PharmaTimes recently published an insightful article on the future of outsourcing, including commentary from Ashfield. John Gerow talks about a new sales model for the era of patient centricity and Karen Bell discusses the skills required for reps to succeed in a multichannel world. The article also features a debate around insourcing vs. outsourcing with comments from Paul Frater and Adam Zaeske, the managing director of Takeda UK, on our lengthy, successful partnership.
‘Complexity’ is the word that comes up most often when talking about modern pharma sales, and it means that sales rep is a very different role than it used to be.
“We have to deal with many more types of stakeholders, and many more people are involved in the decision than previously,” says Jonathan Dancer, managing director of Redbow consulting and member of the Executive Steering Committee for the PharmaTimes Sales Awards. “This has led to the rise of key account management and companies are reorganising themselves to deal with that new reality.”
Many of these complexities arise from the very systems sales works within. “The bodies that procure medicines are now increasingly sophisticated in the way they operate,” says Dancer, “and that needs a more sophisticated approach from pharma. We’ve got national stakeholders like NICE and the SMC who also talk to bodies across Europe – so there’s increasingly an international dimension. In the UK those bodies are interested in cost-effectiveness, but at a local level you have a number of bodies that are really interested in affordability and budget impact – and cost-effectiveness doesn’t mean that it will necessarily be used in a widespread way. There is a place for face-to-face clinical sales, but increasingly it has to be wrapped around with other approaches.”
Dancer adds that the specific competencies that individual sales reps need have also changed. “Influencing is still important, and communication skills are more important than ever. You also need resourcefulness, business planning and conceptual thinking to be able to understand how the different stakeholders interact with each other. Increasingly, having a broad technical understanding is also important, as some of the medicines that we’re promoting are extremely complex products. So it’s a much more complex sell. It’s not the case anymore that you can just apply a simple sales process with a single customer and expect a sale.”
Ryan Wooller, business development director at Star Medical, says that this means the ability to navigate complexity and demonstrate flexibility is an essential skill for the modern sales rep. “The biggest trend we’re seeing at the moment is that companies want representatives to be able to flex and respond to commercial opportunities more fluidly.
“The historic model where reps have a set territory doesn’t always meet company needs over time. Geographic flexibility, coupled with the ability to work across different complex customer groups is now essential. While relationship building with NHS customers will always be important, the ability to articulate a strong value proposition to diverse stakeholders has become increasingly key.”
He adds: “The individuals that are winning out there are those that are comfortable engaging with payers, providers and clinicians on a range of topics. Individuals than can transition between market access, promotional and service development activities. Identifying and continuing to develop these rare individuals should be a critical part of any company’s sales strategy.”
Multichannel account management
Karen Bell, business development director at Ashfield (part of UDG Healthcare), says that reps also need to adapt to advances in digital. “Around half of today’s healthcare professionals rely heavily on digital and remote channels as a primary source for medical enquiries and medical education,” she says, “so it is essential that the pharmaceutical industry evolves its approach.”
Bell adds: “Today’s medical sales representatives need to be thinking now about how they develop their IT and digital capability, as well as their remote customer service skills. It is essential to effectively influence the practice support staff in order to gain access to the HCP, but equally important that they engage with HCPs over the phone and on remote detailing platforms, especially those that are less familiar with this medium. Familiarity with iPad detailing, use of WebEx, and the remote coaching of HCPs to engage with these new delivery channels are key skills that the majority of representatives will require to be effective in the future.”
Specialist sales organisation OUTiCO is another company focussed on multichannel, and has built its entire model around this idea of using these communications to adapt to the customer.
“Multichannel account management is a flexible approach to NHS engagement which is both time saving and very successful,” says OUTiCO’s director Mike Cooper. The company’s model is built around managing accounts through various channels, engaging NHS customers in their preferential style. “It adapts to the individual,” Cooper adds, “whether they prefer face-to-face meetings, telephone calls, email, or remotely viewing electronic data. It is a truly ‘customer-centric’ model delivering the information in a way the customer defines, not the industry or company.
“If you’re going to the effort to create trusted relationships, it’s logical that all sales staff are trained to tailor their approach to match the clinician’s preference. Why spend hours sat in traffic, burning time and fuel if the HCP would prefer to talk to you on the phone?”
Cooper says the OUTiCO team has seen success so far with 179 formularies in 117 CCGs and Health Boards over the last two years.
Dancer says that these new complexities mean that sales is increasingly about working as part of a cross-functional team. “Sales people of the 90s didn’t necessarily have to be team players, but I think that now, with the complexity of the environment, team working is a very important component.
“Sales managers now have a broader role. Whereas before they might have been managing a team of single-discipline sales people, they might now have sales people, market access people and other more specialist roles, and they themselves are often involved in the market access process itself.”
Wooller adds: “If you’re in multiple therapeutic areas there is a real need to be integrated in the way that you’re approaching the NHS. Companies have not always focused on delivering a ‘joined up’ customer engagement plan, however NHS customers are becoming less tolerant. The industry needs individuals and managers that understand and can navigate the complexities in any local health economy, individuals that can be a catalyst to change customer behaviour.”
Dancer suggests that companies could look to hire people from different backgrounds to help diversify their sales teams. “Pharma people tend to to be of a similar mould, with a somewhat similar background and similar knowledge and approaches. Some companies are bringing in people who perhaps don’t have that traditional background, and in some areas that can be extremely effective. If you bring people in from electrical engineering or other high-tech sales environments, they perhaps don’t have the same pharma specialist knowledge but they do understand technical selling in a complex, key account driven environment.”
As with the entire industry, another major trend in sales at the moment is the move towards patient-centricity. Companies are now considering how they can go beyond simply pushing the sale of a drug and keep the patient in mind at every step.
“Reps need to understand the NHS’ agenda in some detail, and not just in passing,” says Wooller. “By pushing a single-minded, product-focused agenda, individuals run the risk of alienating important NHS stakeholders and diminishing the value that drug company representatives can add.”
John Gerow, service team strategy partner at Ashfield, is using a radical approach to address this. His model separates sales reps from dedicated ‘service reps’, who offer support materials for patients that have nothing to do with selling a drug. He uses the high-end car industry as an example of somewhere this has already been done well.
“Lexus have been rated number one for customer satisfaction in that industry,” he says. “In 2012 they introduced a new role called a vehicle delivery specialist. Traditionally the sales rep sold you the car and you met with the same person when you picked up your car. They thought they could increase the customer experience by hiring different, more service-minded people for that second stage and paying them different incentives. It was a huge success – they increased customer retention, experience and profitability.”
In pharma, service rep calls typically centre around explaining and promoting patient materials, such as support programmes for patients and their families, instructions on how to use medical devices more effectively, or tips about lifestyle, diet and exercise, and do not speak about any drug products.
“We want to line up the whole model around the patient,” says Gerow, “so the patient service team is really driven to not talk about brands but to focus on delivering value for patients that are suffering from the disease state that you happen to be working within – and it doesn’t matter what that disease state is.”
He gives an example of service materials he has used when working on gastrointestinal diseases: “When your GP sends you for a ‘scope’ in the hospital at the end of a meeting you might have no idea what that means. We made a simple roadmap, which explains every step of the process – where you need to go, how long it takes, what the procedure looks like, etc. It’s simple language, and it also allows the patient to explain it to their loved ones. We fundamentally believe that if we can provide these simple services we can bring value to patients and physicians in a way that pharma hasn’t traditionally done in the past.
“Pharma usually thinks it’s about a push message, and that they need to push that message for five or six years after they launch a product. I think that’s a mistake. There’s a period of time where doctors really want to debate about a new product, but it very quickly becomes more about how you can service a group of physicians and nurses, rather than just coming in, giving them three key messages and measuring success based on that.”
Gerow has used this model in several companies and the feedback so far has been very positive. “In over 90 percent of cases doctors believe it’s highly valuable to them, and highly valuable to patients. There are some countries in Europe where 50 percent of offices have signs saying ‘no reps allowed’. In every one of those offices a service rep can get in, because the doctor absolutely sees the value of this for patients.”
Insourcing vs. outsourcing
Another recent shake-up in pharma sales came when Takeda decided to start insourcing its sales operations, leading some to wonder if this would be the start of a trend. This was particularly notable given that the original outsourcing model was developed at Takeda as a partnership with Ashfield in 2004.
“At the time, the Regional Account Director (RAD) model was a radical departure from how pharmaceutical companies went to market,” says Adam Zaeske, Takeda’s managing director, UK and Ireland.
“That was why it was set up as a partnership with Ashfield, which had a long history of providing its expertise to healthcare companies and in pushing them to change their model and to try new things. It worked extremely well – so well that many other companies have tried to emulate it over the years with varying levels of success.”
Zaeske says that the insourcing decision is not about changing the successful model, or the roles and jobs, but about taking what he describes as “the engine of the company” and bringing it in-house.
“We want to bring those people inside so we’re all part of one organisation, one team marching forward under one roof. Having all of those sales teams in-house creates a whole new set of opportunities for development, not only for those individuals but for those here who might want to go into sales or get some sales experience.”
But the continued need for flexibility in sales means that the partnership is by no means over between Takeda and Ashfield. “We are still going to work with them in some areas,” says Zaeske. “It’s not a black or white situation. If we were to do something similar again where we wanted to try something new and different, we would.”
Paul Frater, Ashfield’s operations director, expands on this. “I’m really excited about the future of the partnership. Although it’s very different to what Takeda previously needed, there are still opportunities for us to use our expertise, breadth of services and flexibility to complement their strengths. There are also smaller headcount pharma companies who like to retain a nimble, dynamic approach and who can really benefit from coming to a one-stop-shop for services, regardless of where the product is in its lifecycle.”
As such, Zaeske does not necessarily think this will be the start of a wider trend in the industry. “This is not something that every organisation should do and I would encourage people to partner with companies like Ashfield because they have expertise in this area, and they can help a company evolve.”
Frater says that this is another main reason why outsourcing sales will continue to be crucial for the industry. “We see the 12 years that we spent leading up to Takeda’s insourcing as being of significant benefit to both us and them. We were able to build, grow and develop their business to such a point that they were able to bring that back in-house. That’s almost the ultimate compliment, because I can show other companies that we can grow their business and then when they’re ready we’ll hand it back over in great shape. That is a huge benefit of outsourcing.”
Redbow’s Dancer agrees that companies should weigh carefully the decision of whether to outsource or not. “You have to decide whether your sales force is a core competency or not. If you believe having your own sales force with the relationships and the technical knowledge and being closely connected to the company is a core competency then that might point you towards building your own team. If you quickly need extra resource or you don’t see your core capability as building your own sales force there are plenty of very highly-specialised sales forces that you can outsource, and clearly those are actually pretty cost-effective and easy to manage.”
Once again, it seems that flexibility is the answer to any new complexities the industry may face. Pharma sales and its reps have shown a remarkable ability to adapt in the past, and if they keep that up the future could be very bright.
This article was originally published on PharmaTimes.com