As 2020 dawned, life science companies seemed poised to shake things up on the digital transformation front. The industry’s use of digital tactics to reach physicians had hit record highs over the prior three years, according to MM+M’s 2020 Healthcare Marketers Survey data. If not a breakthrough year vis-à-vis innovation, 2020 would certainly not be business as usual.
Along came the COVID-19 pandemic and the ensuing lockdown. Pharma’s move toward remote technology and data had been progressing at its usual glacial pace. But once in-person, face-to-face access between reps and HCPs was put on indefinite hold, the notion of the gradual digital transformation became obsolete overnight, forcing firms to adapt and execute their long-term commercial plans.
Over the long haul, COVID may or may not shorten the road to digital maturity. Nevertheless, a new, universal truth took hold among healthcare marketers last year.
“Because of the disruption caused by the pandemic, that meant that concern about their own disruption was gone,” says Derek Choy, cofounder and COO of life-sci analytics firm Aktana.
Because such concerns have been relieved, commercial leaders have felt more emboldened to enable digital channels — and to think about how to integrate them more quickly than they did pre-COVID, Choy adds. On the other hand, while leaning on digital media preserved HCP contact, the experience also exposed several challenges with the way commercial organizations are making the aforementioned switch.
First, let’s get the existential question, “Do we really need reps anymore?” out of the way. The answer: Yes, we do.
There’s no doubt that the industry has suffered from a historical overreliance on the sales rep channel, and we now see the pendulum swinging the other way. It’s also an equally settled fact in industry circles that in-person HCP contact isn’t the end-all-be-all.
“Face-to-face is no longer solely in-person,” confirms Sal Paolozza, senior director of sales operations for Antares Pharma. “Whether in-person or over the phone or internet using a
GoToMeeting app — as long as you’re face-to-face with the physician, that counts as face-to-face.”
Indeed, Zoom meetings are now counted as another of the myriad arrows in the healthcare marketer’s quiver. That’s not just because they enabled business to continue through last spring’s COVID surge (and likely the current one), but also because they proved themselves worthy of future use, promising longer, richer interactions with the industry’s most important and elusive customer.
“There’s a realization by all the reps and all the companies that [rep/HCP virtual meetings] are not going away,” Paolozza stresses. “I don’t know what the percentage is going to be, but it’s definitely staying.”
According to a Sermo survey, remote sales rep interactions are expected to comprise a larger share of doctors’ interactions with pharma, while in-person interactions are set to decrease. Remote sales-rep interactions, meanwhile, are about 20% shorter than in-office ones. With those times trending downward, and doctors becoming more sensitive to traffic volume because of all of the disruption in their own practice settings, reps will need to be more prepared and strategic in order to lengthen calls.
In an October Digital Health Coalition survey asking pharma marketers for their take on COVID’s business impact, 71% of respondents landed smack in the middle of the change spectrum, saying some things will shift while others will stay the same. Indeed, while COVID may have accelerated pharma’s shift to digital and prompted companies to roll out digital tactics (whether ready for prime time or not), it remains to be seen if this is a major turning point or a short-term detour.
Digital won’t drive the rep toward extinction. “There will always be a role for people. Relationships matter,” says Veeva SVP, commercial strategy Paul Shawah. “Also, digital alone has one level of effectiveness. Digital combined with a human being is significantly more valuable because the rep is able to curate resources and leverage that relationship — family, kids and sports. That level of trust makes digital more powerful.”
Choy agrees, adding, “Essentially, the pandemic has meant that the industry has finally evolved to this truly mixed model of engagement, where you use remote meetings, events, phone calls, in-person visits and emails.”
Not that it’s been a smooth transition to this new world order. After a two-week period, during which most of the pharma world was adjusting to the new reality, reps and medical science liaisons (MSLs) didn’t avail themselves of remote-meeting tech right away.
Back in April and May, right after lockdowns went into effect, “Multiple [pharma] organizations were scrambling to put their MSLs in PPE and try to get them back into hospitals. Medical affairs quickly realized that that was a failed attempt,” recalls Robert Groebel, VP of global strategy for Monocl, a med-affairs specialist firm.
That brings us to a second challenge, which isn’t as much a challenge as a reality: Reps still rely heavily on their relationships. As numerous drugmakers have noted when recounting their COVID experiences, it was their preexisting connections with KOLs that paved the way for the Zoom transition. If there’s one constant amid the turbulence of the past year, it’s the need for strong relationships, both between KOL and rep as well as between pharma company and vendor.
Managing those relationships is getting tougher, though. For instance, average call activity for Antares’ reps has risen from six or seven per day to eight or nine, Paolozza reports.
“Reps are asked to do more,” Paolozza notes. This includes recording not only the call itself, but the activity around the visit and related administrative tasks.
Meantime, physicians are getting digital fatigue. “What I’m hearing from my reps is that, yes, there were a lot of fruitful conversations. But because of the length of the calls and the richer data, and given the increase in companies using the technology, physicians are getting inundated with requests to do remote engagements,” Paolozza says.
As a result, physicians are becoming more selective in who they’re actually engaging with remotely. That’s made it harder for reps to schedule their calls.
Personalization is key, suggests Salesforce.com global VP of life sciences Ian Marks. “You want to have a greater understanding of the needs of patients and HCPs so that you can effect better outcomes for them.”
Along those lines, the digital shift has forced medical affairs people to rethink their metrics. “They had always held on to the length of time that they were talking to someone as a measure of impact,” Groebel explains. “A phone call isn’t going to last 45 minutes; it’s going to be five minutes, and an email is even shorter. But if you delivered on the need for the expert, then you’re adding value.”
However, instead of getting personal, less digitally adept pharma companies broke one of the fundamental rules of digital marketing. When their in-
person detailing taps suddenly ran dry, they merely took all their paper-based detailing collateral and digitized it.
“You can’t just digitize your content,” says Paolozza. “You have to refresh your digital content on a regular basis.”
A third and perhaps underappreciated aspect of the pandemic’s impact on sales efforts is its effect on predictive analytics — the next-best-action tools powered by AI. Amid the fast-changing conditions of early 2020, the suggestions on AI became even more important, Paolozza says.
There was just one glitch. Any cognitive tool is only as good as the data used to train it, and in this case the AI had been programmed to know what makes a physician tick under normal conditions. Algorithms then calculate “triggers”: How many days should a rep wait between calls? In which channel does the clinician prefer to receive information? What’s the best day and best contact sequence?
All of this is to say that when many medical offices closed their doors, suddenly the AI wasn’t making recommendations upon which reps could act.
“When the pandemic hit, the biggest complaint from the reps was, ‘You’re giving me feedback, but the account is closed’ or ‘You’re telling me to go see them, but they’re not seeing folks,’” recalls Paolozza. “The channel-preference dynamic started to become a roadblock.”
But it was a roadblock that could be overcome. “Around February and March, every physician came in as no-see. We had to change our algorithms to only make recommendations for digital channels and remote and virtual interactions, instead of in-person ones,” Choy says.
“The outcomes of what you can do from a suggestion are a little bit more limited compared to what they were one year ago,” Shawah adds.
Then again, he notes, the data generation is better in virtual meetings. Over the long term, that will be better for AI modeling and some of the next-best-action suggestions. Similarly, virtual meetings often provide better avenues for follow-up.
“What happens during a virtual call or even in an email, if done the right way, is very much trackable,” Shawah notes.
That more robust data set couldn’t have arrived at a better time, because the pandemic upped the ante on the need for sales and marketing to better target doctors. “The pandemic has really increased the need for more accurate, more specific information around physicians, so that marketing and sales can improve how they target and how they personalize their messages to physicians,” says Marks.
The flip side of the coin is that digitally savvy sales forces are leaning on their marketing colleagues to pump out fresh content. They need better technology and better content in order to get precious time with physicians.
“Within our marketing team, there’s a lot more pressure for them to output digital material faster, so that our reps have fresh content that they can share with their physicians in order to get that virtual time,” says Paolozza, whose firm launched one of its branded injector devices last year.
A rep, he notes, sees a physician anywhere from six to eight times a quarter. They need to have content — particularly new material — to share with them.
“That has been the biggest challenge,” Paolozza continues. “In person, you spend two minutes with the physician — just remind them of the product — and you spend time with the staff. Virtually, that’s not the case. No physician is going to spend 30 seconds with you virtually unless you have something to say.”
And what’s the most popular content type among physicians? It’s still rep-to-HCP email, with Zoom-based video calls running a close second, according to the Digital Health Coalition.
But emails pose a risk as well. Choy has seen pharma’s outbound email traffic rise threefold in the U.S. and five-fold in Europe, both to cover more physicians as well as to increase frequency per physician. In spite of that increased activity, open rates have increased slightly or remained roughly flat, he reports.
The risk when engaging physicians via non-personal digital channels is that, well, they’re less personal. It’s difficult to ensure meaningful engagement and relevance.
“You end up with quite a lot of digital fatigue, because you have multiple brands and companies sending emails to physicians. And the physicians, just like anyone else, perceive that as spam.”
Innovation didn’t stop just because there was a pandemic. Neither did commercial organizations. In order for physicians to make informed decisions in a specialty marketplace, they need effective communication channels.
That may translate into less feet on the street and more enterprise software seats. But as the pandemic gives the industry an opportunity to rethink its commercial models, to the extent companies invest the time and energy to examine how information is being delivered and who’s delivering it, physicians will be better served.