Sales Report: Interactive Forces

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With sales forces feeling the pinch from physicians, Merck is turning to technology to realize efficiencies and help reps hit their targets. The firm has deployed tablet PCs to 5,000 of its 8,000 reps, placing it in the vanguard of of companies seeking to upgrade, not downsize, their sales forces. “It's a technological solution that leverages the advantages of tablet PCs, sales force automation, sample signature capture and all of our promotional materials,” says Gary Pond, executive director of multichannel communications at Merck. “We believe we can achieve certain efficiencies by having everything in one place.”

It's a simple enough concept—instead of juggling a raft of promotional materials, a PDA, reprints and cards, Merck's reps will be able to access all of their materials through a lightweight PC, allowing for smoother, more assured presentations and packing more information into each session. From sales aids to sample sign-off, it's all in the box. That's critical, because a few seconds of a physician's precious time wasted due to fumbling can mean months of alienation.
“The advantage is that we can cover a lot more information with the customer in a shorter amount of time,” says Pond. “Physicians that have a positive experience with the rep will be more likely to ask questions. If you're asked a question and you can't find the answer quick enough, you lose their confidence and they'll walk away.”

Tablet PCs also provide valuable data. “It gives you much better analytics,” says Mike Luby, president and CEO of TargetRx. “You have a timestamp of when you clicked through the detail and when the doctor signed.” That means more detailed post-game reviews and greater accountability for reps.

And the program ensures compliance with fair balance requirements, which reps must fulfill before dispensing samples. “This ensures that the appropriate balance information is covered with each customer on every call, and that's really important to us,” says Pond. Once fair balance is covered, the rep clicks on a tab marked “samples,” fills in the quantity and the physician's ID number. The physician provides an electronic signature for the samples and they are dispensed.
Merck declined to name its software provider for competitive reasons, but Pond says the promise of the technology is finally coming to fruition. “The software has really gotten to the point where it's scalable and dependable,” he says. Merck has outfitted all of its primary care reps with the PCs and is modifying the software for its hospital-based reps and some other specialty sales organizations.

New technology is just one of many tools companies are experimenting with as a means of increasing efficiency. “Everybody's working on some version of ‘Sales Force 2010,'” says Mark Bard, president of Manhattan Research. “They're all trying to figure out: What's the right size sales force? What's the correct allocation? What's the role of sample drops as opposed to education?”

Piloting new approaches
After a period of soul-searching in 2005, as the industry contemplated de-escalating the sales force race, most firms decided not to go ahead with sharp cuts, but instead to try and make do with what they had, preferring to retain sales expertise and maintain the muscle needed should their developmental prospects deliver. There's a consensus that the mirrored reps model—with five reps hounding a single physician—doesn't work anymore and may be counterproductive.

In place of one big idea, many firms are running pilot programs, trying out new approaches and redeploying their forces so as not to deluge high-prescribing physicians with too many visits from too many reps. “There's no magic bullet that anybody's yet discovered,” says Angela Bakker Lee, principal at ZS Associates. “Companies are moving away from the share of voice war to focus on the quality of dialogue with physicians, rather than the traditional one-size-fits-all, blanket the country with reps and sales aids approach, and that may mean new roles and responsibilities in the field, with different capabilities than reps have had in the past.”

Instead, some are targeting NPs, PAs and front desk staff more often. Many are reassigning some of their reps to serve as sample-droppers only. And all are ramping up various forms of non-personal promotion, as doctors' time becomes ever-more scarce and physicians rely less on sales calls and more on online media for timely product information.

“Physicians have access to a lot more channels of information these days,” says Manhattan Research's Bard. “Ten years ago, reps were really one of the premier sources of timely product info. That's changed. At the same time, companies are saying, ‘We can't diminish the role of the rep to dropping off samples.' They want the rep to be a relationship manager.”

Reps remain by far the most effective means of delivering information to doctors, says Bard, but other approaches are needed as well. “Reps are good at highly interactive, customized conversations,” he says. “Even the best strategy can't adjust to how Dr. John Smith likes his information presented. The challenge to pharmaceutical companies is that physicians are changing the way they get information.”

The non-personal is political
Merck is augmenting in-person details with e-detailing, though Pond doesn't see it ever replacing face-to-face contact. “It's changing the way we leverage that face-to-face communications channel,” he says. “The challenge to industry is how to best use all the different channels to meet the needs of the physician and help them do a better job of interacting with their patients. There's consensus that where we've been, with large sales organizations competing for reach and frequency, is not a sustainable model.”

While some companies are experimenting with “virtual” e-detailing, Merck has been developing a live e-detailing program where reps can interact with physicians remotely, typically outside of office hours, when busy docs can find time for them. “We find we have high-quality interactions with our customers through that space. The key is the quality of the information and content you can provide.”

Pond worries that if e-detailing is done insensitively, physicians might shun the medium. “Adoption of new technology is really commensurate with the quality of information available,” he says. “If we put information that's not valued by customers into these channels, others will fill the void. Most of the major companies are trying to do this responsibly, but it only takes a couple people to turn off the customer, and just as we're seeing with physicians voting with their feet by not providing access to reps, the same thing is going to hold true in other channels. It's up to the industry to make sure we're using it appropriately and respecting the time of the physician.”

This is particularly true among specialists, whether communications take place online or in-person. “If you're dealing with a small audience of 2,000 or 3,000 physicians, you don't want to frustrate them and spoil the relationship,” says Subbarao Jayanthi, who heads Campbell Alliance's sales force practice. As drug development veers away from mass-market products targeted toward primary care physicians, reps will be focused on smaller physician universes.

In addition to e-detailing, Merck is investing heavily in cutting-edge online resources for physicians. Along with the standard rich banner media and sites, the company has developed, a Web site featuring a suite of research tools including journal abstracts, a medical dictionary, clinical podcasts, anatomical slides, e-CME info and PDA tools. “That gives you an idea of the commitment we have to providing value to our customers,” says Pond. MerckMedicus offers the company an opportunity to burnish its corporate brand and build a relationship with physicians while fulfilling its high standards of service to the industry.

The site furnishes a valuable window onto the interests and behaviors of its users. “Although it's unbranded, it gives us some insight into our users,” he says. “A lot of those are younger physicians in residency or early in their practice. As those younger physicians who are more tech savvy get more experience, the technology will grow with them.”

MerckMedicus dovetails with Merck Source, a consumer-directed site that physicians can refer their patients to. “We make that available to physicians to provide to their patients as a way to ensure that they have a way to get information in preparation for a visit or post-visit, for disease information,” says Pond.

The benefits of happy customers
Altruistic motivations need not be the only ones for programming like Merck's. Better-informed physicians and patients are, after all, happier, and that could translate into fewer of the restrictions bedeviling sales organizations. “Public opinion drives policy in Washington, and if it improves, there will be less scrutiny on the investments these companies are making,” says Campbell Alliance's Jayanthi.

Being bombarded by reps has soured many physicians, but that's not to say that companies are scuttling the mirrored model altogether. “Instead of five reps, they're going down to two or three,” says Jayanthi. That's because even diminished ROI figures are eye-popping compared to other media. “Even in a saturated market, it's still positive,” says Manhattan Research's Bard. “If the numbers didn't work, they would be scaling back at a much faster rate.” And while large pharmas are holding steady on numbers, small- to mid-sized companies are ramping up their sales forces as their products come to market. 

“The mix is changing,” says Paul Mignon, president and COO of Ventiv Pharma. “Historically, if you look at a sales division, you'd typically have 10 people and one manager and that's it. The trend is, you're going to see six reps, two clinical nurse educators, two sample droppers and a manager. It gives greater reach and frequency and you can communicate different messages.”
Companies are demanding greater responsibility from each rep. One of the weaknesses of targeting physicians with many reps is that it makes individual performance nearly impossible to assess. “What they're trying to do is get a level of ownership and accountability for reps,” says TargetRx's Luby. “When you have four reps calling on a doctor, it's hard to know who's the star and who's the dog.”

They are also trying to target resources better, crafting more carefully-tailored sales plans for individual brands based on their lifecycles, and are making use of regional and seasonal pulsing, particularly for products in categories like antibiotics and antihistamines. “They can't be throwing the same resources at each brand, because each has individual needs,” says Nancy Connolly, SVP and general manager at PDI. “They might not use the same sales force for every brand.”

Some larger firms like Wyeth and Pfizer have implemented flex-time forces, both as a means of retaining staff who are looking to start families and to add scalability. Among smaller- to mid-size firms, says Luby, there's a movement toward giving reps a greater say in how they conduct their calls, based on their knowledge of the physician. “They're leaving more to the rep, so that they're not going to tell you to promote Brand A over Brand B, or that you must make eight calls. That allows you to measure not just sales but the quality of the sales force effort.”

Mixing it up
Rick Keefer, COO of Publicis Selling Solutions, sees clients giving reps sole responsibility for a given doctor's office on a portfolio of products. “That allows the rep the ability to cater their presentation based on the doctor's specialty, prescribing propensity, managed care affiliation, etcetera,” says Keefer. It also allows reps to build relationships with physicians, who are more likely to make time for a detail from a rep they know and respect.

Part of the crunch on physician time is attributable to managed care, which provides doctors with an ever-larger volume of paperwork to deal with. But Medicare Part D has redrawn the map in other ways, as well—as some firms reassign personnel to liaison with managed care organizations, and others experiment with regional field forces as a means of mitigating the impact of formularies on their bottom lines.

And as physicians become more inaccessible, companies are shifting their focus to other healthcare professionals. “We're starting to see more NPs and PAs turn up on target lists and being considered as high-value targets,” says Connolly of PDI. That's not surprising. Verispan recently reported that NP and PA retail scripts increased 22% through August compared to the same time period a year ago, while physician retail prescriptions increased only 2% for the same period. 

“There's a lot of goodwill and a desire not to frustrate customers,” says ZS Associates' Bakker Lee. “The industry gets a bad rap for what for many years was a good model. Physicians needed and wanted that information. It just escalated.”

SIDEBAR: Keys to maintaining compliance

With prosecutions for off-label marketing on the rise, training reps to stay within the letter of the law is more important than ever. So even before Schering-Plough's $435 million settlement for Medicaid fraud and off-label marketing last August, the company was overhauling its training to put compliance front and center.

“Fred [Hassan] said he wanted a different approach to compliance,” says Brent Saunders, SVP global compliance and business practices at Schering-Plough. “He wanted to really put it out front as part of his commitment to changing the culture of the company.”

The message most reps get, says Saunders, is that compliance is an afterthought. “In most companies, when you train a new rep, you spend nine days of that two weeks telling them how to sell and then at the very end, you bring in the compliance people and say, ‘Now, this is what you can't do.' We said that doesn't make sense.” Schering-Plough interlaced compliance topics throughout its sales training courses. Under Hassan's leadership, the company has also taken a more science-focused approach to marketing.

“We found that historically, it was around 70% about selling and 30% about the science behind the product. We flipped that.” Now, around a quarter of a detail is devoted to marketing a product, while three-quarters is devoted to the science, he says.

Schering-Plough has also adopted three golden rules set down in training and embossed on a variety of company paraphernalia: DMs and reps are instructed that the company does not buy business; only markets products in a fair and balanced, in-label way; and only hires healthcare professionals when absolutely needed and for sound business reasons, paying fair market price. “If our sales force and our DMs follow these three rules, 98% of our compliance issues are going to be gone,” says Saunders.

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