From 0 to 400: Blueprint to Scaling Global Teams with George Abatjoglou

Nilesh: Hello and welcome to the latest episode of the Zinnov Podcast- Decoding Private Equity series. I’m Nilesh Thakker, President at Zinnov and your host for the day.

In this series, we take a closer look at companies owned by private equity firms. We explore their strategies, the challenges they face, and how technology plays a key role in driving their growth and resilience.

Today, I’m honored to be joined by George Abatjoglou, President of EMS Management and Consultants. For over two decades, George has steered PE-backed healthcare companies towards explosive growth. His expertise lies in crafting build, partner or buy strategies that maximize profitability or market share.

Leveraging financial acumen and operational leadership, George has built high performing teams and led successful outcomes for multiple companies. I’ve known George for a few years, and I’ve really enjoyed working with him and learning from him.

Welcome to the Zinnov Podcast, George.

George: Thanks Nilesh. It’s great to be here and thanks for inviting me.

Nilesh: So, George, I’d like to start with a few questions. You’ve been doing this for a couple of decades. You have successfully set up RCM teams globally and particularly in India.

Could you share how the process and strategies for establishing successful RCM operations in India have evolved? What were the major challenges you faced initially, and how have those challenges been addressed or changed over time?

George: Yes, sure. The strategies for establishing successful Revenue Cycle Management (RCM) operations in India have significantly evolved over the past couple of decades.

Initially, the work was largely transactional data entry from paper records outsourced to generalist BPO partners without deep RCM expertise.

However, the landscape has transformed with the proliferation of Electronic Health Records (EHRs) enabling embedded workflows that facilitate work from anywhere, the advent of advanced collaboration tools for global teams, the emergence of well-established companies specializing in RCM services rather than generic BPOs, and the rise of a skilled RCM-trained labor pool in India as young people pursue it as a career path.

Nilesh: That’s a great insight, George. It seems like technology has made things easier. You’re able to do, interact, collaborate a lot more.

Does that mean your expectation of what you can do from global locations has increased and now you are able to provide more responsibility and ownership to your global teams?

George: Honestly, with the exception of direct patient interactions, which we still handle domestically due to dialect and societal preferences for now, our company is able to perform every other function from our global operations, including India.

This allows us to thoughtfully distribute workflows across a 24/5 operation by strategically allocating sequential steps to different locations. By leveraging our skilled Indian workforce and technology, we can streamline processes like billing, collections, and transportation services in an efficient manner. This enables us to reduce cycle times and accelerate cash flow for our healthcare customers, which is their ultimate priority.

Nilesh: You mentioned some of the differences in approach and strategies required to set up successful RCM teams.

Are there other instances, like the recent one, where you didn’t even travel to the India office for a few months or a year almost after setting it up?

I think that would not have been possible earlier, so, it seemed like you could almost do this without even travelling. Is that a true assessment of what’s possible now?

George: The pandemic forced us to learn how to operate remotely – recruiting, interviewing, onboarding, and training employees virtually.

While some companies brought employees back to the office, we changed our operating model.

Even with a large 50,000 square foot office, only around 20 people come in daily. We recruit talent, engage, interview, onboard, and train entirely remotely, with our India operation following the same process as the U.S., starting new hire classes every two weeks through a virtualized training program to integrate them into the organization.

The hardest part of establishing the India operation was not having anyone on-site initially for 4 months until our first person arrived. We needed a local partner to find a facility and set up the initial operation.

But beyond that, we could handle the people aspects remotely because we had developed the ability to manage, engage, and train employees in a remote fashion – a crucial capability whether you’re opening an office in India or middle of nowhere Montana.

Nilesh: In my experience, leaders tend to feel that when they’re setting up global operations, the productivity is not going to be high enough.

So, one of the things I wanted to ask you was when outsourcing RCM operations globally, and particularly in India, what factors do you consider in determining the optimal team size? How do you strike the balance between having a team large enough to handle the workload efficiently while also maintaining the quality and cost effectiveness?

George: We hold the same productivity standards for our U.S. and India operations, though it took longer initially for the India team to reach those levels given that our industry is a niche part of healthcare, so, they had to learn the niche aspects of it.

When we started with just 30 hires who had no peers with prior knowledge, it understandably took more time. But now with nearly 400 employees, around half with over 3 years of experience, we’re seeing faster ramp-up as that critical mass of organizational knowledge builds.

Our initial focus was on maintaining quality, leveraging India’s cost advantages to allow more training time before reaching full production level. As more staff gain experience, new hires get up to speed quicker.

In the early offshoring days, there was productivity loss from the oversight required when tooling was immature. But that gap has closed as the industry’s offshore capabilities matured. We now operate at parity, with the same standards across locations.

Nilesh: And now you are already at 400 people in a few months, which is pretty impressive. You went from 0 to 400 in like almost 10 months. Could you elaborate the reasons for going so fast and the need for rapid scaling?

George: We decided to establish our own center in India for a few key reasons. Over 50% of our workforce was already offshore with third-party vendors, but having our own employees directly connected to the customer would create a better experience.

Additionally, we were rolling out a new platform and realized it would be easier to train our own new hires on it rather than hundreds of vendor employees during that complex migration. This was the compelling event that made us accelerate hiring rapidly, despite it making the leadership uncomfortable initially. We also needed to integrate acquired businesses into the new system, so our expert new hires could handle that work.

The final driver was winding down the remaining vendor work by moving it into our operation. Sometimes organizations need a forcing event to make a decisive move rather than incrementally dipping toes in. That strategic catalyst allowed us to really accelerate, and I’ve been happy with how establishing our own center unfolded.

Nilesh: That’s great. So, any strategies or considerations that you have learned and you could share with the listeners ? Something you did or something you would not do again? What are the things that you have learned over time?

George: Two key hires were instrumental to our successful India center launch.

First was the country head – someone with prior experience establishing centers at scale for revenue cycle companies. Our sponsors emphasized this was a critical hire, and they were right.

The second was being very deliberate about the initial set of operational leaders and managers under the country head. Once we had that core leadership team in place, we knew they could build out the rest of the organization.

Additionally, we invested significant U.S. resources on the ground initially to ensure those first classes of new hires felt fully part of the company. Our U.S. team was there for their first day and led parts of the first two weeks of orientation. This fostered connections, set clear expectations aligned with our standards, and allowed them to then mold the approach while achieving the required outcomes after 2 to 4 weeks.

Nilesh: That brings us to the last question. You mentioned earlier that you’re part of a private equity portfolio company. How has involvement with the private equity helped you or enabled you to do this faster? Would you encourage other private equity companies to let their portfolio companies do this?

George: Our private equity owners were very supportive as we established our India center, though it was their first services organization doing this versus prior tech center experience in their portfolio.

They provided helpful resources who had gone through similar launches before. Most critically, they supplied the necessary capital investment for upfront costs like our initial 25,000 square foot facility that’s now expanding to 40,000 square feet.

Beyond enabling financial support, they took more of an advisory role and were admittedly amazed at the rapid pace we moved to get the operation going.

Now that we’ve proven the successful model within their portfolio, they’ve asked me to present our approach to establishing an offshore center to leadership across their other companies, allowing them to replicate our learnings.

Nilesh: George shared his valuable perspective on how the ability to rapidly scale high-performing revenue cycle teams in India has significantly improved over the past couple decades, allowing him to successfully ramp up 400 staff in just 10 months while achieving parity in productivity and quality compared to his U.S. operations.

Thank you, George, for sharing your perspective with us. Really appreciate your time today.

George: Yeah, my pleasure, Nilesh. Thank you.