Change is the constant

– are stepping up to provide the data and training pharma sales teams need to make headway in the new reality.

Surprisingly, despite public hearsay, physicians actually do want to hear from pharmaceutical companies, but they do not want their time wasted.

According to the 2014-2015 version of Publicis Touchpoint’s “What Physicians Want!” report, more than half of the 260,000 physicians surveyed said they would like more visits by healthcare representatives. This is an increase of 14 percent from the 2013-2014 survey, executives say.

In 2008, only 31 percent of physicians surveyed wanted more representative visits. Today, the number is 56 percent. Moreover, there is a strong demand for “higher-quality” traditional representatives (such as those who engage in discussions around clinical studies and evidence-based medicine), as well as different forms of support from a new breed of nontraditional teams.

Nearly three quarters of all doctors want more clinical health educators for patient support and more customer service representatives for office support. More than six out of 10 want “hybrid” representatives, who reach their target physicians through a variety of both field and virtual channels and at times that are most convenient for each physician. Specialists also want to see more specialty representatives, with more than nine out of 10 indicating that they want more knowledgeable representatives calling on them.

“The physicians definitely want to see a representative, but the caveat on that is that they want someone in the process to give them information that can meaningfully help them with their patients,” says Michelle Keefe, president, Publicis Touch-point Solutions. “If you talk to physicians about what they want from their life sciences partners, they’re looking for more information to support their patients, certain critical information like understanding of reimbursement, how to get a product reimbursed — more support for the patient through their journey, and help for retention and adherence all the way around to their treatment plans.”

Touchpoint provides contract sales forces and sales force training, particularly for new drug launches. According to Keefe, the company is seeing more demand for representatives who can act as clinical health educators or clinical liaisons.

Part of this demand is being driven by the types of drugs that are being launched.

“A lot of these products being launched are injectables, they’re biologics, they’re more complex treatment regimens than traditionally taking a pill just once or twice a day,” Keefe says.

Publicis Touchpoint executives say clients are interested in learning how to build integrated teams that are calling on physicians.

When it comes to serving the large medical practices becoming increasingly common, life science companies will have to serve diverse needs. “There might be someone going in to talk about the payer landscape, and there might be a clinical nurse educator coming in to support their clinical needs,” Keefe says. “You might also have an MSL call in on the medical group, to have medical to medical, scientific conversations about disease states and the status of clinical research, and then they might also have a sales representative calling in.

“So the trend that I’m seeing is pharmaceutical companies trying to figure out how do they have these integrated teams that call on the customer, but everyone calling on the customer understands each and every role, and they all know what each other is doing so all of them support the practice and treat the patient.”

Additionally, “We’re seeing a lot more life sciences companies trying to figure out how do they get the content they want developed to support the physician and the patient, and in front of these key stakeholder,” Keefe says. “So we’ve seen a lot more facilitated content, or facilitated Web browsing, and review by virtual representatives. And we’re seeing clients using this to connect to their patients as well, to find a way to have a relationship with the patient through their disease state.”

Touchpoint executives say doctors are increasingly dependent on digital technology, with more than nine out of 10 of those surveyed using smartphones and three out of four using iPads or other tablets. A majority – 83 percent – are asking for more disease-state websites designed for healthcare professionals, while seven out of 10 want more physician-focused product sites.

Even with today’s considerable use of iPads by representatives, 76 percent of survey respondents still want to see more or significantly more use of iPads/tablets by representatives calling on their practices. In line with this preference for digital media, 64 percent of physicians want representatives to decrease use of traditional print visual aids.

The affinity for digital technology also extends to how samples are obtained. Physicians continue to be “enthusiastic” about eSampling. Eighty-one percent of respondents told Touchpoint that they want more or significantly more availability of eSampling, defined as requesting samples via the Internet and receiving them by mail. Although not as popular as eSampling, 58 percent of respondents want more tele-sampling – inside service representatives calling physicians to offer mail-delivered samples.

Though survey was done entirely with physicians who use the doctor’s social network site Sermo, these physicians are also active in other social networks. Facebook is the leading nonmedical social networking site for these physicians, with 63 percent active. LinkedIn places second, with 40 percent reporting use in this year’s survey. Google+ and Twitter are distant followers, with 20 percent and 19 percent, respectively, using them.

Jeff Tagney, CEO of the physician network company Doximity, is well aware of doctors’ demand for sophisticated digital technology that can aid their practices.

Doximity’s growth – with 50 percent of all U.S. physicians now on the network – shows how physicians are moving online.

“Doctors get a bad rap when it comes to adopting technology,” Tagney says. “The truth is, doctors don’t like adopting technology that slows them down, that takes them time, that doesn’t improve care, that doesn’t make them more money. So much software is just another regulatory insertion in their already very full workdays.”

This is why there is so much resistance to billing software and electronic health records, he says. “They’re designed more for administrators.”

Physicians also want mobile solutions, Tagney says. In fact, 70 percent of Doximity’s use is on mobile devices. “We had developed an iPhone app and an Android app before we even had a Website,” Tagney says. “Doctors are really the most mobile-first profession.”

Tagney was the founder of ePocrates, which was the first to offer a “pure play” mobile app for physicians.

Whether they are using mobile or desktop solutions, physicians will embrace technology “when it actually saves them time and improves their care,” Tagney says.

While Touchpoint has identified what physicians want and Doximity shows that physicians are not technology-averse, sales forces are still struggling to get their messages in front of physicians.

Multichannel remains the dominant mantra when it comes to pharmaceutical campaigns, says James Corbett, senior director of strategic solutions at Cegedim Relationship Management. “The biggest issue that we see is that no one is really able to measure the impact of all those interactions across all of those channels,” Corbett comments.

According to Corbett, he saw this first hand when he led sales force effectiveness and operations at a top 25 pharmaceutical company. “My biggest gripe overall probably was my marketing team always investing in the latest and greatest, in an ‘other people are doing this, we need to be doing this’ sort of idea,” he says. “There was no innovation, there was just replication. We had products that were on TV, and we were like, ‘Why are we on TV? We have such a small target audience!’’”

Cegedim’s OneKey data set has been built to a point where a pharmaceutical client can tell which channel a physician has been active in.

“We not only know that a physician has a Facebook page or a LinkedIn page, or that they use blogs, but we measure whether they are an absorber – someone who just goes out and gets their information that way, or if they are publishing and writing and have people following them, so they are a thought leader,” Corbett says, adding that the information also includes whether a physician sees reps and wants samples.

To have their clients be able to better access all of this data, Cegedim is creating the Customer Engagement Hub.

“It’s a measurement of all the touch-points that hit every customer, and then it looks at what is the best way to engage that customer, and it suggests to you that ‘this should be the way we think that this customer should be engaged next,’” Corbett says. “It’s the idea of a next, best action. It gives you the single view, because it has the OneKey data, it does all of the analytics, so it can tell you how your programs are running, which engagement model by which channel is working best, it helps you segment your doctors, and then it actually assists with the campaign management across all of your channels.”

 

Cegedim has been showing the Customer Engagement Hub to key clients, but at the time this article was being written, the official launch of the solution had not yet occurred. So far, the reaction by specific clients has been mostly positive, Corbett says, but some individuals have been less receptive.

“I’ve actually seen some marketing people be threatened by it, because they have budgets and the ability to do whatever they want with that money,” he says. “I’ve also been in meetings with more senior members, the ones who have to justify the budget and where is the best spend, and their eyes light up with the understanding that we’re not just throwing a grenade over a wall and trying to hit something. This can give us a really focused way of marketing, and a really focused way of measuring as well.”

But perhaps the biggest trend affecting pharmaceutical sales forces, experts say, is the rise of accountable care organizations and integrated health systems and their absorption of independent physician practices.

“With these new networks, you are practically forbidden in meeting any of the physicians, sampling the physicians, detailing the physicians, etc.,” Corbett says. “They have their own list of preferred drugs, they’re running their own formulary process. It’s a very closed network, almost like the Kaiser model that developed in the ’70s and ‘80s. So the access to the physicians is almost completely limited and completely controlled.”

In some markets, such as the Midwest, 70 percent to 80 percent of all physicians are working for an accountable care organization or an integrated health system.

Cegedim has been tracking the slow demise of the private physician practice. As of November 2014, 73.5 percent of physicians in Wisconsin were employed in a large network system, compared with 68.2 percent in November 2011.

In November 2011, 40.2 percent of physicians in Oklahoma were employed by networks. By November 2014, it was 51.5 percent.

Even New Jersey, Nevada and Florida, three states where most physicians remain in independent private practices, are feeling the effects of the networks acquisition trend.

In November 2011, 19 percent of physicians in Nevada, 19.9 percent of physicians in Florida, and 20 percent of physicians in New Jersey were in integrated healthcare systems. By November 2014, that number had risen to 23.5 percent in Nevada, 27.1 percent in Florida, and 27.7 percent in New Jersey.

The trend has accelerated in Midwest states because they have more large single-employer regions or towns than someplace like Florida or Nevada, which has a population that swells during the winter with part-time residential “snowbirds”coming from many areas (and thus many healthcare systems).

It’s also accelerating as older doctors in private practice retire and new physicians just coming out of medical school look at how they want their careers to be, and find large practices more stable and appealing.

“You’re going to have the worst hours in the group, but you’re going to have set hours on the schedule, you’re going to have 401K, you’re going to have medical benefits,” Corbett says. “To run a private practice today, you don’t have medical benefits. You have to rely on Obamacare and things like that. For those coming out of medical school, it’s a no-brainer. ‘I may not get free lunches every day, but I can bring in my own salad, and if I get sick, I’ll have healthcare benefits to meet it.’”

Many pharmaceutical companies do not know how to react to this trend, but some are trying out plans, according to Corbett.

For example, one client, a prominent pharmaceutical company near Chicago, has created a new type of sales force, in which the emphasis is on people with medical experience who can talk to more than just physicians.

“To be a representative, you have to have a Pharm.D. license or a medical license, almost like an MSL,” Corbett says. “And you don’t call on the physicians, you call only on the key stakeholders at those organizations. You network down where you’re allowed to. But unlike an MSL, they actually get involved in contract decisions and contract negotiations, almost like a market-access type representative. They’re also having the medical dialog and trying to differentiate their products and have the organization understand why their product should be approved, should be preferred, etc. So it’s a secondary conversation on the medical side and the contracting side. And then once given guidance – ‘OK, now you can go inform other people in our organization’ – they need to be able to have that same person turn around and do a face-to-face sales call.

“So it’s a multi-faceted person who needs an entirely different background – you just can’t come out of college with a communications degree anymore. As a result, not only are the qualifications very different, but the number of people you need in that model is entirely different.”

The unexpected expert

As pharma sales forces grapple with a more complicated, regulation-heavy, information-heavy sales environment, their training has become a challenge. For companies that want uniform, consistent training for global sales teams, whether on an outsourced basis or getting an internal program designed, experts at Xerox say they have the answers.

Yes, the technology company whose name has become a synonym for its copy machines does actually have about half of its business in learning solutions. And Xerox can boast several pharma clients on its roster, which company executives say is a growing area for them.

Thomas Kupetis, VP and capability principal at Xerox Learning Services, says he realizes that when people think of Xerox, they do not think of learning services. That business originated as a consultancy at Ernst & Young that was acquired by ACS in 2006. ACS in turn was acquired by Xerox in 2009.

But Xerox had been known back in the ‘70s and ‘80s for its sales training approach, Kupetis says. “What is the spin sales method today was born out of selling experts at Xerox,” he says. “So Xerox has a long history of developing talented sales people through best-in-class training programs.”

The pharmaceutical industry as a whole tends to consume a lot of learning, Kupetis says. On the manufacturing side, a lot of training needs to occur to instill the standard operating procedures for each role and function. “If a standard operating procedure is changed, the training needs to be updated, it needs to be consumed by the responsible parties, they need to sign, in a validated manner, that they’ve taken the training, and detailed, rigorous records need to be kept,” Kupetis says. This means if the FDA does come in for an inspection, a company can prove very quickly that training has been done in a compliant manner.

Other areas of pharma companies, such as R&D and sales and marketing, have their own knowledge needs that Xerox Learning Services can meet with training, Kupetis says.

Robert Blondin, VP, learning strategy, at Xerox Learning Services, says what differentiates Xerox from other training companies is the breadth of coverage it can provide.

“A lot of organizations come in with targeted solutions, you have people who want to sell a version of spin [selling], or something like that,” he says. “Our approach is to sit down with an organization and understand their business goals and business drivers, and then to assess their current approach, looking at all of the various factors that are important in that, based on recommendations on key issues that their sales force is facing and then work with them in creating a learning solution that will address those issues. I think it’s the consultative approach, it’s the outside-in approach, and it’s the end approach that differentiates us from a lot of other organizations.”

When pharma companies approach Xerox, they are not looking for the design of a brand selling program, Blondin says.

“They are less focused on the product and more focused on the type of sales environment they’re working in, and the things that we have done have been most focused on helping them move away from a focus on selling a particular product and more of a focus on selling solutions,” Blondin says. “The move away from being a pill pusher to a problem solver, that is what organizations are pushing for very strongly – and so, really focusing on selling solutions rather than selling products.”

Blondin says as the pharma sales environment continues to grow more complicated, the challenge of training sales people to operate effectively has increased.

“It’s getting people who have traditionally sold product, who understand the product, who understand what’s on the label, who understand the disease states that they support, but don’t necessarily have the consultative skills to problem-solve with a physician and figure out how those products can be used as part of what that physician or that hospital or that pharmacy is trying to do,” he says. “Building those skills is a challenge.”

The amount of data available about physicians and consumers and other customers has become overwhelming, and knowledge management has become key for pharma sales forces.

“It used to be that a sales person could carry most of what they needed to know in their head or in their back pocket,” according to Blondin. “Knowing where to find the answers to questions and knowing how to balance those knowledge needs becomes very critical.”

According to Blondin, Xerox is designing learning programs to meet those knowledge management needs. In some cases, the company designs a learning and training program to help a client use its existing data systems more effectively.

“Xerox is also involved in a number of initiatives, many of which generally fall under the ‘agile workplace’ umbrella, where we are working with organizations to provide tools and in some cases, Xerox is providing linkages to our key vendors to help position those products, and is providing services and software that work on those devices to help drive the workflow,” Blondin says. “So we can be agnostic about it, or we can provide solutions that can be tailored to meet a customer’s needs.” medadnews