of Propio and found out I have struggled personally, outside of the country, being the interpreter myself to family members in emergency situations that happened in the past. I personally connect with the mission that we are trying to accomplish. I was very happy to see the United States have come along so far in terms of rights and access to the LEP population so that brings me to Propio and the entrepreneurial bug. The willingness to start my own business and take it to the next level is something that I am very passionate about, the ability to make mistakes of our own and help develop the team and do something different. I love the language of industry. It is a legacy industry, comes from a very traditional background, has been passed down from generations, and started with interpreters. I am very passionate about all of that. About the M&A side and the private equity background, those are things that as the world evolves, the access to technology, talent, and all of those things, are being taken into consideration here. I am trying to grow a business, be highly competitive, but at the end of the day, provide the best service we can to our clients and also work with our interpreters and translators. 

Florian: What made you decide to team up with private equity and why do you think generally private equity financing is so popular in the language industry? When we look at our LSPI, one-third or half are basically now funded or financed or owned by private equity, why is that? 

Marco: When I joined five years ago it was a very different landscape and we are seeing the market become very hot from that perspective. In the past two, three years we had public companies acquiring language companies and examples that we all know. To me, you have private equity, you have investors, you have people that believe in a segment in the market that is untapped, and to me, tying that back to Propio, I could not be happier with the partnership with Triple Tree. We highly specialize in the healthcare domain, they do the same. 100% of their investments are in the healthcare domain so the least important thing to me is capital. The most important thing to me is how we can get all the tools in the hands of the CEO and the company to better provide access to our team here, to continue developing, for the company to grow, and ultimately to reach the market faster. 

Esther: What else does Triple Tree bring to the table? Are they helping operationally at all? What support do they offer? 

Marco: The main reason that I was considering PE was we had two owners, the founders, who were looking to retire at a time so that helped as well to provide equity to the prior owners to fully retire and for me to continue on our journey for the future. Triple Tree is a firm 100% focused on healthcare. What they bring is existing relationships and their approach is something that I was very careful in selecting the parties. As you might know, this is a hot market so I got intentions from several parties and what comes down to it is how do we operate together, our principles, the way that I see a company should be going, the way we treat our employees, our interpreters, our clients. None of that is conflicting with Triple Tree’s mission so it is very collaborative. What they bring to the table mainly is partnership and future opportunities down the road. 

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Florian: In the US, language access legislation, for lack of a better word, is key to underpinning a lot of demand for interpreting. How do you see the political forces here at the moment? How do you see the future for regulatory-driven language services and tech? 

Marco: We have a competent group and language industry experts taking the lead on some of the topics. For example, ALC, which we are members of, takes primary instances and talks to the regulators and things of that nature. From my point of view, I am focused on providing a high-quality service. At the end of the day, regardless of the direction that one country, one city, one state might point you to, it is our role as business owners and entrepreneurs to adapt and to prove that there is a way to add value here so that is what we are focused on. We do not discuss or take this theme as more important or less important. We treat it as is. We are very aware of the environmental changes. We have come a long way to where we are today. One thing that is shifting a lot, especially in healthcare, is the value-based outcome instead of processing quantities and ticketing so that is where we come in and we partner with our clients to add value to their chain. We do not see ourselves as just a cost-base to them. We find out how to provide better care, better access to whatever they are trying to do and we insert ourselves in that context. 

Esther: I am just curious about your take on the supply side of the interpreting market because the US seems very US-centric when it comes to interpreting providers. Europe also keeps pretty much to its borders even though it is highly fragmented. Do you expect US-based interpreting providers are going to expand into the European market?

Marco: I hope so. I believe supply-demand is an evolutionary question for the whole industry. As we get more mature, as companies are able to articulate what they are doing, questions around security, around data, around where the interpreters are located become much more fluent and that is where we believe in a service with no boundaries with clients. We partnered with global clients, with United States clients. Most of our clients, in fact, are in the US but we do have partnerships outside of the US and we work with our clients. Our role here is not to tell them or dictate what they should be doing or not. It is to just explain our capabilities and then be transparent and fair in their conversation and then let the client understand. We are seeing over time more and more companies understanding that we live in a global world and talent is everywhere, so why not leverage it.

Florian: Why do you think that written translation is more global in the sense that even smaller vendors would have a US office, a London office, or a Singapore office? Now in Europe, there is basically no real pan-European interpreting provider. What do you think is different, written translation versus interpreting in that sense? 

Marco: That is an interesting point and we are going to be announcing our first international office on the interpreting side. We do see opportunities in translation, localization already. We believe that it is possible to bring that to the interpreting world. In terms of the demand side, governments usually take that first step in providing the revenue stream for companies who set up in their countries. That is why I believe we see a little bit more in the United States since there is more advanced regulation and thought process around providing equal access to all populations. Plus if you are taking into consideration capitalism, companies, and more advanced businesses, the United States is the prime location for all of that but it is just a matter of time. I believe that’s where the world is going. I lived in Brazil working with ex-pats down there having the same issues that immigrants have here, so it is just a matter of time for that concept of increasing value access to all of the citizens. 

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Esther: Tell us a bit about how Propio recruits, on boards, and supports interpreters. You have got a training initiative as well, perhaps you can tell us about that?

Marco: This is the hidden work. I like to tell my team here that you can have the flashy technology, the best sales process, and beautiful marketing but at the end of the day, if you do not have high-quality services, you cannot build a business and businesses consist of interpreters, translators, and linguists. Interpreters are the core of everything we do, from recruiting and qualifying to working with them, training, and giving them the tools in order to increase the overall quality. Helping them with career advancements is very important to us here at Propio. We have several initiatives, the one you mentioned, Interpreter Academy, where we help new interpreters become more proficient. We also have several ways of working with them in a knowledge management center and giving them the tools. I speak three or four different languages, but I could not interpret so it is a very high-value skill where a different scenario comes every time. You might be talking in an emergency and then you have a children’s hospital, then you have a social service call. I am very happy to say that a third of our company is highly engaged with interpreters with years of experience and we are expanding on that even more.

Florian: What is the modality in rough percentages, like OPI, VRI? Are people mostly in their own location? Or do you have a hub where people can come in and they work remotely, but they are from a location that you provide? How do you manage that? 

Marco: All of the above. The biggest misconception, for example, is if the interpreter is specialized on-site, the interpreter would like to work only on-site. It is not the case most of the time. It is the same thing as translators are not the same as interpreters. Within interpretation, there are different skill sets, so over the phone, video, in-person. Those are preferences, modalities that the interpreters decide and are comfortable with. In terms of where they work, out of all the challenges, COVID helped all of us to understand how to better collaborate remotely, so in general, we are all aware of our backgrounds more. We are all aware of our internet, our headsets, and all of those things so that helped propel us in the remote side of things and so most of the interpreters worked from home. We do have partnerships and proprietary locations where interpreters can come and do hybrid modality so we try to leverage and play to what is relevant to the market and to what interpreters want. We do not believe in enforcing our clients or interpreters to do anything. We are here to offer different modalities and different ways of working and that way our operations try to do that chess game every day.

Florian: Is your top language Spanish? What are the top 5 languages and what are the harder to source or maintain languages?

Marco: It is one thing that blew my mind when I started thinking that it is possible to predict who is going to come into a hospital, who is going to make a call, or what language is going to come across, as you grow, as the company acquires scale. This year, for example, we plan on doing over 70 million minutes of remote interpretation, so if you look at the numbers, it is very consistent. Every city is different, every location might be different depending on the population that surrounds it but, in general, 70% of the language market in the United States is Spanish. The language varies by location so in our case, we have a good Spanish presence on the East Coast so we see the heavy influence on European languages. In the Midwest, there are African languages, Somali being a popular one. Russian on the East Coast is a popular one, for example. We do not approach on a language basis, we work with our clients at the end of the day, from a business perspective. That is the beauty of scale. You mentioned recruiting, we do have a global recruiting team that looks worldwide depending on the level of skill set. Sometimes it is interesting to think that, for example, in Vietnam, there are doctors that make more interpreting for us highly specialized in the domain, so why not leverage that talent and bring it here. We come across all of those types of scenarios and recruiting is vital in finding the talent because we want to work with them for the long term.

Esther: You said earlier that all of the technology Propio uses is proprietary and you launched something called Propio ONE. Can you tell us a bit about Propio ONE and why you made the decision to launch that in particular?

Marco: We have big aspirations, big ambitions and we believe that it is possible to offer one entry point to our clients and let them use what they contract us for. Propio ONE is our communication channel for our clients. We have more things coming down the pipeline here to be announced soon but the concept is very easy. We try to simplify interactions. We do not try to make technology complex. We understand that we need to be efficient and connect fast and to be easy on our approach is critical. Propio ONE allows us to put our own spin into bringing language access to our clients. Propio ONE is a mobile web browser product. We have a product team that works with our clients who bring innovation to that product more and more over time so we are very excited about that. Equally, we are going to be launching a product line here pretty soon for interpreters and for other things.

Florian: How do you manage the day-to-day interpreting workflow? Here you are developing software, but who does it? Do you have a background in this? Do you have a good CTO? How do you do that?

Marco: That is an eternal joke here. I joke with my CTO every day and say, if I ever go back to the job market and try to find a job, I will probably be better off as a CTO than a CFO or CEO. That is one thing that I am very passionate about, technology products, and I do believe I am a heavy study of businesses. I believe that we need to get pros and cons from each business and try to make our own. When I entered the language industry it was very clear that technology was not at the forefront, so that has been a journey. I always believe in the human side of the services and I never want to take away that and the importance of that. I believe that technology can enable us to do much more. Over the past two years, since I became CEO of Propio, I have been putting a heavy agenda on the technology front, on cloud-based services, on the microservices environment, and all of those things that allow us to be scalable, but at the same time bring innovation to our clients. It is very hard to cover all those topics but that is why I believe in the power of teams, the power of hiring talent. I do not try to do their jobs. I am here to augment them.

Esther: How do you plan to maintain growth as you are scaling and as you are growing and what do you think are going to be the main contributors to that growth? 

Marco: It is a very exciting time. I could not be more excited about what is ahead as a CEO, business owner, and entrepreneur. It is a good problem to have, however, let us not ignore the fact that growth is hard, high growth is harder so it takes a team to do it. We focus every day on organic growth so we believe that the way to grow market share, to build a reputable organization, is to prove that we are the better option and drive clients to our door every day so that is our focus. However, when you mentioned my background in M&A, we have a partnership with Triple Tree, so we do have the resources and capabilities to act strategically if the opportunity arises. Last month we closed on two acquisitions. We had been partners for years, it was very natural for us to bring that under the Propio umbrella and further accelerate that curve so we look for opportunities naturally. We do not try to have one approach versus the other. Our focus is on our clients, in our interpreters’ organic growth but we are also aware of what is going on around us. In 2021, we closed with 120% growth. This year we are on a trajectory to beat that again so more and more, I have a feeling that people will hear about Propio and see the things we are doing.

Florian: How do you see potential competition from giant hospital systems or insurance companies that build their own internal teams and maybe selectively work with vendors, but do most of it themselves? Do you see this as a potential threat or do you see we are currently more in an outsourcing wave?

Marco: My role as CEO and leader of the company is not to try to dictate what others do. I control what I control and in effect, I see it very positively. We partner with all types of clients. We have healthcare clients that take that trajectory and build their in-house staffing team and we have tools and systems that help them manage that and reduce their cost and the burden of managing internal staff so that has been a very successful partnership. We like to see our clients as partners so we work with them on an exclusive modality basis where they are all in-house. We work on a hybrid where we are the overflow and we work with clients where they trust us to be their sole provider. I believe in running the business on what you are experts in and focusing on your core and then being the best at your core. I am not opposed to clients or companies trying to do different modalities. I believe in that value-based outcome, higher quality of services years and years of being specialized. I am always going to be in favor of contracting with a company that can take care of that for you so we can focus on your core, but at the same time, we have excellent partnerships where we partner with them and help them manage their internal staff. 

Florian: That is a complex pre-sales cycle, how do you manage that? Who in your team is taking care of that? 

Marco: That was one of the biggest challenges when I joined the industry. The sales cycle is typically longer than a different industry and the conversation can be very different, and we believe we found a way to simplify that conversation and make it scalable. The reason why you do not see, in my opinion, explosive growth in the languaging industry is one of the main blockers is a sales cycle. That is what we unblocked and unlocked so the conversation can get very complex. The stakeholders are very different depending on the party you are talking to, their level of interest, their focus is very different so we have a proprietary way to approach conversations and help. Our view is not that we are trying to sell you something, our view is to understand your problem. You cannot solve a problem if you do not understand the problem so we first try to take a client-first approach in our sales cycle, understand what is the pain point, then come back with a solution. That is a killer and then you cannot say no. Joe Samoszenko, Chief Revenue Officer, has been in every single role in this company and he is leading those efforts. Most of the conversations and the team report to him, so he is critical in that process as well.

Florian: Marco, you have got a lot on your plate. What are your key initiatives for this year?

Marco: We have big aspirations for 2022. We are coming from a record year and we are prepared to do it again. We have several initiatives coming in the pipeline that we will be able to share very soon. One particular that we are expecting to make a big impact is our first international operations center outside of the US. We are building a facility in Mexico. We have secured a large facility to accommodate over 200 employees and I cannot wait to make an impact in the communities we are present in and we service so that is a big part of what we do. We make an impact in our surrounding communities. We are also doubling down and bringing innovation to Propio ONE with new features that our clients will love. Our focus is to simplify the interaction, empower the end-users with real-time data, so 2022 is going to be a big year for us to bring that data analytics to the forefront and share that with clients, and try to differentiate ourselves, and continue evolving as a company. 

Florian: It is a good announcement. Thanks for the exclusive here. 

Marco: It is an operations center. It is going to be in Guadalajara, Mexico. We have been working on this for the past five, six months. We have close to 20,000 square feet down there. I have worked in Central America, I have built relationships in those countries. I left my country in 2014, I have lived in different countries and worked with different cultures. I am a big proponent of making an impact where you have a presence and being respectful of those cultures, so that is what we are trying to do with our headquarters here in Overland Park, Kansas, being thoughtful in our approach to our community. Now we have offices in Ohio after the acquisition we did last year with Vocalink. We have a presence in Minnesota, so working locally, as well as thinking globally, is at the forefront.