salesforcerport09.pdfJust a few short years ago most doctors were technophobic. You would have been hard-pressed to get a physician to consider electronic prescribing or logging-on to a web-based medical conference.

What a difference a few years can make. According to Manhattan Research, in 2009, 87% of US physicians are considered “ePharma” physicians. In other words, they use the internet and other technologies to interact with drug and biotech companies. That’s up 23% since 2004.

The pharma industry is paying close attention to ePharma physicians. They are a force to be reckoned with.

With less time on their hands, doctors aren’t relying on traditional sources of information such as journals and medical meetings as much as they used to. Instead, they are turning to the internet where they can view a web conference on-demand. That option offers docs the ability to have their information needs addressed while sitting in front of their PC after hours, or on the weekend instead of interfering with their day-to-day practice. Data from IMS Health reveals that traditional face-to-face, primary care detailing has been on the decline over the past several years.

“Doctors are using the internet a lot more than ever before to get information, we see that through our e-detailing and web conferences,” says Joe Regan, vice president, US sales for Millennium: The Takeda Oncology Company.

Millennium, which offers a number of online programs, is part of a growing number of pharma companies that are responding to the increasing reliance that physicians have on web-based information. Millennium has jumped head-first into the digital sales age with a variety of sales and training tools that include e-details, online seminars and virtual training sessions.

Regan noted that part of the challenge from a sales side is helping docs to organize relevant information to their practice. “When you start doing these searches on the internet and looking for information, it can be overwhelming. Regan added, “what we do is we integrate our sales representatives efforts into that, looking through the eyes of the physicians—if you think about the number of offerings and information that they are bombarded with on a day-to-day basis here is where a sales rep is critical in ensuring that the right program or the right product fits that particular physician’s need.” Sales representatives serve as a resource to let physicians know of online programs that are available.

Industry analysts also predict an increasing role for the sales rep in one-on-one, rep-to-doc e-detailing, via teleconferences and webcasts. That’s an area that Regan says his company is exploring.    

Regan’s colleague at Millennium, Christophe Bianchi, executive vice president of commercial operations, explains that fewer and fewer docs are attending medical conferences and are opting to get the abbreviated version, the highlights of what happened on the web. “It works extremely well. I think the challenge that people face right now is the balancing act of time spent, versus data they can collect,” says Bianchi.

Paulash Mohsen, vice president of strategy for Pfizer’s Primary Care Business Unit, commented that Pfizer’s whole model is premised on educating physicians and that the time squeeze has obvious implications for the pharma industry.

“The physicians need for information has actually gone up, not down,” he says. “Technology is a big factor across all of healthcare, including data capture, electronic medical records and prescribing, as well as a growing factor in the way physicians’ access information.”

Reinventing the Rep 
Insiders point out that the sales force landscape remains under pressure and it will remain that way for the foreseeable future. As physicians increasingly have access to a growing body of clinical reference resources, product information, drug reference databases, comparative literature and clinical trials data “on demand” through digital channels, the likelihood of the individual sales rep to serve as a differentiated, proprietary, timely and convenient resource drops over time, notes Mark Bard, president of Manhattan Research.“That is not to say the rep has no role in 2009 or 2010. In fact, the rep still wields significant influence in the product and treatment information mix for the average physician today.” Bard asserts that as the number of channels increases each year, the ability of the rep to go above and beyond those other channels—that undergo innovation each year—becomes harder with every passing year.  

As pharma companies become leaner, they are also becoming smarter about how they handle costs and there is a realization for the first time that there is another way to do things. “Most of our customers are exploring and brainstorming about new business models for their commercial teams and how they achieve intimacy with their various stakeholders (prescribers, payers, etc.),” says Mark Fleischer, senior vice president and general manager North America for CegedimDendrite.

Bard points to a continued migration towards digital resources for product-specific information. Digital resources, collectively, now rival traditional offline sources in terms of time spent by a physician audience. “While the rep remains the single largest traditional resource, the collective value of the online channel is eating away at the allocation of time they spend using traditional resources such as journals, conferences and of course the individual sales representative,” says Bard.

Millennium’s Regan says that while the traditional face-to-face encounter between rep and doctor will always be there, the dynamics of that relationship is changing.  “I think that we have to address the question: What value are you bringing to me? I think it’s important that we really begin honing in on the needs of those physicians. As long as we do that, the rep will always be relevant.”

Mark Gleason, SVP, corporate development for Aptilon, says that in the new environment, well trained reps will talk about a company’s drug when it’s convenient for the physician.

“The doctor-rep relationship that pharma has built the market around has become much more challenging,” he says. “Alternative access channels, such as applications on a physician’s desktop, web-based tools and smart phones, increasingly are becoming a part of physician engagement.”

According to the results of a study by Manhattan Research, “Physicians in 2012: The Outlook for On Demand, Mobile and Social Digital Media,” physician smartphone adoption rates will experience significant growth over the next few years. Currently, 64% of US physicians own smartphones, but this will increase to 81% penetration in 2012.
Pfizer, for its part, is embracing a broader web arena including social media.

“We entered into a strategic partnership with Sermo to jointly develop services that provide value for and leverage the power of Sermo’s online physician community,” says Mohsen.

Industry experts’ note that as the commercial model changes, so is the amount of time the field reps are getting. As a result, drug companies are looking at being more productive with the field forces that they already have in place.

“What you’re seeing now is a change from a highly compensated rep in certain areas to a little bit lower compensated rep for products that are a lot farther along in their lifecycle,” says Howard Drazner, president of Pharmakon, a PDI company that provides Peer Persuasion Programs.Drazner notes that pharma companies have also migrated more to what is called “non-personal promotion.” That’s really the buzz today where they’re trying to leverage both personal and non-personal together in more of a unified strategy where they can get more time with their customers based on tactics that their customers like to participate in.”

Online training
Not only is the pharmaceutical industry using digital channels to disseminate information to physicians, internally they are using web-based programs to train their sales reps. The use of 3D animation, interactive games and video is catching-on.

“We have interactive training programs that are web-based,” says Millennium’s Regan, who added that the initiative has shaved a week off of front end training and says that it’s a much more effective use of time.

“Educational games now provide an additional vehicle for the pharmaceutical industry not only to communicate scientific and clinical information but to engage, educate and inspire audiences (physicians, patients and even caregivers) and with the most recent PhRMA guidelines, we don’t see that changing,” said Andrea Bielecki, managing partner, InViVo Communications. InViVo specializes in 3D medical animation, medical illustration and interactive media.

Jennifer Randall, vice president of sales, Maestro eLearning explained that part of the solution is to “ditch the text” and engage individuals visually so that they are interested in learning the materials. “We also like to tell a story through the materials so they can relate it to their own experiences and apply their own knowledge,”  she says. Maestro specialized in online training for sales reps at healthcare companies.

A recent US Department of Education meta-analysis and review of online learning studies revealed that classes with online learning (whether taught completely online or blended), on average, produce stronger student learning outcomes than classes with solely face-to-face instruction.      
Looking ahead
As the pharma sales force landscape undergoes significant change, what will the future look like? The number of pharma reps in the US has declined from its all time high just a few years ago. The bottom is expected to end up somewhere between 55,000 to 65,000 reps, almost half of what the force was half a decade ago.Amy Lombardi, executive director of marketing at PDI, expects to see a smaller, more educated and more informed prepared core force of pharma sales reps whose ability to access the physician and convey information is going to be enhanced through all the new channels. And with all the changes that are taking place—will the relationship between rep and physician become easier or harder? “It will depend on how well pharma companies actually listen to what the prescribers are saying they want with regards to their relationship with the pharmaceutical company and its information channels, both rep-based and electronic,” says Lombardi.

Studies indicate that docs are tired of having an army of reps sitting in their waiting room interrupting their day. Physicians still want to see reps—but when they come into their office they better bring value, they better know what they’re talking about and they better be able to have a deeper, more meaningful conversation with the doctor not just a very high-level canned pitch of days of old.

“It’s imperative for pharma companies to truly listen to what physicians want in crafting their future strategies in order to deliver quality, meaningful interactions with them. If they don’t listen, getting access will be difficult,” says Lombardi.

Millennium’s Regan asserts that “online” has profoundly changed how Oncologists, for example, get their information. Historically they got information through journals, meetings and sales reps and while they will continue to get that face-to-face with sales reps, Regan says that the industry has to be smarter in how they apply it.

In the new universe, instead of going to those meetings doctors now have the ability to access the same information online. “Instead of reading through every journal doctors have the ability to be able to find that information very quick and that’s very pertinent to the practice—as opposed to just cruising through each article,” Regan says. “The companies that are going to be successful are the ones that understand that it’s not just in providing information but its also organizing and delivering it in a manner which for that physician, fulfills the specific need that they are looking for, that helps manage their patients more effectively.”



E-Health: How doctors use communication technology
Increasingly, healthcare providers—from primary care physicians to specialists —have been incorporating communications technology into their practices to alleviate the tension between efficiency and quality in patient care. The more popular tools and uses include:

Email: Physicians commonly ask patients to email information they are unable to provide during office visits, such as lists of current medications, results from tests administered by other practitioners and so on. Physicians also encourage patients to email rather than call with disease- or treatment-related questions. Email as a communication tool enables physicians to indicate their willingness to provide attentive care while at the same time keeping the actual in-office visit free from inefficiencies such as trying to jog patients’ memories about current treatments.

DR: You can also email directly to me or my secretary or my nurse if you need a refill, or need to change your prescription or if you have a question for me, or if you want to pass any information on to me here. (Rheumatologist with new-to-biologic patient)

Clinic-Specific Internet Sites: A growing number of physicians are developing their own websites and online patient registration tools as a means to keep patients informed about health- and treatment-related topics that concern the local community. The advantage physicians have in these websites is the ability to post content that is relevant to the local patient community, as well to proactively communicate with select patient groups via email addresses provided during online registration.

DR: The advantage to signing up on our website is we have your email address and so when our flu shots come in, we can send an email to everyone. (Primary care physician with OAB patient)

Health-Related Internet Sites: At times, physicians point patients to online health resources to supplement disease and treatment education provided during office visits. These resources range from branded and unbranded websites to independent resources that help patients become better managers of their own health. Because physicians have limited time to communicate and check patient understanding of treatment information, they often look to these resources to help shoulder the burden of providing lengthy and comprehensive patient education.
DR: I’d use that until the tree pollen is gone.  And if you get on, the website, they’ll send you a daily email if you tell them your ZIP code. (Pediatrician with allergic rhinitis patient)

With the average in-office visit lasting less than 10 minutes, physicians do not have the time to conduct comprehensive patient education, nor to attend to the softer communication challenges of encouraging patients to remember forgotten information or share latent concerns and fears. Through these tools and resources, physicians are effectively able to close the in-office visit with an open-ended tone, reminding patients that advice and assistance are never more than a few keystrokes away.

Jeff Kozloff is co-founder, president and CEO at Verilogue and David Franke is director of linguistic insights and analysis at Verilogue

Pharma marketing: A model for maximizing
The sales force remains pharma’s most effective means of building product awareness, stimulating trial and adoption and growing demand for branded drugs. Representatives rely on marketing to produce materials to communicate and position a product favorably and aid in motivating the physician’s prescribing habits.

Companies are increasingly challenged to provide materials that are useful to all of their stakeholders: physician, patient and payer. But materials must also be useful for the sales force. The challenge for any company is to identify the most valuable materials for all stakeholders.

Re-engineering the Process
Shire recently used a simple but powerful methodology to clarify which programs and/or materials are most successful and then redirected their expenditures toward those tactics to increase both rep effectiveness and physician prescribing behavior.

The ADHD business is very complex and there are multiple groups of physicians and patients to address. Of the many promotional materials developed for this broad swath of the population, Shire faced a key strategic question involving the Pareto principle: did 20% of the materials produced deliver 80% of the value to the sales force? If so, then promotional effectiveness could be significantly improved by understanding which promotional materials had the greatest value to the sales force.

Healogix was asked to carry out research with the sales force to get answers to these two questions:

  • Which promo pieces were most effective (according to reps)?
  • Would the company be better off spending more money on fewer programs rather than a diverse portfolio of materials?

Identifying What Works
With the cooperation and direction from Shire’s sales and marketing leadership, over 80% of the sales force participated in a secure 15 minute internet survey. The survey utilized the MAXDIFF method, which requires respondents to repeatedly indicate which attributes are best and worst. It is a simple but robust task which allows for testing a large number of attributes in a variety of contexts.

Each sales rep evaluated 40 tactics in 12 separate tasks. Each task consisted of a list of five attributes and reps evaluated how well the attribute engages the physician in dialogue and whether the information increased physician prescribing, with the goal of identifying information that achieved both objectives. The output assigns a winning percentage to each sales tactic on each dimension—how often each tactic “wins” against all other tactics. The most valuable tactic overall won decisively in both categories— 91% of reps reported that Program A allowed greater access and 95% said it increased prescribing volume. The next closest tactic, Book A, ranked 72% and 89%, respectively.

Regardless of rep tenure or share, reps consistently selected the same tactics as most and least valuable. The survey showed that the top five tactics accounted for 20% of all the “wins.”

The Results
As a result of this engagement, the company was able to determine which programs and/or materials really provided significant value to the sales force and to the physician customers whom they serve. Shire has continued to use other approaches to drive maximum value from its sales force to its customers.

Harris Kaplan is CEO and founder at Healogix and Tim O’Rourke is chief research officer at Healogix