S03E17: Translation Services for US Healthcare Insurance Market

Luis Miguel Musi

Thank you, Sultan, it’s a pleasure to come and to talk to somebody in the industry who we share values with.

 

Sultan Ghaznawi

Absolutely. It’s a pleasure to have you over and we’ve been trying to coordinate this for a while and finally it happened. But for those people in the industry who are listening now but they haven’t had the pleasure to meet you in person or learn about you, can you give them an introduction and tell us what you do?

 

Luis Miguel Musi

Absolutely. Well, I look at myself in many different contexts, right, because I’m a father, I’m a husband, I’m a CEO, I’m an immigrant, I’m a son. So there’s a lot of different roles that I play in society. And here in terms of the industry of the translation localization industry, I see myself as somebody who is informed by my immigration experience. My family came over to Mexico about 100 years ago from Lebanon and they settled in Mexico, they made a good life for themselves. We prospered, thank goodness. It’s a very rich and very welcoming country. And when I was a young boy, I had similar inclination to move on and look towards the United States, the colossus to the north of Mexico. And I immigrated from Mexico to the United States. And in that process, I saw that I’m also very lucky because I come from a privileged background, my family did very well in Mexico, I got a very good education. And I saw that a lot of immigrants in the United States who did not have good education, good access to linguistic resources were not doing very well. And I committed to help those immigrants do a lot better in the United States by working within the language industry.

 

Sultan Ghaznawi

So let me ask you about that. How did you find yourself in this industry? Can you share a few words in terms of how you started out your translation work? What prompted you to get involved?

 

Luis Miguel Musi

Absolutely. Well, as I mentioned, I came over to the United States and I actually came to college in Davis, which where my company, Avantpage is located. And during that process of being in college, I started taking a course in something called International Agricultural Development. And with that course, one of the things that it did is we traveled all around California and we visited lots of different agricultural operations. And I saw firsthand the lives of migrants, primarily from Latin America, but also from many other countries. And how poor their language skills were and also how that limited their opportunities in the United States. And so I actually acted as an interpreter during this course because I spoke fluent Spanish and a lot of the other people in the course did not understand Spanish. So I started to establish a rapport with a lot of these immigrants and I identified with them and saw that if they could only really have access to some of the resources that I had by knowing and understanding the culture and the language, that their lives could be radically different. That informed my career choices as I moved out of college and in a circuitous way. But eventually I ended up in the language industry and I’ve been here for about 30 years and love every single day of it.

 

Sultan Ghaznawi

Wow. You are truly a veteran in this industry. Luis, I want to hear from you about your experience in terms of the major events, changes, evolutions, observations that stand out to you in this industry. What have you witnessed over the past 30 years that you’ve been in this industry? What things actually captured your attention and you still think about?

 

Luis Miguel Musi

That’s a great question, Sultan. This industry really is, I would say, extremely giving to those of us who are in it in the sense that it has really been there and it’s really growing and growing and growing and growing. You see it growing in so many different areas. In the area where we have chose to operate, which is in helping immigrants within the United States who don’t speak English well, there’s many more immigrants now than there were before. And there are lots of businesses and other organizations that want to reach these groups of people. And so the number, the language access requirements that include interpreting, translation, accessibility, and things of that nature have just been growing very, very steadily. Of course, you see it also growing in terms of the globalization of the world, right? Because many companies now have websites that are in twenty, thirty or even more languages because the markets have diversified. The United States economy was so dominant before the United States.

 

The English was number one language in the world. Now, if you want to do really well, you have to really be looking at selling in China, selling in Germany, selling in many other countries. So I see it as a really great place to be. It also tends to be a recession proof, meaning that as there’s been dips and s and flows in the world, the appetite for language services has continued to grow. And in many cases, as you well know, I’m sure we’re going to get into this later on. This is mandated through regulations and laws. And so even though there may be a dip in the economy, we have to provide these services to people because it’s just the right thing to do, because it’s the just thing to do, because it’s what the government says that needs to be done. And so the demand just keeps growing, which I think is wonderful for us who are in the supply side of the equation. And then there’s been a lot of different developments in the world that I think also have influenced the industry. One, for example, I think of the incredible drop in costs for communications.

 

When I was a student here until a number of years ago, I used to pay four or five dollars a minute to call long distance phone calls to Mexico. Of course, that has gone down to maybe a penny a minute, if not even less. Now we’re talking real time, you and I, and at practically zero cost with video calls to the Internet. So that has allowed the industry to really have people located in many different places and work simultaneously, you know, work together. So that’s one area where I think has really impacted the industry. The fact that we can now talk to people all over the world for practically zero costs. The growth of the Internet and the web, of course, has also been very good for the industry. Again, it has allowed, my company has offices in three different countries with people in more than three different countries. And we work seamlessly because we have an office in Mexico City. We have an office in California. We have an office in Europe, in Poland. And because of the web, because of the Internet, we’re actually able to collaborate and work on the same file simultaneously, for example. So that really has been also a huge influence in terms of allowing the companies like yours and mine to really be able to collaborate and work on things in a way that was never possible before. I mentioned globalization in another context, but I think that also has been really fantastic for the industry because it has opened up the world, the markets incredibly.

 

It also has allowed us to hire people in different countries and have a lot of things in common already because we share a lot of the same media, a lot of the same values, just because the fact that we are much more integrated in terms of the kinds of things that we read, the kinds of things that we are exposed to, the way we work and so on. I mentioned briefly the fact that there’s been lots of regulations. We work in two highly regulated areas, health care in the United States, as well as state and local government. Both of those areas tend to be highly regulated. It is because of those regulations that a lot of the demand for our services comes. And finally, I see that there’s in the computer, in the systems area, we have great growth in the capabilities, the things that we can do. For example, the tools that we have are disposed to work on, the computer aided translation tools like translation memory tools or translation project management tools. Those have really grown tremendously in terms of sophistication and the kinds of things that we can do with it.

 

Finally, I would say that there is a huge revolution that we’re seeing today in terms of the influence of AI and machine translation. That has really affected how people consume and a lot of companies produce translation, interpretation and other resources in our area. A lot of things, I covered lots of different things, but I see that that is the good summary of what I see as the major events shaping our industry.

 

Sultan Ghaznawi

Thanks, Louis, for sharing that about your experience and about what you’ve seen in our industry. I would like you to share your experience now and knowledge about a very specific subject today. That’s something that is dear to you and I know this is an area of expertise as well. Can you talk about your current view of translation services for the healthcare insurance industry? Where things are? Can you give us a high level bird’s eye view of this industry?

 

Luis Miguel Musi

Sure. As I mentioned before, our company at Avantpage is primarily working in the areas of supporting immigrants in the United States. Immigrants who don’t speak English very well. We work in primarily two areas, the state and local government, but also healthcare, healthcare insurance. And broadly, more broadly than that, also just supporting healthcare institutions that provide these services to people in the United States. It’s a huge market. If you look at different estimates, about 20% of the economy is taken up in the United States by healthcare and that is much larger than in many other economies, but it is because of the way that the industry is structured. And if you look at the value of how much money actually is spent directly on healthcare services, about a trillion dollars, with a trillion with a T, that’s a thousand billion dollars.

 

That’s huge amounts of money. And there are, you know, the United States tends to see healthcare in ambivalent terms, right? On the one hand, we don’t have a universal requirement for healthcare to be provided to everybody, like you do in many other countries. But we also have Medicare, which is the healthcare system that provides it to all seniors. We have Medicaid, which is the service that provides it to people who are of limited resources. And we have also regulated it in many different ways to make sure that those people that don’t speak English well are also able to receive healthcare services. So it’s highly regulated in terms of requiring all kinds of services and that these services be provided in a language or in a way that is understandable by the patients, by the recipients. And it’s just huge, huge, huge in terms of how much of the economy it consumes.

 

Sultan Ghaznawi

Luis, you mentioned that this sector or this part of the industry is highly regulated, you know, because of so many reasons. It’s a situation of life and death in most scenarios and so forth. The healthcare insurance industry has been inclusive and the Affordable Care Act or Obamacare, as it’s well known, it contained requirements to ensure non-English speakers could understand everything about their healthcare insurance products. Now, how did that affect the language industry? How did things in terms of demand change for us?

 

Luis Miguel Musi

Very good question, Sultan. The Affordable Care Act or Obamacare, as you mentioned, opened really a large number of opportunities for immigrants to receive all kinds of services. I was glad to see it come into play. It actually has been really important for our company because we provide healthcare for our employees. And through the healthcare exchanges that the Affordable Care Act made possible, it has allowed us to open up opportunities that we didn’t have before. In terms of regulations, the opportunities that came through the Affordable Care Act, for example, I just mentioned the exchanges made it so that they opened up a whole new marketplace, whole new areas of demand. The actual regulations of the ACA are not the ones that actually affected us so much because those regulations already existed before, which are more grounded under the Civil Rights Act that was passed in the 60s. So what happened with the ACA, at least the way we see it, is that it opened up the market, it increased opportunities, increased the services that are offered. For example, rather than just simply translating a certain number of, small number of documents, now it also expanded to the fact that you have to do it to the web, for example.

 

It also meant that when you make things that are on the web, you have to make it more accessible to people that are not necessarily able to understand things or work within the computer. It also increased the languages to which we have to be doing work, for example, in translation or interpreting because the Affordable Care Act, you opened up the system to many, many more millions of people, primarily people that were in the lower rungs of economics in our society. That also tends to be people that many of those are immigrants. And so the number of languages that institutions are translating or interpreting or making accessible increased tremendously. And then, of course, it opened up new territories, meaning that areas that in the past, let’s say certain rural areas in California or some states, like I’m just making this up, somewhere in the middle of the country in Kansas, that were not doing any interpreting or translation before, all of a sudden they had the funds and they had the opportunity to provide services to populations that they didn’t have before. And so that expanded the market in terms of the number of places that are now able to provide these services to their patients.

 

Sultan Ghaznawi

I understand, Louis, that demand for translation work in the health care insurance space is on the rise, as you just mentioned. And as such, our industry has responded quite well. Your company is a very good example. My own company, for example, has developed processes and tools to address this specific market. What type of opportunities does this sector present to LSPs in general?

 

Luis Miguel Musi

This is similar to the question we’re talking about. I think that there is a very large and growing demand. And on the other side, this means that it’s a very competitive marketplace. Your company is playing in this space. My company is playing in this space. We are colleagues. On the other hand, we’re also competitors. Sometimes we bump against each other. Another thing that happens is that the requirements and the specialization that you need to have to be able to do a good job and be credible in this space have really increased. So I’ll tell you, for example, what our company has done to respond to this large increase demand. We have invested huge amounts of money in our development team for systems. So we have software that we are developing because our clients have increased demands and they need to get things sooner. They need to get them in a more convenient way than before, in much larger volumes than before. So we created something called the Avant Portal, for example, to be able to help our clients to be able to access our services much faster, much more efficiently.

 

Another thing that we have done to respond to this need is that we become more specialized. So our network of linguists is now super focused on the health care arena. Not only do they know huge amounts about medical terminology, they know the difference between a hematoma and a hemorrhoea. They also have to know very much in detail how the health care marketplace and insurance market works in the United States. They need to understand, even if these people are from different countries, they also need to understand that what Medicaid is, what Medicare is, even though they don’t have it in their native countries, for example. Another area where these things have really changed and we have had to respond is the fact that infrastructure, the technology infrastructure, has had to really mature and become very, very much something that is very solid. Because these health care institutions have very tough regulatory requirements, they need to work with companies that have an infrastructure that guarantees, for example, that even if there’s an earthquake, which has happened to us, we’ve had earthquakes happen in Mexico, that we’re still able to keep working.

 

We have an emergency response plan that allows us to keep working so that their patient records that need to be translated from Chinese or from Armenian actually keep flowing and they’re going to get to the hospital on time so their physicians are able to see and understand what it is that they’re facing with their clients. Another tough issue that we’ve had to deal with is the fact that some of these regulations require that all the work needs to be done within the borders of the United States. That is something that at the same time, they also want it to be done very, very cheap. And of course, we both know the United States seems to be one of the most expensive countries to work in, and then we’ve had lots of inflation. So this has provided a huge challenge for us in the fact that we have to have our supply chain completely within the country, but at the same time, they want us to be able to charge the prices that companies who work in much lower cost countries are able to provide. So those are some a lot of the challenges that we as companies have to face. And how do we do it? Well, we develop relationships with providers. We give them lots of volume of work, and we make sure that the process that we use is such that we’re able to lower the cost through automation and through efficiency. So it’s a challenge, Sultan.

 

Sultan Ghaznawi

Understood. Well, you answered my next question, Luis. I was going to ask you about requirements for the sector, and you talked in great detail. So let me ask you about the demographics and the languages that are underrepresented and where health care insurance can make a bigger difference to reach with true translation. And what are your observations?

 

Luis Miguel Musi

As we mentioned before, one of the effects of the Affordable Care Act and so on has been that health care has been able to be extended to many more communities within the United States. And that has meant that languages of more limited diffusion like Syriac or some of the Mayan languages or native languages in Mexico or Quechua from South America are in demand. And a lot of these languages are very difficult to source, as you may know. We observe that in different parts of the United States, you have local populations that have different requirements. We recently experienced huge migration from Afghanistan, right, because of the withdrawal of the United States from that war. That created a huge demand for a number of those languages like Pashto and Urdu and so on. And we have been able to respond to that by essentially having to work within the United States immigrant communities.

 

Again, we’re not able to bring this work outside of the United States, so we need to work with the within the borders of the United States. So we have to be constantly reaching out to these communities, the people that come. A lot of these languages don’t have a good number of established formal certifications, for example. So we work with the health care companies to make sure that they understand that even though some of the requirements that they say mean that these translators or these interpreters need to be certified, that there really is no such thing as a certification for these languages. And so we’ve developed ways of self certifying them through our own institution and make sure that this is something that they validate and that they consider to be valid. So in other instances, a lot of these languages don’t have a good written language, for example, not language, but system. A lot of these languages tend to be the only oral. And when you have to have a translation, for example, of some of the Mayan dialects that we encounter, whereas in reality, if you look at their writing system was done in hieroglyphics, that’s been a big challenge for us as well. And our linguistic department, our provider network has been very creative in meeting some of those challenges.

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This podcast is made possible with sponsorship from Hybrid Lynx, a human in the loop provider of translation and data collection services for healthcare, education, legal and government sectors. Visit HybridLynx.com to learn more.

 

Sultan Ghaznawi

Let’s talk about customers again in the space. Who are they? Are these insurance companies or third parties that work with health care insurance providers? Who are actually the buyers of translation services for this sector?

 

Luis Miguel Musi

We do quite a number of we see quite a number of local government agencies that, for example, the Yellow County Health Care Authority is one of them. So we see it at a lot of different local and state government levels in the United States. It starts from cities, goes to counties, and then you can go all the way up to the state level. That’s where we operate. So there’s regulatory agencies, and then there’s agencies that actually are in charge of providing their services to the public. So that’s an area where our health care and government sectors sort of intersect. And you have, for example, the California Department of Managed Health Care is one of those agencies. And then as I mentioned, Yellow County, for example, Office of Mental Health is another one. We also have work with the city of San Francisco quite a lot. So state, local, and even city, you know, county level governments.

 

There’s also local health plans. Health plans here in the United States tend to be the entities that provide the actual health insurance. So they’re not going to be providing the actual services to the people, but they actually provide the mechanism through which they get the services. They work with hospitals, they work with clinics, they work with the actual physicians. So for example, in my company, I’m on page, we provide health care insurance to our employees. And normally that means that we contract with health plans. And these health plans can be with actual entities that provide the health care, for example, it could be Kaiser Permanente or it could be Sutter Health. Those two actually have their own health plan and they also provide the actual services. But then there’s also entities that are just like Blue Cross or Health Net that are just the insurance agencies and then they also work with the actual providers. So health plans is one.

 

Another one is I mentioned hospital systems, right? Or health care systems. So I mentioned Sutter Health. Sutter Health has clinics and they have hospitals and they have individual physicians. They’re based here in Northern California and they are the ones that actually are providing the actual health care to patients. There’s also all kinds of supporting infrastructure of companies. So there is health care marketing companies that help these entities to actually reach their client base to advertise their services or to let them know that there’s something going on, like it’s open enrollment time. There’s health care education companies that help people educate their patients so that they have better hygiene or better nutrition, things of that nature. And then there’s also physician groups, groups of doctors that work individually but they have like a way of association and they are actually seeing patients on a day in and day out basis. So all kinds of different levels of health care institutions that work in this space.

 

Sultan Ghaznawi

So now let’s talk about, since we are educating the industry, the LSP side, what does the sales process and sales cycle for the sector look like without giving too much detail in terms of your own proprietary things that exist, in general, how do you find it compared to other sectors?

 

Luis Miguel Musi

Because we work exclusively in the healthcare area and the government areas. It’s hard for me to tell you in detail how different it is from other sectors. But I’ll tell you a little bit about how we see it within our area. Of course, government and healthcare for us tend to be different. Economy tends to be more driven by requests for proposals, requests for quotes, and so on that are pretty much driven by the procurement requirements that government has. Many times those requirements have nothing to do with quality. They have more to do with price. When you’re talking about the actual healthcare sector, the sales cycle tends to be quite long. It can be anywhere from six months to over a year. Some of our clients we recorded for two or three years before they actually became clients of ours. The kinds of ways that we actually approach selling to these entities is through relationships. We use building that relationship is really critical there.

 

They need to understand that we are specialized. That’s really, really critical. They need to understand that we have a good track record. That is, we also have a number of other entities like them that we work for. They also need to make sure that we are compliant with them. That’s really, really critical because they are audited all the time by the government. If they find that they’re not able to comply with any of their myriad of regulations, they tend to have pretty severe consequences. Once you establish that relationship and they see, okay, a long page checks all these boxes, you still have to go through an actual competition through their procurement entities, so request for proposals. Now, these requests for proposals tend to be rather different from those that I mentioned to you before for government. Here you are actually competing in a non-public setting. When you’re doing with government, it’s more public. All of the information that you provide is going to be actually seen by other companies. You have more information about what has happened in the past. When you’re dealing with a healthcare provider like, let’s say, Blue Cross or Blue Shield or HealthNet, they are not subject to the same public records that other entities in the government are. They are also able to use many, many different criteria when they choose the actual providers.

 

Price is one of the factors, but they’re also maybe looking for a particular set of languages or a certain capacity or a certain variant of a language. Let’s say they are operating in Orange County and they have a large number of Vietnamese immigrants, but they are primarily from Southern Vietnam. They would want people that are not the Vietnamese interpreters or translators from today, but from the old times that came to the US at the same time as they did. They have all kinds of different requirements like that. It is through those relationships that we have built over time that they have the trust and confidence to invite us and then for us to move forward in those requests and proposal processes. As I mentioned, just even the process of request for proposal can take several months. You have to be very patient. It’s a long game and you have to have a lot of credibility. If you don’t already play in this sector before you actually go into one of these competitive situations, it’s going to be really tough for you to actually be considered and to be able to do well.

 

Sultan Ghaznawi

Of course, the key there is patience and obviously this specific sector, healthcare in general, moves very slow. Luis, let me ask you about two things here. One about the type of content that this sector generates that requires translation. Secondly, what type of translators are best suited? You alluded to this earlier, but what type of linguists are best suited to operate in this space?

 

Luis Miguel Musi

Great question, Sultan. Let me tackle the translator, the kind of linguists that do really well. When we evaluate linguists, we look for a large number of characteristics. They have of course to take some kind of linguistic exams with us. We make sure that they understand that they are really high quality in terms of the linguistics, right, in terms of the quality of work that they produce. We also make sure that they’re very familiar with the terminology of the industry. We quiz them on do they understand what Medicare is, what Medicaid is, what open enrollment is, things like that. They need to be very familiar with the industry. They also need to be very much resident in the United States, which is as I mentioned that before. They also need to be very familiar with the tools that we use. I mentioned before machine translation. I also mentioned CAD, computer aided translation tools. In our industry, because of regulations, machine translation is not accepted for the most part. It’s banned.

 

This is something that happened way back in the 60s, 70s, 80s when machine translation was in its infancy and the quality was very poor. Some companies use machine translation and it was being so poor that there were some laws and regulations that said no, this is completely unacceptable. Some of these have not been updated to reflect the fact that today things are different. We need to make sure that the people that are working with us are going to be able to work within the context of a TEP as you will now translation, edited, and proofing. Three steps all done by different humans so that they can work within a team. They also know how to work within the tools that we have and that they’re super responsive because a lot of the work that this entity is requiring needs to be done very, very quickly. For example, today we have a requirement that we get hundreds of letters on a daily basis that have to be not only translated but actually mailed back to the patients or health plan member the same day that we get them. It’s really tough and we need to make sure that the translators, the linguists, the editors are all super responsive.

 

Sultan Ghaznawi

Luis, let me ask you while we’re talking about that, about standards and regulations in this space. What are those that LSPs should know and pay attention to? For example, given that there is a lot of privacy and healthcare data in this content, are LSPs required to remove them? What safeguards do they need to have in place? How do they actually play safe in this space?

 

Luis Miguel Musi

You’re absolutely correct, Sultan. We are subject to a large number of regulations that safeguard patient information and confidentiality is critical. We are subject to a lot of compliance programs and that includes standards of conduct, adoption, and implementation of those. General compliance is really critical, including HIPAA, which is the Health Information Protection and Accessibility Act that deals with privacy and security. We have to make sure that we are also in compliance with fraud, waste, and abuse regulations. All of our employees have to training in this area. We have to make sure that we do implement and distribute compliance program policies. We need to make sure that we do regulatory exclusion monitoring so that we have developed a system that we call the AvantShield, for example. This AventShield, what it does is it makes sure that if there’s any information in the text that we’re given that is private, let’s say a name or age or place of birth or date, we black it out, essentially. We take it out of the translation stream workflow.

 

Then we train our people so that they’re able to do the translation without having to see all of that blackout information. This protects the privacy of the patients, of the members, and ensures that all of the regulations are followed. And then this event shield software, once the translation is finished, puts that information back into target language so that it makes perfect sense in the context of the actual translation. I’m not giving you the specifics. There’s tons of different regulations. But essentially, we are subject to something called a Downstream Entities Regulations so that if our health plan is required to comply with, let’s say, HIPAA, they make sure that a lot of the work that is done by their subcontractors, in this case, Avantpage, that these entities also are required, we consider it to be a downstream entity in the workflow, that we comply with all of those same requirements. And then we are required to have to pass these requirements on to the individual entities that we work with. So it’s a chain of compliance that we are required not only to fulfill those requirements ourselves, but actually to make sure that all of the entities that we work with also comply with those requirements.

 

Sultan Ghaznawi

Luis, while we’re still talking about standards, regulation, and compliance, do clients and health care insurance space require audits from their LSP partners? You mentioned this earlier that they are government audits, but do insurance firms themselves also go through an audit? Please provide a sense of what that includes and looks like.

 

Luis Miguel Musi

Yes, the answer is definitely yes. We are constantly audited by our health care partners, and it’s very tough. This is partly why I was telling you before that if you don’t have all the infrastructure and all of the processes and procedures in place, it’s going to be very difficult for a company to actually get a contract in this space. So these audits are done periodically, sometimes every year, sometimes every two or three years, depends on the partner that we work with. And they look at everything that we have from our technological infrastructure. So, let’s say that our information technology has done a high trust certification or that we do penetration tests on a yearly basis.

 

And penetration tests essentially is when you pay somebody to try to infiltrate your systems from outside to see how secure your system is, they also look at our processes and procedures. Do we actually have processes in place that ensure that the people that are saying that they sign and that they’re actually complying with these actually show that they are doing it? Do our employees, have they actually been trained in all of these ways program abuse, for example, prevention? Do we actually shield the information that our clients provide to us that is actually private? So they look very deeply at what we do, how we do it, when we do it. Do we actually protect information from being shipped out of the United States? Do we actually work with things that are certified whenever that is available, let’s say through the American Translators Association or through our own internal certification processes for those languages that don’t have an ATA certified examination? So yes, those are very tough audits. We spend a lot of time, we spend a lot of effort in making sure that we comply and then we have a dedicated team of people inside the company that actually make sure that we answer to these audits and that we comply with all the responses. It’s a lot of work internally, Sultan, as you well know.

 

Sultan Ghaznawi

Luis, I think that there is an element of seasonality to work from the sector as well. I would like to hear from you in terms of some insights into what drives translation work in this space.

 

Luis Miguel Musi

You know, there is some seasonality to things, but in reality, the great majority of the work that we get tends to be very constant and very consistent, Sultan. So, I just mentioned to you the fact that we deal with hundreds of letters every day that have to be translated and mailed the same day to the patients. That happens day in and day out, Monday through Friday, regardless of the season. There are some seasonal elements, like for example, when the enrollment periods come, which tends to be the fall, the winter. And there is some work that is done at that time to update the contracts, to update the actual reaching campaigns to reach out to customers. But the great majority of work tends to be very consistent. And it is, at least in our case, consists of smaller documents or discrete phone calls that tend to be short in length, but required to be done with high precision and that they need to be moved very, very quickly. So medical records, for example, as I mentioned before, letters that are sent from customers to the health plans and then from the health plans, the response to the customer. The actual phone calls between the physicians and the patients. So that tends to be the great majority of the work that we deal with, as opposed to the seasonal remissions that you see in the industry.

 

Sultan Ghaznawi

Zooming out, Luis, how big is the space? You mentioned at the beginning of this conversation that it’s a growing space. What kind of branches do you see emanating from healthcare insurance sector that may drive more translation work for our industry?

 

Luis Miguel Musi

Well, actually, as I mentioned before, healthcare tends to be one of the top four sectors in our industry. If you look at Nimdzi reports, the 22 market report shows that it’s number four in terms of how many companies are actually working in that space. I mentioned also that it is about 20% of the actual touches, about 20% of the actual economy in the United States with over a trillion dollars actually spent in healthcare. So it’s huge. It’s also growing. What kind of branches do I see? Well, there’s a lot of work that has been doing these days in telehealth, right? Because of the pandemic, a lot of the actual interactions between patients and doctors or nurses has been done through the web. So, a lot more, there’s been a huge growth in the area of remote interpreting. There’s also been a lot of growth in the area of actual information that is provided through the web and electronically to patients.

 

There’s also quite a bit of work that has been done that requires accessibility. So by accessibility, this is something that when you are not able to read very well because you’re visually impaired, for example, things have to be spoken to you. But normally what happens is that this has been done in English only. So now we have to make sure that accessibility includes that the spoken words that you have when you’re navigating a website is also in the patient’s language, for example. So it’s a lot of work that’s been opening up. There’s quite a bit of work having to do with medical, with healthcare education as well. And more and more education is being provided online. So you see you have companies like, let’s say, Better Health, you have companies like Babylon Health that are providing apps to people that allow them to access their medical records, that allow them to monitor their heart rate, that provide them with nutrition information, all kinds of things like that that are now being done electronically. And that has opened up quite a bit of opportunity in that space for companies that are beyond the traditional of intake forms or contracts between patient and provider and so on. It’s a rich sector and growing and growing.

 

Sultan Ghaznawi

Luis, I was going to ask you to look into your crystal ball and tell me how do you see the sector evolving in the next two to five years? If we are looking at LSPs, how should they prepare for changes that you foresee coming in the healthcare insurance sector?

 

Luis Miguel Musi

That’s a really good question. It’s hard to have a, you know, to be able to predict the future. You’ll be very sad. It’s really hard to predict, especially the future, right? On the other hand, I think you can see several trends. You know, the healthcare space tends to be not super high tech. They tend to be conservative organizations. They also tend to be organizations that have a good understanding of the linguistic needs and the regulatory requirements, but they’re not as highly automated or as, you know, super high tech as you will find when you’re dealing with companies like Google or Apple or things like that. That is an area where I don’t see them that they’re going to be growing. They’re going to be changing quite so much that it’s going to continue to be that they’re looking for solid providers with solid processes and procedures, but they’re not going to be looking for, you know, the latest and greatest AI, neural machine translation software. They also, as I mentioned before, they’re driven by regulation in many cases, and that regulation changes slowly. I don’t foresee that the TEP model that we’ve been using is going to change quite a bit. On the other hand, I see it growing, continue to grow in terms of the fact that we still have about 20 million people in the United States that do not have, don’t have good healthcare insurance.

 

I see that that part of society will continue to be catered to, I see. I do see that the provision of telehealth services is going to continue to increase. The help that we get from our watch, you know, electronic watches from apps that we have on our telephones and so on will continue to increase. So I just see that the traditional part of the industry that we’ve been working with is going to be there, it’s going to continue to grow, but there’s going to be new areas that have to do with the evolution of the technology and the way that that technology has been able to reach into our daily lives, day in and day out, to reach patients.

 

Sultan Ghaznawi

Thank you, Louis. As we reach the end of this interview, can you please share a few words of advice to LSP executives thinking about branching out to this space? I know you shared a lot of advice here, but what would be your ultimate advice?

 

Luis Miguel Musi

I think that the most important thing is that you really learn what the regulations are and make sure that you have the infrastructure in place to comply with all those regulations. That I think would be the most important piece of advice. I think it’s a good sector to be looking into, but don’t just try to go in and think that you’re going to be able to do it from one day to the next. It’s a process that takes years of patient work to get into. I’ll give you an example in our own space. Even though we’ve been working in the healthcare arena for a number of years, the telehealth sector opened up dramatically during the pandemic. We were not quite ready at the time to take advantage of the fact that a lot of the care was now being provided remotely. We have not been able to capitalize on these opportunities as much as we would be able to do because we were just not ready with our systems and our processes. We are investing in it. We are now catching up, but it just takes a lot of infrastructure, a lot of foresight to be looking into the future, to be able to provide the services in this space.

 

Sultan Ghaznawi

That was an amazing interview with one of my colleagues and someone I respect a lot in our industry for his knowledge and experience. Luis, this opened up my eyes and how the sector of regulated industries operates with regards to translation. I’m hoping we can talk about this subject more in future episodes. With that, I want to express my gratitude to you for sharing your experience and perspective. Thank you for your time.

 

Luis Miguel Musi

Thank you, Sultan. It’s a pleasure. You are a very knowledgeable person as well. You are somebody whom I admire as well. I learned from you and it’s always been a pleasure to work with you, to encounter you as a colleague and a competitor. I hope that both you and Avantpage can thrive together in this space. It’s a wonderful thing. We are committed to helping others. Ultimately, I think that is the most important thing that we do. We provide a service that is useful to society. It’s a service that is useful to the immigrants. People don’t speak English well and yet are able to participate fully in the riches of our society and to be able to contribute fully through the language services that we provide. Thank you, Sultan.

 

Sultan Ghaznawi

I appreciate that. Thanks again, Luis. I’m so happy we’ve talked because you and I, we share quite a few things in terms of values. We both are determined to improve quality of life through language, whether it’s the quality of life of our beneficiaries, the end users of translation or the translators in the US or outside the United States and the people who work within this industry. So I’m very happy we had this conversation. Again, Luis, thank you so much and I wish you a wonderful day.

 

Luis Miguel Musi

Thank you, Sultan. Same to you.

 

Sultan Ghaznawi

We heard from Luis about how the healthcare insurance industry consumes translation service products. This is a constantly evolving space. Healthcare in general is a very sensitive industry and translation has always supported this industry to fill the gap in communication barriers to deliver better care and service. Recently I spoke with Duncan Shaw, president of DTS language services, about clinical trials and how translation is a critical aspect of research in this space. As he pointed out, regulations continue to be defined and the need for compliance and equality is paramount. If you’re an LSP trying to expand into this space, your mindset should be focused on creating services that are absolutely focused on accuracy. It will come with a cost, investment and infrastructure and the right type of competence is very critical and patience is key because healthcare moves very slow. Be patient and do the right thing. Nothing else will fall in place.

 

That brings us to the end of this episode. I hope you were able to find a couple takeaways from this conversation that you could go back and apply to your business. Improving your translation business is the main goal of this podcast and we are constantly meeting that goal from what I hear. Don’t forget to subscribe to the Translation Company Talk Podcast on Apple Podcasts, iTunes, Google Podcasts, Spotify and other platforms. Make sure to give this episode a 5-star rating. Until next time.

 

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