Taren Grom, Editor
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By Taren Grom
With the ongoing transformations in pharmaceutical salesforces, it’s become vitally important for sales representatives to provide value beyond the marketing message. Pfizer, Wyeth, AstraZeneca, and many other major pharmaceutical companies are taking feet off the street. This reversal in the long-held “arms race” strategy has analysts and physicians nodding in agreement that reducing the number of sales representatives congregating in the waiting rooms is long over due. By reducing the number of sales representatives calling on one physician, in some cases, from four to one, the question becomes how can companies effectively and competitively market their key brands in crowded therapeutic markets to physicians? And, just as important, how can they provide real educational value to their physician audiences? Some say the answers lie in providing a more valuable scientific and targeted approach to sales calls. Best Practices For Selling Beyond the Message Many industry experts agree that selling beyond the message means that the sales representative must be a credible and knowledgeable resource to the physician. This requires providing valuable information and answering physician objections according to company messaging. “In addition, representatives must have the company knowledge that allows them to help physicians get answers to questions that they are unable to answer,” says Peter Sandford, executive VP of NXLevel. “In the regulated healthcare environment in which we work, selling on message is vital, but it is the additional knowledge that the representative has that can also be useful to the physician. This allows them to essentially sell beyond the message, but still within the guidelines.” Oftentimes, it is the connection or relationship that sales representatives have with physicians that generates the most success in terms of uncovering what their needs are. “Precall planning and effective questioning techniques serve as the foundation for uncovering the needs of customers and their patients,” says Bryan Horveath, VP and managing director, Ventiv Professional Development Group. “Armed with this knowledge, a skillful representative can then align the marketing message with the expressed needs and provide strategic value to the customer and patient.” Catherine Baker, principal at Frogkick, agrees that the key is for sales representatives to make a “professional” connection. “They need to know the physician’s professional interests and align resources that support these, for example, studies, books, or professional associations,” she says. “They need to become a trusted advisor and weave information pertaining to those interests into their sales discussions. They should consider the ‘human factors’ of the selling process and know personalities and behavioral styles. And they should adjust their style to sell to the style of the physician.” Industry experts agree that good sales representatives should provide added value in the form of staff and patient education and they should design this education for specific patient populations. Ms. Baker says this information should be delivered in different forms, for example in-office programs, brochures, DVDs and videos, online communities and references, community-based presentations, and workshops. “Staying competitive in today’s market requires representatives to have a much broader understanding of the managed-markets arena, including specific product reimbursement issues, Medicare Part D plan coverage, and patient assistance programs,” Mr. Horveath says. “They need to go beyond knowledge for knowledge’s sake; companies need to train their salesforces to use this type of information strategically.” This consultative selling approach is a best practice that can help physicians achieve their desired results for their patients and their goals for their practices. “Companies need to understand what truly drives physicians,” says Rolando Collado, president of OnCall LLC. “Sales representatives need to stop talking about win-win situations; they need to make win-win situations come to life for their physicians.” According to Celeste Mosby, VP of industry marketing, pharmaceutical, biotech, and medical devices, at Wilson Learning, because physicians are providing less time to sales representatives and some are making drastic changes in office protocols, it is critical that representatives are prepared to show unexpected value. “Selling beyond the message is a hard paradigm shift for some companies, but can lead to big opportunities for companies that are successful in helping physicians and their office staff view their sales representatives as trusted advisors that add value to their practice during every call,” she says. “Representatives have to get better at sharpening their discovery skills. Uncovering the critical success factors of individual physicians and their practices will enable sales representatives to align solutions that will help physicians have a greater impact when treating patients and greater efficiencies when operating their practice.” Ms. Mosby says these factors will differ based on the physician’s patient population, demographics, and specialty. Representatives who effectively support the life cycle of the brand understand how to impact the total physician and patient experience with their products. Industry experts agree that the days of the traditional detail alone being enough to sell products and satisfy physicians are over. “Sales management today must recognize that sales representatives need to play a much larger role in building value-based relationships with their target physicians,” says Jeffrey Zornitsky, senior VP and practice area leader, sales performance improvement, TNS Healthcare. “It is now clear that physicians want a total, coordinated experience that enables them to provide the best possible patient outcomes. To be effective, physician experiences must integrate multiple value-add activities, including, for example, patient management and compliance programs, as well as educational and information services. For optimal results, today’s sales managers must bundle together a mix of sales and service offerings to create practice-based solutions for their target physicians. As a result, successful sales representatives must know more than their product’s message. They must be knowledgeable about and have access to their company’s support services and programs. Just as critically, they must understand their target physicians’ needs and be prepared to provide the right combination of activities, as well as the appropriate scope and level of support, to meet those needs.” According to Mr. Zornitsky, among the sales representative behaviors that doctors have identified as most important to them are therapeutic class knowledge, respect toward competitive products, the ability to engage physicians in meaningful dialogue, and respect for the practice’s time constraints. It’s Not Just About the Physician In today’s professional sales environment, it is more important than ever to develop communications and relationships with the physician’s supporting staff. “Physicians clearly are focused on the science of medicine when making prescribing decisions, but the team that supports the physician also has a vested interest in making sure that the products used by the practice support patient-management needs as well,” Ms. Mosby says. “Nurse practitioners, physician assistants, and office managers put a high level of value on sales details when they can also discuss their needs regarding reimbursement or insurance coverage, formulary status, Medicaid and Medicare information, and most importantly patient-education materials.” Going deep into an office to really get to know the particular needs of each physician and office is key. “We train our sales teams on the total office call, which focuses training and performance management specifically on going beyond the message to communicate and provide value to every key member of a healthcare professional’s office,” says Rick Keefer, chief operating officer at Publicis Selling Solutions. Mr. Horveath agrees that representatives need to consider all of the customers in the office down to the billing manager, and determine which information makes his or her job easier. As the dynamics of the industry continue to change, so too does the definition of our “customer base,” Mr. Horveath says. “The total office call has been employed by many organizations to train representatives to reach all decision makers within an office, not just those writing scripts,” he says. “The important facet of this model is identifying the needs of each member of the office staff. Those needs may include delivering better patient care, identifying patient assistance programs, or helping with reimbursement issues. Today’s sales representatives must fully align themselves with each account to maximize the value they bring and the impact they have during each call.” Just as the needs of healthcare professionals change based on their role in the office so too must the messages. Mr. Sandford says specific training must be created to addresses the needs of the target audience and the experience and expectations that each particular audience brings to the discussion must be recognized and spoken to in a manner that they find useful. “One size, or one message, does not fit all,” he says. “Physicians don’t have the same concerns as nurse practitioners so representatives need to be prepared to address their particular needs if they are going to be of value.” Mr. Collado adds that the nurse practitioner might be more concerned with patient education and compliance issues while the physician assistant may be focused on diagnostic issues or problems, such as potential side effects or contraindications of a particular medicament. “The physician is more concerned with the general management of his or her practice as well as the overall management of a patient’s short- and long-term needs,” he says. “The messages that are delivered must clearly and concisely address their primary concerns, help them overcome limitations, or unlock potential opportunities.” Because nurse practitioners and physician assistants, in most cases, are tasked with delivering primary healthcare to patients, Mr. Keefer says it’s important that there is solid, ongoing training to prepare representatives to provide information and materials to further educate NPs and PAs. “In addition to providing them with samples and patient information, sales representatives should develop long-term partnerships with these important healthcare professionals,” he says. Best-in-Class Training Techniques To improve the dialogue between the sales representative and the physician, as well as his or her staff, there are several training techniques that experts in the field believe provide the best results. “Training representatives on how to anticipate questions that are on the mind of the physician can prove to be a critical differentiator in creating and positioning training techniques,” Ms. Mosby says. “Tailoring discussions that can address these questions by integrating the technical details of the product and the right approach to the various styles of physicians can help improve these interactions. The right to engage in dialogues with physicians is earned by building credibility and trust. There are four main factors that help build relationships with physicians — propriety, competence, commonality, and intent. Training that helps to develop skills in identifying physicians’ expectations in each of these areas before calling on them will undoubtedly impact and improve the dialogue between representatives and physicians.” For Mr. Horveath and his teams, one of the most effective tools they use is DialogCoach, which is a personal role-play simulator that allows sales representatives to practice and refine calls at their own pace. He says by creating this safe harbor, DialogCoach promotes skill development without the feeling of being evaluated or watched. DialogCoach applies a scientific approach to creating cognitive recall. The program improves message delivery by preparing sales people to quickly and effectively respond to key questions or objections commonly raised by their customers. Other best practices, according to Ms. Baker include roundtable discussions with physicians relative to therapeutic choices, practice challenges, and the future of care, which provide a true sense of what is faced on a day-to-day basis and what can be anticipated for the future; role-plays performed in a simulated real setting with real doctors; and online topic forums with professional communities where doctors share their voices and have representatives explain how they would address various issues in a call. “Another best practice is to have top sales performers serve as mentors in the field,” she says. For Mr. Zornitsky, best-in-class training approaches need to begin with viewing the physician as the customer. “Effective training is doctor focused — and starts with understanding the expectations and requirements of the physician customer,” he says. “Sales representatives have to be trained to meet those needs, which means they have to know how to take advantage of the full range of pharma services their company makes available to physicians and create the right mix of services for their physician customers.” In addition to providing product information, Mr. Zornitsky says sales representatives must be prepared to help physicians benefit from the range of service offerings — from practice management support to education programs to Internet-based services. Through a variety of multichannel approaches to training that are now the standard — from the standard low-tech to multimedia, such as Web-based training and assessment, interactive preceptorships, Web conference training, Podcasting, and so on — Mr. Keefer believes that it’s imperative that sales representatives are trained to hit the ground running. “Training should not be approached as a one-time event,” he says. “Training should be a continuous ongoing process that combines home study, workshops, e-learning, performance management, and so on, with continuous focus on refining their skills such that they are providing real value to healthcare professionals.” All good sales representatives, must have a keen understanding of the needs of patients and physicians. According to Mr. Collado, just as important, representatives today must have an understanding of the business drivers impacting healthcare. “Most representatives receive an abundance of clinical training, yet few receive the business training that helps him or her understand the ‘behind the scenes’ management of a healthcare practice,” he says. Give Physicians What They Need and Want If one of the keys to improving the sales representative/physician relationship is providing real value then it is imperative to address the types of data physicians need. “Physicians are looking to representatives to provide value-added services to their practices by offering clinical-study data that are valid, reliable, and relevant to their practices,” Mr. Keefer says. “The ultimate goal is to provide the data and information that will help physicians provide better healthcare to their patients. Representatives who can thoroughly understand a study, assess the physician’s needs, and present data to meet that particular physician’s need are professionals who will strengthen that relationship and really stand out from the crowd. “Patients’ concerns are the physicians’ concerns: cost, efficacy, tolerability, convenience, and so on,” Mr. Sandford says. “Any data that speak directly to those concerns are what physicians are looking for. Again, this information must be compliant with OIG guidelines.” Although detail pieces usually cover the important information on indications, efficacy, and safety, physicians really value the clinical data found in journals and clinical reprints, Ms. Mosby says. “Comparisons of products in the same drug class are very useful, because it gives physicians the information they need to make important decisions regarding the various patient types they treat,” she says. “Customizing the presentation of these data by aligning them to specific physician’s interests, needs, and objections will help to highlight critical information that is important to making treatment protocol decisions.” In addition to the traditional peer-reviewed, head-to-head product comparative data, physicians now are focusing on patient outcomes and evidence-based medicine clinical support. Ventiv’s Mr. Horveath adds that physicians are asking for reimbursement information for specific products and categories. Incentivizing for Top Performance According to TNS’s Mr. Zornitsky, there are two issues involved with enabling sales representatives to become top performers. “The first is recognizing that, like physicians, sales reps vary in what is important to them,” he says. “For some, financial incentives are most important, while for others, career development is most critical. The key to setting the most effective incentives is understanding the workplace needs of sales representatives and providing a solution that they will find compelling and motivating. The second issue is establishing KPIs — key performance indicators — that drive physician value. Clearly, sales is one such KPI, and sales reps need to be incentivized on the degree to which they hit their targets. Sales numbers, however, are retrospective measures that do not address future physician behavior or the quality of the physician/rep relationship. Relationship metrics also are needed, if pharma companies are to be successful at creating customer-centric sales and service programs.” Mr. Collado adds that companies need to focus on rewarding desired outcomes, not activities. “Right now it seems that the focus is on rewarding the number of signatures captured, calls per day, and samples left,” he says. “Companies need to focus on rewarding substantive changes in physicians’ habits. This is harder to measure but it is clearly more indicative of a representative’s competency and performance.” Mr. Collado outlines several areas for evaluation: the type of relationship the representative has built with the practice; how much physicians value the sales representative’s advice; and whether the representative is viewed as a primary influencer in that practice. “These are measurements that take more time to quantify but they clearly distinguish an individual’s performance and ultimately the success the sales representative will have in a given practice,” he says. In Mr. Horveath’s experience, the most significant driver of incentive compensation also is one that motivates performance based on realistic and measurable goals. “Sales management must align compensation, career development opportunities, and personal competencies with their business needs and performance objectives to truly change behavior and drive top performance,” he says. Furthermore, Mr. Keefer recommends that incentive and recognition programs be developed specifically to support the strategy of the promoted brands. “Whenever possible, top performing representatives prefer single accountability for performance, and incentive programs should support this concept,” he says. According to many experts, in addition to incentives, companies must provide their salesforces with the best tools, resources, and knowledge to do their jobs. “Company culture and practice should reward representatives who remain focused not only on sales, but on the service they provide to the physicians and consequently the patients,” says NXLevel’s Mr. Sandford. “If emphasis is placed on truly serving physicians, and ultimately their patients, sales will follow. Short-term selling strategies that don’t align with true physician interests should not be incentivized.” PharmaVOICE welcomes comments about this article. E-mail us at email@example.com. Celeste Mosby • Wilson Learning With physicians providing less time to sales representatives and some making drastic changes in office protocol, it is critical that representatives are prepared to show unexpected value. Peter Sandford • NXLevel If emphasis is placed on truly serving physicians, and ultimately their patients, sales will follow. Short-term selling strategies that don’t align with true physician interests should not be incentivized. BrYan Horveath • Ventiv Professional As the dynamics of our industry continue to change, so does the definition of our customer base. Tips for Improving the Open In an age of communication overload when everybody is bombarded on a daily basis, it’s more important than ever to cut to the chase. Sales representatives need to remember that doctors are no different than they are. After a long day of surgical procedures and patient visits, the physician wants to go home, not spend more time than necessary with a sales rep. So, in today’s world, it’s no longer about the close; It’s about the open. Tip No. 1: Skip the small talk and get to the point. If the main message is that your product can solve a problem that physicians or nurses assistants deal with every day, then tell them what that is as soon as you start talking. Tip No. 2: This is not about you. It’s about your listener and how that person can better serve their patients or customers. So, look for ways to take the “I” out of your pitch and put yourself in their shoes to address their problems and concerns so you make the message specific to them. For example, a doctor might want to know how your product differs from what he or she currently prescribes while a nurse practitioner may care more about the administration of the product. What they don’t want is a history lesson. So instead of trying to share everything you think you need to say, think about what they really want to know. Then inject some real-life examples or quick stories that are relevant to them. Tip No. 3: Most doctors rely on sales reps for practical information that includes new effective procedures or products to prescribe, but if the rep comes across as boring, flat, or overly promotional, it really won’t matter how great the product is. Think of the three E’s: engaging, energetic, and enthusiastic. If you aren’t engaging, energetic, and enthusiastic, why should they be? Research shows people buy from people they like. Tip No. 4: Finally, junk the jargon. Just because they understand medical terms doesn’t mean you should sound like a glossary. Regardless of the audience, it’s always best to keep the message simple. Karen Friedman Jeffrey Zornitsky • TNS Healthcare It is now clear that physicians want a total, coordinated experience that enables them to provide the best possible patient outcomes. Catherine Baker • Frogkick Sales representatives need to make a ‘professional’ connection. They need to know the physician’s professional interests and align resources that support these, for example, studies, books, or professional associations. Catherine Baker. Principal, Frogkick, Asbury Park, N.J.; Frogkick helps clients implement effective change through performance improvement solutions. For more information, visit frogkick.com. Rolando Collado. President, OnCall LLC, Cincinnati; OnCall is a contract sales organization that provides sales solutions for the global pharmaceutical, biotech, veterinary, and dental industries. For more information, visit oncall-llc.com. Karen Friedman. President, Karen Friedman Enterprises Inc., Blue Bell, Pa.; Karen Friedman Enterprises counsels spokespeople, newsmakers, and executives to make the most of every interview, appearance, and presentation. For more information, visit karenfriedman.com. Bryan Horveath. VP and Managing Director, Ventiv Professional Development Group, Somerset, N.J.; Ventiv Professional Development Group, an inVentiv Health company enhances employee performance with the development and delivery of customized training programs For more information, visit ventiv.com. Rick Keefer. Chief Operating Officer, Publicis Selling Solutions Group, Lawrenceville, N.J.; Publicis Selling Solutions offers a complete range of proven, results-based selling solutions. For more information, visit psellingsolutions.com. Celeste Mosby. VP of Industry Marketing, Pharmaceutical, Biotech and Medical Devices, Wilson Learning Corp., Edina, Minn.; Wilson Learning provides human performance improvement solutions for Fortune 500 and emerging organizations, with operations in more than 30 countries worldwide, including Japan and the United States. For more information, visit wilsonlearning.com. Peter Sandford. Executive VP, NXLevel Inc., Hopewell, N.J.; NXLevel’s core business is creating and deploying standards-based, media-rich, instructionally sound, e-learning programs. For more information, visit nxlevel.com. Jeffrey Zornitsky. Senior VP and Practice Area Leader, Sales Performance Improvement, TNS Healthcare, New York; TNS Healthcare, which is part of TNS, provides globally consistent solutions and custom advisory services to support product introductions, brand, treatment, and sales-performance optimization, as well as professional and DTC promotional tracking. For more information, visit tns-global.com.