As our mission is to primarily serve the sales and marketing functions in healthcare, we regularly try to cover the opportunities, challenges and other issues that affect each. This month we have recruited a panel of long-term executives with deep experience in the realm of sales.
In the last few years, the industry has suffered from various shifting tides: loss of product differentiation, adapting to changing technology habits, responding to the influence of massive information overload, strategizing allocation of human resources, and more. The people we reached out to have been through all of that, and have had to apply their own expertise to the hurdles before them. Here’s what they had to say.
Our panel of experts:
VP Sales and Marketing
Medac Pharma USA
President US Commercial
Bio Products Laboratory
Sr. Director of Digital Customer
Regional Sales Manager
Cardiovascular Systems, Inc.
How much change is happening today in the realm of the sales forces in healthcare?
BOB ROSSILLI: Change has been taking place at a rapid pace in healthcare over the last couple of decades and has not slowed down in recent years. Some of the change has been needed and predictable while other elements have been hard to predict. When you think about how change impacts sales forces you should first focus on your organization (and product) strategy. Your sales force should always be aligned to your overarching strategy. If your strategy needs to change to stay current to changes happening in the market place then your sales force should change to align to the new strategy. If your strategy is current/relevant and hasn’t changed, then you will only need to make small tweaks in your sales force to enhance execution of the strategy. To me it always comes back to making sure you have a tight alignment of your sales force to your strategy.
PAUL MURASKO: As we all know and have seen, rep access has been declining and continues to do so. I expect to see this trend continue. Despite this, the sales force remains a foundational component of the pharma-HCP relationship. Even though doctors are spending less time with their reps, that does not mean physicians are not interested in the information the reps have to offer. They are. However many are just choosing to get the information differently. By differently I mean digitally since they can do it on their terms, in ways that are more accommodating for their very busy schedule. The “internet-savvy” physician is no longer an emerging group or trend, nearly all physician are online weekly or more often for professional reasons.
RYAN BLASKO: Change is rampant in healthcare sales currently. The addition of new technology in medical devices will continue along with the disruptive and innovative spaces of surgical robotics, digital health, predictive analytics, VR/AR and big data in healthcare.
What specifically are the challenges for those in medical device?
RYAN BLASKO: Access remains an enormous challenge in the med device space. Many reps need to belong to a variety of national credentialing companies just to step foot into a hospital. These come with expensive membership fees and the hassle of staying up-to-date or potentially being banned from the hospital. Another challenge is the commoditization of the industry in general. As companies like Amazon move into healthcare, the need for personal representation for routine procedures goes away. Finding a way to continue to bring personal value and service to each account will remain paramount in order to overcome these challenges.
What specifically are the challenges for those in pharma and bio?
BRIAN PETERS: In addition to decreasing access to health care providers, the changing reimbursement models and increasing payer, as well as hospital and physician networks influence on physician prescribing habits are daily challenges for sales forces across our industry.
PAUL MURASKO: With doctors spending an average of 84 plus hours a year on reading digital marketing material and many drug websites now including a separate page just to educate physicians, digital must become a complimentary tool for our reps. This is slowly happening but needs to be accelerated. I believe another challenge lies in the need for better alignment between sales and digital marketing or NPP as it is called in pharma. They both share a common goal to build long-term relationships with HCPs. The misalignment is the sales force is very focused on script volume and meeting their numbers, while digital marketers are hyper focused on physician engagement. Sales and marketing teams need to get on the same page with regards to digital pull-through. By doing so you will drive scripts through an enriched customer experience that enhances physician engagement and maximizing the company’s investment
BOB ROSSILLI: Payer challenges continue to bubble to the top of the list as well as the ability to bring clinically differentiated products to market. That is why the drug development process and clinical trial design of new medicines are critically important and can help generate strong clinical evidence vs. current standards of care.
What do we have to do to improve access?
PAUL MURASKO: Beside the stricter access policies being implemented and the limited amount of physician time to see reps, the trend of using online resources via multiple channels is increasing and going to increase significantly in the future. I believe there are several ways to help improve this. Let’s focus on one – invest and use technology efficiently, effectively and appropriately. Tablets can improve the in-person detail experience; however, reps must use them consistently, effectively and the content needs to continually reflect the latest updates. And in addition, remote rep communication is underutilized to share info between meetings and with those hard to see or no see physicians. A recent study showed that despite industry enthusiasm for rep-triggered email software like Veeva, only 12% of physicians said they had emailed with their rep in the past six months. More than a third (36%) said they wanted to. Similarly, just 9% of physicians are engaged with remote detailing programs, such as a self-detailing app, click to chat, or on-line live discussion with their rep while 35% are interested in doing so.
BOB ROSSILLI: I have not heard any new or innovative ways to improve rep access, however I do feel following some “old school” rules can help.
One: Make sure all your reps are well trained “expert” sales reps that know their products inside and out. They need to have deeper product and therapeutic area knowledge than their customers/ accounts. That won’t happen overnight, but we do need to appropriately challenge our sales teams to get that point and be EXPERTS! I call that having a deep therapeutic expertise.
Two: Reps should strive to appropriately learn the customers’ practice goals, objectives and obstacles/ pain points. Asking questions, showing you care about their challenges and learning as much as one can about the practice, the physician/customer and their pain points can help build credibility and trust. I call this superior business/ practice acumen.
Three: Appropriately tailor your product or service to the customers and their specific need(s) while selling with integrity and following the rules that govern our industry. I call this selling/account mastery.
Again, not innovative. However, challenging our teams to be experts in those three areas can, over time, improve and continue to earn access.
RYAN BLASKO: In the past an industry representative could attend a case with an invitation from the department manager or physician performing the procedure. Just because your device is being used on a patient isn’t reason enough any longer. You must be cleared by the hospital’s internal credentialing system or be a member in good standing with many of the national credentialing companies. Overregulation has created inefficiency and made it difficult for many physicians to partner with industry representatives whose expertise they value in a procedure.
BRIAN PETERS: Access to health care providers continues to decrease, although our primary focus is rheumatology where we still have fairly decent access to our customers. What’s more challenging is the trend we’re seeing with limited time availability. I continue to be in the field with our representatives and see HCPs give us one minute or less in the hallway or five minutes or less at a lunch or a breakfast. It’s imperative that we optimize the time we have with our customers by creating value during the conversations.
How has the regulatory landscape changed in both the U.S. and abroad?
BRIAN PETERS: I think risktaking has gone down due to the regulatory environment we currently work in.
RYAN BLASKO: It’s changing as we speak. Popular documentaries like “The Bleeding Edge” on Netflix have sparked a call to action against current processes and put organizations like the FDA and AdvaMed on notice. According to Institute of Medicine, the 510(k) process does not include enough assessment of devices after they are put on the market. The panel said it found “substantial problems” in how devices are examined after their approved by FDA.
The panel concluded that “the 510(k) process generally is not intended to evaluate the safety and effectiveness of medical devices and, furthermore, cannot be transformed into a premarket evaluation of safety and effectiveness.” It added that “FDA’s finite resources would be better invested in developing an integrated premarket and post-market regulatory framework that provides a reasonable assurance of safety and effectiveness throughout the device life cycle.”
This may drive more studies to be conducted abroad, where it’s sometimes viewed as less difficult to navigate the regulatory process.
What kind of people are you looking for to populate your sales force? Do they have to have healthcare background?
BOB ROSSILLI: I look for ALLSTARS!! In specialty pharma it is important for me to hire people who have consistently demonstrated success over time (top 25%), have superior selling skills and operate with integrity. In specialty pharma, I do tend to look for sales reps with a healthcare background and I do feel it is important to hire people who LOVE selling, the selling process and have a work ethic second to none.
RYAN BLASKO: The hiring profile has definitely changed. Many med device reps are leaving the space for healthcare software sales. Companies like Vocera, Dell EMC and many others are now filled with former med device reps.
With this new dynamic, many sales leaders are having to hire outside of the traditional requirements. No, they do not have to have a healthcare background at all. Strong business-to-business experience from companies like Cintas, ADP, Xerox, Enterprise, Black & Decker Dewalt and Gallo Wines has proven to help with a successful transition into the healthcare space. At the end of the day the kind of people I look for exhibit a customer-first, servant leadership attitude. It’s all about effort. If people are willing to give an “A” effort they will usually be successful with the proper leadership, guidance and autonomy.
BRIAN PETERS: Our hiring profile has evolved since we started the company 5+ years ago. Our current focus is finding candidates with a fair amount of pharmaceutical sales experience, with category experience not a necessity but a plus. We tend to look for people with good general business acumen as well as great selling skills, since they have to call on multiple disciplines and make themselves relevant to the entire office, not just the prescriber.
What kind of training do you need to provide that’s different than it was a few years ago?
RYAN BLASKO: Many companies are investing in sales training models that focus on how the customer wants to be managed. Less about the company selling the product and more about the value of the partnership. Think risk-sharing models and lifetime value of patients being explored by ACO’s. Companies are spending big money to train on “Challenger Selling” or work with major consulting groups to design specialized training. In the past, relationship sales were enough. Not any longer, especially when relationships won’t get you in the door to many institutions now that access is being denied unless you are on a GPO contract as a “preferred vendor.”
PAUL MURASKO: The traditional pharma sales model and thus the training it currently comprises is far from dead, it just needs some revamping for the modern age. I would suggest investing more time and resources into all things digital. Reps need to be educated, and better training in understanding and appreciating the NPP tactics and tools that are being used with their HCPs.
BOB ROSSILLI: Training on the business of healthcare, customer insights and account management has bubbled to the top.
How are you breaking down silos between sales and marketing – and other divisions as well?
BRIAN PETERS: We are big proponents of cross-functional teams, utilizing the collective expertise of the sales force, sales management, managed markets, trade and IT. For example, during the marketing planning process, each discipline has a seat at the table and ultimately contributes to a plan that is well-positioned for success because of the synergies created during the planning process.
PAUL MURASKO: We have been very focused on ensuring the reps feel comfortable and do not feel the inside sales force or the digital channels like the HCP portal are their competition. We are not trying to replace them. We are complementing their efforts and supporting them. I like to say it a great example of 1+1 does equal 3.
BOB ROSSILLI: Build a culture of teamwork and collaboration within your organization while aligning the broader team to the strategy, the execution of strategy and the measurement of the strategy. Signs of a healthy organization all point to how the organization aligns around the strategy and execution of it. The Star Model can help build organizational alignment and break down silos. The Star Model begins with a clearly defined STRATEGY and stresses alignment of STRUCTURE, PROCESS, PEOPLE and REWARDS/MEASUREMENTS back to the strategy. They call it the Star model because all elements are interdependent.
RYAN BLASKO: Where I have had the most success is getting teams to realize how we all win (sales, marketing and the customer) when we combine our resources and collaborate. Think case studies that promote the physician, hospital system, vendor and most importantly a patient success story. It should always be about the patient, or what’s the point?
Where do you think we’re headed in the next five years in the way you will structure your sales strategy?
PAUL MURASKO: The growth in nontraditional field sales teams will continue to grow. In addition to the traditional role for the field sales reps, there will be more and more blended teams that combine customer service, clinical nurse educators, and virtual or inside reps who reach HCPs through a combination of face to-face and digital channels depending on HCP preferences and geographically situations.
BOB ROSSILLI: Over the next five years we must stay current with the challenges and opportunities our customers face and modify our approach as our overarching strategy changes. We must challenge our teams to work smarter, size our teams appropriately and resist the urge to over-invest in certain areas, as resources can be hard to come by. We must also build a strong organizational culture that operates with integrity. The business of healthcare will not get any easier, however if you have a strong culture with great people—ALL-STARS—you can overcome any obstacle or challenge and deliver for patients and your organization.
BRIAN PETERS: The key for sales representatives will be finding ways to utilize the advances in data and technology to their advantage, to leverage the interpersonal skills they bring to the table along with the tools they have available to them. Equally important will be our efforts on motivation and retention.
RYAN BLASKO: Sales strategy is only as good as industry compensation. Sales compensation plans drive behavior, retention or turnover. In the next five years we are headed for a shift in how med device representatives are paid. The industry is being poached by software companies who compensate with higher salaries and larger commission upside. In order to compete, med device will need to continue to shift to a model that raises base salaries and offers higher commissions for performance over quota and lower commissions for below quota performance. Every consulting company out there that has worked with sales operations has recommended this strategy.
It’s my plan to make it as easy as possible for customers to do business with me and my sales team. In a world of two clicks and things show up on our doorstep, we must deliver better service through strategic partnerships.