Optimizing Pharmacy with Offshoring Strategies | Saleem Shah & Tanya Chianese, Collaborative Patient Care Group

This transcript was generated automatically. Its accuracy may vary.

Mike Koelzer: Saleem and Tanya, introduce yourself to our listeners. 

Tanya Chianese: My name is Tanya Chianese, MVP of Strategic Initiatives, and we're with CPCG, Collaborative Patient Care Group, 

Saleem Shah: My name is Saleem Shah and I'm the founder of CPCG, Collaborative Patient Care Group.

Mike Koelzer: So Saleem, when I'm checking stuff out about your company, the word that pops out at me is fragmentation. Is that a huge word for you guys? And what does that mean? 

Saleem Shah: Fragmentation is a philosophy. I learned after operating and building businesses 

Mike Koelzer: And you're a pharmacist.

Saleem Shah: I am still a pharmacist. Very proud. I'm still a registered pharmacist.

still holding on to my license. so the fragmentation is basically a deliberate process of blasting a position, and it can be any position, into as many fragments as possible. Thank you. So that's a philosophy. Break the position in as many fragments as possible.

A cashier in a pharmacy. Do not stop there. How many fragments can I make out of this position? Maybe 20, 30 of them. What does she do? She goes every hour and checks faxes. This is one line item. She greets the patient, she rings them up, and she basically checks the will call also. These are all separate fragments.

 When we break those fragments, Then we give them a global value because we are a global firm. And then when we put the global value on it, now we know exactly by minute, what is the actual cost which needs to be spent and what is the cost which is being spent right now.

Now you know how much you are utilizing your cashier.

You are paying her 18 an hour. Is the work worth 12 an hour because of the minutia or is she really giving you 35, 40 some So in a nutshell, this is the fragmentation rule, but it goes obviously way beyond that. 

Mike Koelzer: So you've got a position and this cashier, for example, they're really doing 30 or 40 things. They might be answering the phone or checking this out or doing the things you mentioned. And You're breaking all those down and saying what is the fractional cost of that? And I, as a business owner, am I getting a good deal on that? Because that fractional cost might cost this much in my city, but that might be something I can get from somewhere else, basically across the world. And it may be economically feasible for me to buy that somewhere else. Something that I can buy somewhere else in terms of her services, her time. Certain talents and things like that. Do I have that close then?

Saleem Shah: Yeah, you nailed it. Actually, this is exactly the whole concept, but it doesn't stop there. So the idea is that our mission is to evolve and thrive. This is the slogan for CPCG. We are not talking about Replacing this cashier. What we are saying is how much money can we extract out of this jewel?

We hired her because she chose to be a cashier. It means that there is glory in this profession, in any profession. She is basically a professional cashier. That's why she leaves her house and she can tell her kids or anyone, a relative, a friend, I'm a cashier. She needs to take pride in it.

In order for her to take pride in it, she needs to be providing the functions which are very unique to a cashier.

So the idea is that if you took 40 percent out, it's going to look like your cashier is free for 40 percent of her time. The next mission is to evolve her. So when we start the evolution process, either she is going to be the best cashier ever born

Mike Koelzer: Yep.

Saleem Shah: or she's going to evolve into something else.

Why not? She becomes a pharmacist eventually and a story of a lifetime. There are many stories I saw where someone started as a cashier and then from an intern and then tech and then pharmacy school and now they're working as a pharmacist.

So that's the idea, evolve and thrive.

Tanya Chianese: the fragmentation role it plays into everything that we stand for at CPCG with our resources and what we do on the back end is we try to take the fragments that do not necessarily need to be performed in house or physically in the store level. And we take those repetitive offshore functions into our team so that we can allow the in store team to focus on what they need to focus on. So you're streamlining and kind of concentrating those functions onto each position and individual performing that position and tasks.

Mike Koelzer: It's really what a pharmacy owner or any business owner really already does. I mean, as a pharmacist, I'm saying, what do I need to do as a pharmacist? And what can I hire to do, whether it's a cashier, someone to answer the phone, maybe I'll get some marketing done out here and maybe I'll use the 

Post office to deliver things across the world for me. You're already segmenting those things out. But I think that we haven't used technology to say, all right, we fragmented those things out. Now do the same thing for your technician. Do the same thing for your cashier, fragment those out. And who can those people as if the cashier is the CEO, who then can they hire out for things they're doing let them do the best things they can do as a cashier, just as the CEO is doing the best thing they can do as a CEO.

Tanya Chianese: Absolutely, Mike.

Mike Koelzer: All right. So Selim, I heard there is a way to do that. You've got to get either people that are specialized outside of your store. So we have outside accountants who can do a hell of a lot better job than local accountants, because I don't have to convince them that. These DIRs, or that's, I'm talking in the past now, but this screwy pharmacy accounting, I don't have to convince them that yes, this is true. You have to treat us differently than any other business you have that you're serving as an accountant just do it.

You have to learn it. So no longer do I have to be teaching my accountant, the accountants that I'm using are across the country and they're. Teaching me because they have a group of pharmacies. And so when I send something out, sometimes I'm doing something that's not just cheaper to put out, but better in, which is maybe cheaper in the long run, but it's a better service.

So if I'm sending something out, I'm thinking of lower costs or maybe higher costs, but more specialty. And I heard you mention the word offshore. And so I'm thinking that means. Well, not only outside of the pharmacy, but maybe even finding those services that are better slash cheaper. In the world.

Saleem Shah: Actually, yeah you mentioned this one also. I'm glad you are just hitting the nail Mike on this one. I wouldn't call it a challenge that would be very daring, but you know, I mean, we have done this to our own businesses and So what you mentioned is cheaper. We don't like to use the word cheaper first.

We like to use the word quality first,

And here is a reason why. Tell me, or any pharmacist can call me if they have ever gathered their three, four technicians and make them memorize a script or rehearse how to pick up the phone. Has anyone done that? No. Why? Why haven't they done that?

Picking up a phone is a specialized function.

There are professions, there are companies I mean, you probably can imagine the companies who are offshore already,

Mike Koelzer: Yeah.

Saleem Shah: Enrollment, Aetna, Comcast, they all have thousands of people offshore. So when they do that, what I'm trying to say is that picking up a phone is not a minute function, it's a profession.

You have to put a smile first, you have to be ready, and then, keep your backbone straight. There are many body exercises. It's very nerdy when it comes to this.

Mike Koelzer: imagine.

Saleem Shah: So this is where the better part comes in. Assume that a durable medical equipment and medical practice pharmacy, they want to have patient recruitment exercises.

Assume they say, Hey, listen, Salim, go ahead and recruit them for my influenza, for my level three billing. I want these patients to come in. The people who are going to be calling those patients are professional outbound communication people. They are not flyby people. Now, is the pharmacy staff flyby?

Not really, but I can say for this profession, if you put a nationally certified tech who basically burned the midnight oil to pass her exam in calling patient, that's It's not the job function, which I hired her for, I wanted her to be my right hand so I can run my pharmacy, be my eyes and ear, but not really the sounding board.

Maybe once in a while as a level three, but not on a level one. So the quality goes up. If you are running these small minute looking exercises through a highly professional and controlled system.

Mike Koelzer: Yeah, I just commented on the podcast that came out today. Not only did we get rid of our brand names four or five years ago, but in the last year or two, we got rid of our home medical equipment because it wasn't a big part of our business. I think I almost had it as a challenge to see what entrepreneurial spirits I could do to grow it.

And we did it for over two 20 years. One of the reasons we got rid of it is my great pharmacy technicians they did not feel comfortable when they went out to talk to people about medical equipment here, they were in their own business, flesh and blood able to, Pat Mrs. Smith on the back when it's her birthday, they were not comfortable every time they stepped out there answering a question they sort of knew about some ostomy thing, or, Ankle brace or something like that. And yes, they were their flesh and blood, somebody could do a whole lot better job doing that than they can do.

Tanya Chianese: We can do that, Mike. 

Mike Koelzer: yeah that's

where you guys jump in, right? 

Tanya Chianese: Yeah.

Mike Koelzer: tell me about that part of the

Tanya Chianese: Yeah. yeah.

So, uh, you know, DME is definitely one of our segments that we serve a pretty large community. And it's something that we can start with pharmacy from credentialing. Starting out for somebody that's not already credentialed. Go through HQAA, BAC, whoever it may be as the accrediting organization.

We can walk them through that process to obtain the accreditation. Then we can go through the 855S application process to obtain their PTAN for billing rights. And then we can go with actual order processing. So unlike pharmacies where you need a pharmacy technician under the supervision of a pharmacist, DME doesn't. And so for DME, we can process and help you. Get those orders processed accordingly. Check insurance eligibility, which we all know that billing is very different for DME. You don't get live claim feedback. It's not the same. So, you have to understand fee schedules. You have to understand the billing component, coverage criteria, and diagnosis codes.

It's a different animal. So we can help support all of that from existing supply pharmacies to completely new pharmacies interested in getting into DME. billing, complete revenue cycle management, we can do all that on the back end. And I feel like there's just so many prescriptions that organically come into the everyday pharmacy that I just don't know what to do with.

How many compression stockings orders have they received? And what do they do with them?

Mike Koelzer: Tanya. There's two things I think my listeners might be asking, cause I know it would be if I was in their position. One is. There's a lot of companies that say, we're going to help you with this, but 

it's 

just 

their own billing service. And then they're giving you a cut off of that. It sounds to me like you're saying you actually build the billing. For that company, people are helping to do that. That's number one. The second question people say is, all right when the rubber hits the road, how is that transfer made between Mrs.

Smith hobbles in with her Walker, trying to get a new something for her bedroom. and then that transfer to somebody who is not in the store. Where is that handshake made?

Tanya Chianese: Yeah. So your first question is relevant to what I think is a little bit more unique about our service that we're not going to take a portion of your revenue, especially on the billing aspect, instead we are, you a full time resource,

they become A part of your team. In order for you to be successful, if you need assistance with helping to create that environment for our resources to grow operationally, then we can be there to, kind of hold your hand through that process. Like I mentioned, the credentialing component, get your billing set up, be able to when you are ready.

But our full time equivalents, they're full time, they become part of your team. It's not just us working your AR. So you're hiring remote personnel. 

Saleem Shah: Tanya, not to mention finding the existing DME patients who are already DME patients within the same data set of the pharmacy, who are just not going to the pharmacy. Because. if we look at the CMS, over 35 some percent, if you have 1 spent on a pharmacy, then about 35 cents are being spent on the DME, which means, that 

33 percent to make the math simple, of the patients who are walking into your pharmacy are DME qualified patients. The only reason they are not talking to you about that is the same reason they don't talk to you about specialty drugs. The consumer is trained now. Consumer is not gonna come in and, say, Mike, do you have like 40, 000 injections?

 so basically this analysis along with the professional people who can, because there are some methods where you can look at the spending of CMS, you can check the same and similar meaning is that if government has paid for the DME services and who they have paid, we can even like,pick up the name of the supplier who's supplying those things.

Hey, this guy next to you, by the way, he looks at your friend, he picks up all of your business on the DME.

Mike Koelzer: you can find out where they've gotten their DME from. That's available information to you

Saleem Shah: They are Medicare, if they are CMS, if CMS is paying for it, you can run the same and similar. Same and similar actually is a practice because you don't want to dispense. Remember Mike, you are not getting a live point of sale results on your claim.

You are taking a serious chance. So you don't want to give them a 700, ostomy pouches

and not get paid. So you gotta, this is our practice. If we are doing billing for someone, that's what we are going to do, we are going to run the same and similar. to make sure that it doesn't show up in the record.

If it is, then we are not dispensing it.

Mike Koelzer: That's interesting. So, We didn't build. HME the last, I don't know, 15 years or so, we were just cash and carry, which certainly made the revenue go down because we weren't getting all the stuff that they were getting through Medicare. But yes, that's interesting because you might not get a guarantee you're going to get paid, but you can tell on day one that you're not going to sell a fancy walker to somebody who just picked one up four days ago, but they don't like the color of it from somewhere. You're going to find out. That way you're not going to try to double bill Medicare and find out what company wins.

That's a protection, it's not life. That's a protection that Medicare offers the store, the provider, so that you don't get into that situation.

 Tanya asked about the handoff to a person when they came into the store, so we asked about mrs.

Smith comes in and She's got a few questions they say, let's give so and so a call. How does that transfer take place between someone not feeling like we just sent them away, they're still our customer, but how do you make that warm handoff?

Tanya Chianese: So we have a couple of solutions, Mike. One is that we can absolutely do a warm transfer by phone. So if you want, you can connect the patient or your cashier or pharmacy tech, private may be directly with our representative to the patient. Or, we also have something rather unique, which we call an OCSR. That's an on screen customer service representative. And this is a kiosk that we offer, and we actually station these in a lot of our DME client facilities. And this is essentially a kiosk that has a screen, where one of our representatives lives. Now they're located in Pakistan,

but the person standing in front of them, um, is upstairs, An example. They don't realize exactly how far away they are. They can hear them nice and clearly. They have a Dropbox. They can drop their prescription. There's a scanner right there so they can scan their insurance ID card or their ID. And there's also HIPAA compliant headsets with disposable ear coverings.

So it's a great option and it allows for our representative that might be more trained than your in store personnel on a specific product category or DME supply to be able to answer those questions. Readily available,

Mike Koelzer: Are they audio or visual? 

Tanya Chianese: audio and visual, yep.

Mike Koelzer: very interesting.

Saleem Shah: Well, they can be trained with a planogram of someone's store. If pharmacies are interested in the cash sale, they can perform cash sales all day long. They can consult about makeup products, skin care, so the technician doesn't have to come out, they can hop from one station to another at the press of a button.

So if the store is rather large, they can be stationed in several different aisles.

Mike Koelzer: . They actually know your store.

Saleem Shah: Well, , with our clients, we give them access to the PTZ cameras also. So they have access to the store cameras. They can see the people walking around in the store. They can even focus. Yeah, they can go zoom and they said, okay, Sally, I can see it is right behind you. Third shelf over to your right, one more feet to the right.

 and they can bring them up also because they have the credit card terminals. Okay. Thanks. So Sally comes in and scans it, pays for it, and she's gone. So we don't immediately, like in the first meeting, offer this service because less pharmacies are, they would like to be a cash store, but they are not very much into the cash kind of business.

But you mentioned the handoff, depending on the client's technology commonly what happens is that, one of the fax machines. They get linked to overseas because there is so much documentation back and forth, regardless of what we are doing.

Technically speaking,

I'm your pharmacist, Mike, and you came in and you said, Hey, I sprained my ankle playing tennis. I don't know what this guy wrote. I don't understand. This is it. I look at it, it's some kind of ankle brace with some kind of metal. As a pharmacist or a pharmacy tech, if we are working with a nice firm, and if the systems are tight, all I have to do is to just walk to the scanner and scan it.

As soon as I scan it, someone is standing over on the other side, 9, 000 miles away. And that person knows, remember the word dedicated, so this person is dedicated. This person is a professional who basically checks that legibility. Verifies with the insurance. So maybe assume that we have teams, Microsoft teams.

My message pops up on my screen. Now you are walking around in the store. You are my patient. I said, Mr. Colzer, just wait for like 10 minutes. I'll get you an answer. That person says, prescription received Salim. Let me check the eligibility for this gentleman. Now eligibility came back, all of this.

They said, Salim, go ahead and measure Mr. Colzer. I'm going to measure you and I'm going to say, well, his size is M21312, whatever. They have the software. They're going to type the product. Label is going to come up. Either you have the product or it's going to get dropped. So it's already being checked for your insurance to pay.

We know that your insurance is going to pay for it. We know this item. You measured the patient. So it's a collaborative patient care going on. Collaborative patient care. This is what's happening here. And the patient is gone. Either you grab the box or you'll say, either the driver is going to drop it or maybe they don't have a driver.

Okay, sir, how about tomorrow? Now who's going to drop ship this? Who's going to do that? Guess what? We'll do it because we already signed up with vendors. Under your name, obviously, it's your account, but we have access because you don't have time.

So all day long, when these items are gathering for the drop shipment, someone is going to get online and then start shooting those orders for the next day FedEx.

Mike Koelzer: That's where the collaboration is. 

Saleem Shah: Collaborative patient care group.

Mike Koelzer: That's where that collaboration comes in. That's very interesting Alright, you guys now here's the elephant in the room, and I know you answer this question.

I'm sure you do. Let me tell you a story first and You put my mind at ease. All right. So we're coming home from Chicago yesterday. I've got four of my kids in the back, my wife's with me, and we just make it through a toll road. And I'm going probably 50 on my way up to 70 or something like that.

Miles per hour. Lo and behold, you'll never guess what was in the middle of the highway. It's two porta potties. that had fallen off a truck. And so my kid says, Dad, look out for the porta potty, you know, and it's like, they've got funny rest areas here in Chicago, I guess,

 with somewhat of a language barrier and I believe somewhat of a culture barrier.

So calls and she's trying to explain to this person and now granted this person may be sitting. In Chicago. I'm not saying they're across the world. I'm saying there's a culture and language barrier because 

my daughter's 

saying okay, we're on highway East 80 and at mile marker 10 60, there's a toilet in the middle of the highway.

Now this person says. in his or her accent, East 80, what are you talking about? 

And my daughter's like, 

well, the highway East 80 we're on the highway. And we're at mile marker 10 60. I heard her say that a couple of times to this person. And then. If that wasn't bad enough. Now she's trying to explain to the person what a porta potty in the middle of the highway means. And this person on the line is getting information. They might be trained on what a rest area is and where there's bathrooms and all this kind of stuff.

They've never come across a porta potty, being in the middle of the highway and Eventually Abby just hung up in my mind it was because of a culture and language barrier that now this port a potty is still in the middle of the highway until somebody else calls because nothing got done with that call because kind of left with no agreement of what 

was going to happen.

All 

right. That's a long story for the elephant in the room. Whenever anybody hears about offshore, they're thinking about culture and language. So let's touch on that a bit.

Tanya Chianese: So it's definitely the elephant in the room, and it's probably the number one question we get from almost every potential client.

Mike Koelzer: Tanya, does anybody ever bore you with a five minute porta potty story first though?

Tanya Chianese: No, but that's my favorite.

Mike Koelzer: Oh, all right. Well, I won.

Tanya Chianese: You do win, you do win. That's a good one. It's unfortunate she ended up hanging up though.

Mike Koelzer: Yeah, it just 

Tanya Chianese: uh,

Mike Koelzer: getting anywhere. It was like me

Tanya Chianese: yeah.

Mike Koelzer: customer last week on the phone, trying to explain a, uh, lancet device. It just didn't go anywhere.

Tanya Chianese: No, we do get asked that question almost by every single client. And, the way that I explain it is, do they have accents? Yes, they do.

But you can see, Salim here, he has an accent

Mike Koelzer: that's

Tanya Chianese: and it's

very mild.

Mike Koelzer: got a Michigan, I don't know, twang up here or something like that. My A's are not pretty. They're just, they're

Tanya Chianese: Right.

Mike Koelzer: nasty. You know? 

Tanya Chianese: Yeah. Anywhere you go around the, even, stateside, I feel like there's some type of accent, southern accent. Boston accent. There's accents. But you can hear Salim and his accent is very mild, But what it comes down to is when we're hiring representatives to perform job functions, we are interviewing those candidates with that in mind, so if we're hiring for a position that requires exceptional customer service speaking skills,

we're not going to be recruiting those that have harsh accents.

A large portion of our population we deal with is. geriatric, and sometimes I have a hard time with hearing even just me. Personally, I always have to speak up and, and try to, project my voice and which I naturally have a lower voice and it's hard for me to do that.

Um, But the same applies. And so when we're bringing in resources, they have to be fundamental. English proficiency, that as a skill set. And so we're not going to bring in heavy accents and will the accents go away or not be there? No, they will always be there. But they're mild and we find that what you get out of it absolutely outweighs anything, that you may face with some, mild pushback here and there from some patients It might take them a little while to get used to and come along, but what we do see is that in time, one month, two months, three months, they start to hear the same voice. It's like, oh, Jesse's still with Okay, I guess she's sticking around

because Jesse is now a part of the team, 

and Jesse is our resource. And now they realize that it's not an accent anymore. They start to get accustomed to it. And now it's just Jesse,

Mike Koelzer: In the U. S. this is a different question even from 10 years ago. I mean in the U. S. as the melting pot we are, the great nation that we are, the odds of hearing someone like me in the business world is a certain percentage.

If you go back and look at my guests on my show, I mean, there's accents all across the board, all different nationalities and. Customs and all different kinds of language. 

Saleem Shah: And again, I mean, being a professional, that's what we talked about. So since we are hiring, for an outbound function. So basically it's a deliberate action. a candidate comes in and the candidate is a data entry candidate. They will not get penalized if their accent is very thick or they're hesitating when they're speaking English

because their chances of talking to a client are very slim.

They are data entry people. And they are performing a data entry.

Mike Koelzer: Salim, if I have that right, you're hiring a lot of people and someone maybe who is the English languages and maybe a bit more of a challenge, they might be on the data entry side versus on the phone side where someone else who has a little bit more experience and things like that might be.

So there's different levels of English proficiency and they're at the best position for that, for them. 

Saleem Shah: Absolutely. Well, first of all, at CPCG, overseas, once someone steps into the building, the only language they can speak is English. And the reason is that even coincidentally and passing by, we don't want to give an impression of those call centers who are trying to sell you their duct cleaning services, or maybe sell you auto insurance or something.

So we are not those people, obviously performing a pretty high level function. So the only language is English. Within this language, some of them actually have an accent, which you may not trace back to Asia.

I mean, Tanya can say there are few of them, who sound English.

Tanya Chianese: Yeah.

Saleem Shah: And we have seen reviews where this English lady was awesome.

And I asked, I said, which English lady did we hire in Pakistan? 

Mike Koelzer: Yeah. 

Saleem Shah: So now the interesting part here is that What I was saying is that this 9 1 1 operator, it has to be onshore, obviously. It's a government department. I don't think they're going to ship it to Pakistan.

This is interesting, actually. So, if this operator wasn't understanding this, I would not hire her overseas, but I could not say no to her because of our Politically correct position.

Mike Koelzer: very interesting. You're right. Chicago might have to hire her, she's a block away, you wouldn't have to hire her from a different country. here, you have

And don't get me wrong, I don't even know a different language, so I'm not in the boat with any of these people.

it's just different. It's just different from what people 

are used to. The little old ladies and things like that. but yeah, I see exactly what you're saying, Saleem, on that. They have to hire some of the people, right?

Saleem Shah: Yeah, so basically, Providing the service when it comes to making a technology, which is a very big industry. And then providing the service industry. These two are one of the top revenue producers for countries like Pakistan.

Because, they built a lot of people who go in the technology world

And they do in the service world.

And the reason is that they are looking for foreign currency. And, so in the foreign currency, these are one of the top things. So what I'm trying to say is that the people who apply for a job, a lot of them aren't even professionally trained.

There are institutes who are training them on American language and culture.

A lot of my employees know more about America, and maybe I'm dumb, 30 years here, but I cannot talk about a few teams which I've never watched a sport and they know.

Yeah, right. Exactly. They assimilate themselves, to this one.

But again, the bottom line is that, that is the job is not to please the owner of the business. The job is to get the job done,

So they need to be pleasant enough, but at the same time, their job is not to make technicians happy,

For no reason.

So, we don't want to unnecessarily empower the onshore staff because it happens naturally.

 but again, I mean, their valuation is happening on the scope of work, which is documented at the time of the discovery. So Tanya takes a huge role, especially right now, I mean, with the healthcare side, she tries to jump into those calls, and then she listens to them.

What is the scope of work? What is the challenge? And then we drafted a document which was signed by both parties. There is no stone left unturned. Everything is documented and is reported against the documented scope of work.

 When it comes to pharmacies CBCD took birth a long time ago when we used to own our own businesses in the healthcare side. But basically one thing I learned, and Tanya was with me on every step actually when we were building this whole thing, somehow we were either ignorant or we were smart.

One of those things happened. We look for revenue growth. not at the same place where the whole world was looking for.

While we were running pharmacies, we started a large size compounding group because we realized, we saw that 10, 15 years ago, that retail is not going to last.

That was built. Then different collaborative actions, from DME, pharmacy to DME, we call it pharmacy to DME actually, that's literally the name.

So those collaborations start coming in. I wouldn't say that this is the best time. Actually, this is the only time for pharmacies where they need to, I wouldn't say stop what they're doing, but they need to get up. They have to get up. and it's very unfortunate that we got to this point of several thousand pharmacies being closed right now.

And now I'm hearing the screams. At least in my short tenure of ownership, I saw this the day I bought my first pharmacy, that every day a few cents are going down. It's like, like interest in a way, reducing.

So We saw that. So the whole idea is that in my opinion, pharmacy still is a lucrative business and people will think that I'm crazy.

But lucrative enough if you see the patient who's coming in as an anchor for a lot of other services.

Now, I had many consultants and I love consultants, by the way. They are amazing people. I don't want to go against them.

 There are too many of them. But in my life, consultants only depressed me. Because they would come in. It's like basically a radiologist who's gonna tell you that your MRI showed me blotching and spitting and this and that. Okay, what's the treatment? I don't know, man. I mean, you gotta go to the cardiologist.

Mike Koelzer: yeah, right, 

Saleem Shah: And then I asked, I said, okay, so what do I do? Well, in my opinion, you may want to see.

Mike Koelzer: Yeah,

Saleem Shah: I hate that CPCG is not a consulting group and people ask me, there's a Salim. Why do you like it? I told one guy, I said, if I want to, Tanya herself, myself. We have enough degrees and certification and business experience that I'll be chosen and we both will be chosen as a consultant but I'm not gonna call myself consultant. I'm gonna call myself a daily wager. We are labor because there is a labor shortage. There is no consultant shortage in the country

It's a labor shortage. So we are labor,

You know, just give us some respect and just ask me, Saleem, I want this pile of dirt to be moved to the right.

Okay, I'll just keep digging all day long.

You know, that's it. That's what we do.

Mike Koelzer: The consultants. They're not going to come in and look around and say, man, everything looks pretty good. 

So, regarding your team Are

Mike Koelzer: are they associated with your buildings and so on? Or how does that work out?

Saleem Shah: Yeah we are sitting actually. So we have a large parcel of real estate, which we own overseas. This is important for anyone who's looking into an offshoring company.

They need to know there are two or three things here. So for us, we are sitting on a large parcel.

Employees come to our building, we bring them in, they come. There is no work from home allowed in my corporation. We do not. And there is a reason, Mike. I mean, Pakistan. I dislike the word third world country, but Pakistan is not as economically prosperous as the United States.

 Are there internet issues if someone is working from home?

There are electricity issues. They could be living in a two bedroom apartment with a family of five or six people,

seven, eight people, maybe. So our firm overseas actually is a beautiful looking building, with a nice breeze going on. You definitely need a strong AC if it's 110 degrees outside

with 90 percent humidity.

so that's one part. We transport from home, we pick up and drop off all the female employees and the reason is that you can imagine they work. Like right now it's about Tania. What time is it there? What, three, 4:00 AM in the morning. Yeah, it's 3, 4 a. m.

in the morning. So the ladies are working, and then we don't want them to be going through their own transportation. so it's our own vans and buses, which we own.

Mike Koelzer: That's cool.

Saleem Shah: We bring them in, and then basically they cannot even log in from multiple stations because of the HIPAA and the security of the businesses we deal with.

That's it. They have to go through at least three checkpoints. Interestingly enough, we have facial biometric, which we hardly see here, probably in, in the Pentagon.

Mike Koelzer: right.

Saleem Shah: you know, We have facial, like if I'm an employee, so I'll go there and I'll just stand in front of the camera and I'll scan my batch, it's going to do my batch identification, then my facial recognition,

and then it's going to open the door. They are not allowed to bring purses, cell phones, or anything once they are at work, on the floor. So it's very strict. And then they all respect that. That's the beauty, because they are used to working. If they're coming from a decent firm, another firm, they're used to this.

they don't say that, Oh, you know what? I'm going to bring my purse. They have lock boxes. They need to lock their purse. They need to put their cell phone in there. And that's it. They're on. 

Mike Koelzer: I didn't expect that they would all be in your physical buildings, but it makes a heck of a lot of sense. The things that you've talked about that unity and focus and all that, and the longevity of having a partner overseas, but for your pharmacy and stuff that makes a lot of sense.

That's really cool.

Tanya Chianese: I've had a

a lot of, um, of our clients have come to us from others, Others that are using existing services from other countries and some of their experiences haven't always been pleasant. I get asked, is there work from home?

Because there was one time I had a patient complain she was hearing roosters crowing in the background.

No, you won't find any roosters crowing in our background because everybody works in our facility. And I think it is very heavily underplanted. It's a beautiful facility. It's very nice. A lot of features and benefits coincide there. 

Mike Koelzer: how many physical people are in a building like this? 

Tanya Chianese: have a few hundred employees now.

 And we have several floors that are still unfinished and, unconsumed or occupied um, for

Saleem Shah: Yeah.

Tanya Chianese: Yep.

Mike Koelzer: Do you have a U. S. facility for some of the stuff we're doing now. Do you have any other buildings like the one in Pakistan around different parts of the world or is that it? Something here as the main focus maybe, and then Pakistan?

Saleem Shah: It's only the US and Pakistan. 

So the CPCG staff on shore is like, what, six, seven people, Tanya, at the most, I think.

Tanya Chianese: Yep.

Saleem Shah: Yeah, just that's just a handful, and basically the rest of the mission is all driven overseas. None of our processes, they get signed off unless they are on the parameters of ISO 9001 standards.

So we use ISO standards to build all the processes. In a lot of cases, we use Lean Sigma principles.

so it's very scientifically driven, kind of methodologies. We don't advertise this wing, but CPCG actually has a whole technology division. We build software. Some people come to us and say, just build us a software. We know that we will build them a software. They will not use it properly.

And then it's going to tarnish our reputation.

So we only talk to those clients who have the flavor of employees first. And then we know they are serious people. Then we go and start building them unique software for their analytics.

Mike Koelzer: Very interesting.

So tell me about the last year or so where we've seen a lot of this AI coming in and now like chat GPT, they've said it was coming out a few months ago, but like a sped up version of their conversation right now, if you talk to it, it takes like a 10 minute.

Two second delay and so on, but that's coming where it's going to be quicker. When you think about AI in your company, good, bad, excited about it, overplayed, what do you think? 

Saleem Shah: We like AI, we use AI to support our employees, and we would like this technology. And we know this technology will always be on the supporting side. AI actually is just another branch of computer science, if you notice.

Remember the 90s and the dot com?

Dot com industry was a branch of computer science.

So AI is nothing new, by the way. Mike, you probably remember. I don't know, Tanya, if you remember, Deep Blue? Tanya, do you know Deep Blue? When Deep Blue beat Gary

Mike Koelzer: Kasparov.

Saleem Shah: Kasparov

Mike Koelzer: Right. 

Saleem Shah: yeah, exactly, so what was it? I mean, that's like a long time ago, it's almost what, three decades ago? It was like, what, 96 ish, I remember,

somethingSo AI has been around for quite some time. I'm not saying that AI is not a useful, fantastic tool, but we don't basically look at AI as our competitor. We are using AI, actually. To provide even a better service. I do not see that AI is going to be replacing the human element right now.

I am worried about business owners, actually, on, okay, this is what I'm worried about. I've been talking to people for quite some time, obviously in my own ownership and everything, and Mike, you may actually endorse that. You remember this, like you talk to a pharmacy owner and the guy is an experienced guy, and I said, okay, where do you keep this information and stuff?

And he's going to point to his head. He said, it's all up here.

So there was one attitude of pointing to your head and saying, it's all up there. That was a resistance to technology. Now, in today's world, with the employee shortage or employee attitude, or there is a problem going on, retention and all.

Now businesses are trying to find their savior in a tool called AI. And I'm calling it an extreme pendulum swing from it's all up here pointing to the head.

Now they want every problem to be solved by AI. Both positions actually were wrong. It's all up here in the wrong position. They should have been open to technology before and now finding a savior in an AI is a wrong position.

These are extreme positions and extreme positions are only going to bring devastation.

Mike Koelzer: That's really interesting to me, hearing that, because,one thing I learned years ago is writing down every task I do. So every task I have goes down just like a calendar. I hold nothing in my head.

You'd be surprised how little I have in my head. But I've got 60 things a day on my do list. And they're as simple as checking out this idea on Amazon and this and that. Any idea I have goes right to my phone. Technology helps that. I'm glad I have the phone and the list because I can have stuff repeat every week and I can have it, automatically go to the next day if I don't get it done and so on. But if I wasn't doing that. AI can't come in tomorrow and make me productive and keep me on task. It's not a miracle worker. What did I hear? Don't be afraid of AI. Be afraid of somebody who really knows how to use it. Technology. That's the person that you're most fearful of in a competitive way. It's not magic.

Saleem Shah: Well, one thing is not magic, and then Tanya may endorse this philosophy. I basically emphasize the process. And I know Tanya is obsessed with the process. The problem with AI, and by the way, we are a tech firm, so I keep repeating this. If someone gives me enough money, I can build them a crazy AI product, you know. Just don't call me after that.

Mike Koelzer: Yeah,

Saleem Shah: You know, so basically, Mike is about the process. Assume, I give this example, assume that you give me a job. You said, Saleem, I mean, there is dirt on the left side of the field. It needs to be moved to the right side of the field.

There are trucks waiting and those trucks are going to load the dirt and then take it away. I said, okay, fantastic. Now, right now, the process is that there is a manual labor who's loading it in the wheelbarrow. Going across the field and then loading it in the truck. I brought a Kabuto. 

Mike Koelzer: Sure.

Saleem Shah: loaders,

Mike Koelzer: Yeah. Right.

Saleem Shah: Okay, so I bring a technology, right, over on the left side. Now follow me on this concept.

You said Salim, you're an idiot. I mean, there's technology available. I said, okay, there's technology available. Let's go ahead and pick up the dirt from the left side of the field, move it to the right side of the field.

Assume that caboodle cannot load the dirt on the truck, meaning that I have to manually load it. Meaning the whole process cannot be automated.

Now, what I did was pick up a pile of dirt from the left side of the field. And I piled it over to the right side because the whole process was not inspected.

So in some cases, if you put a robust technology in the middle of the process, you may be asking, it could be a recipe for destruction.

You need to look at the whole process. I mean, I remember when Tanya was building this whole thing. I remember that, she would look at the process from A to Z, like all the way to the end.

Tanya Chianese: Your process is everything. And, I think also what you were alluding to earlier, Salim, on the consulting side is, consultants can come in and they can consult, but it still requires processes to be implemented and resources to help implement. This is a big component of what we do on the, policies and procedures side of, going back to the 855s and credentialing and, in any portion of the business from compliance, but policies, processes, implementation, it's all critical.

And it requires something that most people don't have in business, which is time.

And so when we're able to fragment those things out those processes become actual tangible. to implement. And we helped do that.

Mike Koelzer: Boy, all businesses, even if they weren't going to use outside help. It's very important businesses have their processes down, not to the point of being too rigid, but we've got a Papa John's across the pizza place.

And once in a while, I used to bring wheat bread and peanut butter to work. Every day for like the last 20 years my son got me going to Papa John's now. And then he takes off to school and I'm sitting there eating Papa John's every day, I get the Papa Dia and every day it comes out different, one time it's folded, the other times it's folded twice and one time it doesn't have cheese and then they don't put the oil here, this or that. And it's like. 

not having procedures is okay when you're dealing with 

maybe Bob, the owner, who's around all the time, but Bob's not always around. And then you get companies that have no one really, you don't have a solid product and things like that. So what a great thing to have things proceduralized to let customers know what to expect.

If they get something different every time, they don't have that trust in you anymore.

Tanya Chianese: Yeah, Mike, actually when we're onboarding a new client, we have a whole defined onboarding process that we follow. And so it's a written documented process. And part of that is assigning what we call an account assimilator that becomes a designated Sponge on the account. And when I say sponge, I mean they're taking and absorbing everything during those training sessions onboarding to take all the information they can so that they can write out a written procedure. Now, the written procedure defines from A to Z. Login here. Click this. Hit yes or no. If this, then do that. What if scenarios? And it builds an FAQ. And so what happens is that a lot of times we find that our clients have any written procedure and so they end up with this goldmine after 

That, they just went through this whole process for our resource to be able to replicate

now for the training process.

But also, they can reference it internally and say, Oh, yeah, this is the procedure. This makes sense. This is going to help us get from A to Z a lot quicker, more efficiently.

Saleem Shah: another important thing, so there are like detail, I mean, because I think we are almost sick, when it comes to detail,

Mike Koelzer: Sure.

Saleem Shah: the assimilator has to be an independent body within our departments. So the assimilator is not the guy or a gal who's going to be supporting the client.

Why? Because there could be a bias.

Mike Koelzer: There you

Saleem Shah: You know, because we are running a team of several hundred people. So we need control over the process.

So a simulator is going to assimilate. If it's assimilating, for example, a pharmacy or whatever the process is, then a simulator is an independent body, sort of an advocate on behalf of the client, taking it to the operations and saying that this is what the client wants.

And then within the department, there is a chain of custody, which we call it. Where the process needs to be handed over and taken over with signatures that all parties understand that this is internal. Client is not involved here, but internally we are saying who learned, who knowledge transferred, and who said that I understand.

And it's a document which is there because you came back and you said, Salim, I asked for two things and you're only delivering one. We need to be able to press a button and then bring it up

Mike Koelzer: Very interesting.

Saleem Shah: right away.

Mike Koelzer: So Salim, you came from a pharmacy and pharmacy ownership. I think even, how has that played a part in you forming this versus maybe somebody that came in from some other industry and so on.

Sure.

Saleem Shah: Well, I think it means everything. And I'll use two different words, one is understanding a business and one is understanding and feeling a business. So we can claim both because we can feel how pharmacy ownership feels. We can feel how the director and a VP level, Tanya can feel that.

Running the pharmacy on this high level position, feeling and understanding. So a technology firm, a process firm can come in and they can understand the client. And I'm sure so many smart people in the world, they'll understand it.

But at the same time, we can claim that we feel it. Why do we feel it? Because, across the board, From Eastern Shore all the way to Texas, we had built pharmacies and ran them and did really well with them. 

Tanya Chianese: So a pharmacist is listening now and they want to learn more about your company or they want to dip their feet into this. What's the best way to do this? I imagine Tanya, maybe go to your website and look there. Yeah, they can definitely go to our website, it's cpc gr. com, so that's Collaborative Patient Care Group,

Mike Koelzer: I'll put that link in the show notes also.

Tanya Chianese: perfect, yeah and there you'll find a bunch of information about us, about our services that we offer you can submit a form to learn more information, you can schedule a discovery call and I can help walk you through, how to. discover what services might benefit that business and that pharmacy owner the most.

Mike Koelzer: Well, golly, Salim and Tanya. Thanks for joining us.

That was really interesting. And at first, I was thinking of less cost overseas, all that kind of stuff. But then the more we talked about, you guys having your building with a few hundred people in it and that's the spot and so on. It goes from economical, you said it from the start about the expertise that we're bringing into this too, with people that are spending all day doing this as their job versus, someone once a month answering a question about something. And so I can see where those economics are. But also that expertise comes in. So thank you very much. You guys for joining us. Very interesting stuff. I know you've got a lot going on with this growing company. So thanks for your time. I appreciate you spending it with us.

Saleem Shah: Very much, Mike. Thanks for having us. Actually, we really appreciate that. And We are excited for the pharmacy business.

Tanya Chianese: Thanks, Mike. We really appreciate it. , 

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