By Gerald E. Clor
The managed care delivery system that we've watched mature over the last 10 years or so has caused both sales representatives and sales trainers alike a lot of consternation. Sales training faces as big a change as our sales representatives have in adjusting to the ever-evolving dynamics of this volatile market. We've all learned that the "experts," as well as the government have been unable to predict the impact of managed care on the marketplace, and that, in turn, has made the training of representatives all the more difficult.
Part of the reason for this is the inability of managed care to stand still long enough for us to define it. We've done a very good job with defining the hospital marketplace, and have adjusted training to reflect that, but managed care has proved much more difficult to get our arms around. Some industry insiders feel that, except for a few States in this Union, managed care on the whole hasn't been as successful as we expected. And with market conditions that seem to defy all predictions and a constant fluctuation in acceptance, one could make the argument that there really isn't much point in significantly changing how we train our sales representatives.
Pharmaceutical companies have struggled with exactly how much training is needed in the field, as fully 50 percent of America is still a cash (that is, fee-for-service) marketplace. But keeping a sales representative "on message" may still be the best way to approach both the cash and managed care markets. Still, there are distinct differences, and they do most definitely affect our industry. So how we represent these differences in training may make all the difference in the world in how successful our representatives -- and ultimately, our companies -- are in finding success in this often-confusing market.
Physician Influence
In the early 1990s, we saw the erosion of physician influence due to some of the built-in constraints on pharmaceutical prescribing. The "team" approach to medicine that saw its heyday in the '80s was quickly overcome by managed care, and a "systems" approach soon replaced it. Within the older model of team medicine, physicians received input from clinical pharmacy, and the individual diagnosis predicted a path for treatment. The systems environment provided easier management by managed care organizations and was laden with criteria-based directives, restrictive formularies, clinical practice guidelines and treatment protocols. The detractors of the systems approach pointed out that there was no room for exceptions, and that this approach represented a "one-size-fits-all" application of clinical medicine.
We in the pharmaceutical industry were caught in the middle. Managed care providers wanted to use branded products as a selling wedge to employers, but this conflicted with their cost containment efforts. As this "system" issue began to develop, our sales representatives were forced to address it while at the same time still trying to keep the product message in front of the physician. Many companies were declaring that the influence of physicians was "dead."
But there's evidence to suggest that news of their "death" was greatly exaggerated, as the day of the physician may be returning, and returning with a vengeance -- and well within the confines of managed care! As the government began to face patient's rights issues, it didn't take long for managed care companies to get the message that restricting care to manage costs could be a fatal policy. Medical needs, testing, and appropriate medical management are issues now changing the face of managed care. These issues could also force a rethink on how we approach managed care education in relation to training, and complicate matters as the change in physician influence may return us to our fee-for-service methodology.
Law of Averages
In the cash market or fee-for-service environment, territory success was tied to staying on message, and that increased call frequency. It certainly made sense that the more physicians one was able to see and influence, the greater the opportunity for larger sales volume at the end of the day. All things being equal, this rings true. But things are not equal in the managed care environment, and this formula actually placed representatives at risk, as managed care companies were counter-detailing in many instances. If you accept the premise that the MCOs of this world do, indeed, approach our business in this system-driven way, it provokes a change in the training approach, from the "macro" view to one of a "micro-management, each-market-is-different," philosophy.
The physician is still a key player in current prescribing scenarios, but he or she represents only one influence on the market, as the MCO still holds a number of cards in choosing products. If the approach to pharmaceutical decision-making is systems-driven, then a parallel approach could be implemented in training sales representatives, adjunctively to product training. Identifying one's product within the appropriate system with the MCO could prove to be a winning scenario for your company. Product attachment to treatment protocols and clinical guidelines are not new concepts, but are part of the managed care process, and will remain with us in varying degrees. Having your product on a decision tree is key, but driving market share BEFORE you get to that point can predict success. Managed care companies respond to physician prescribing, even if they don't agree with it. The ability of the sales rep to gain physician acceptance in the face of managed care can provoke a positive decision by an MCO for your product.
Talking out of both sides of the mouth
So which is the proper way to go? Is it understanding the systems and gaining acceptance through those systems, or is it a matter of pushing physician use to provoke a response by the MCO in the face of gaining market share? I think the answer is that both things need to happen simultaneously. Training that focuses on micro territory management and "on-message" product promotion stands the best chance of providing paths for sales representative success. This may be analogous to playing both right field and left field at once, but as we see a shift in product marketing away from the one-size-fits-all to a more specific approach, it can make sense. Training that provides the "street smarts" when it comes to managed care is as key as providing important product information. Knowing how the product fits the systems provides the reps with the tools they need to still have an impact on their territory in spite of increasing managed influence.
Information and data support
The demands on sales representatives are always impacted by market dynamics. The role of training is crucial in providing the support needed in face of the need to micro-manage a sales territory. Information here is key. Strong knowledge of the customer base, physician profiling, and some method of organizational dissecting of MCOs is critical to successful training, as well as to successful territory management. The more we provide ways of understanding MCO decision-making -- and the role of the physician in that decision-making -- the more we improve the probability of success for our representatives.
The managed care industry is built on data. As a matter of fact, there is more information within most health plans than they can use. This data overload is the result of the very systems process that is used to manage enrollment, medical risk and many other disciplines within a plan. Prescription use is analyzed with the same intensity, and knowledge of the market and prescribing habits are tabulated for all providing physicians. A sales representative that doesn't realize this is out in the cold. Training that provides ways of understanding all of this market data -- and territory management in relation to the predominant managed care companies -- only keeps one equal to the database of the customer.
Time-Tested Methods
Unlike our experience with the hospital marketplace, we may never have the luxury of developing a defined strategy for managed care. Our response to the managed care market may have to be as flexible as this ever-changing industry itself. Yes, marketplace combined data will be important, but we should not overlook instruction on investigative territory management. This "street-smart" training may be centered around helping representatives understand the following:
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What is the MCOs mission statement, and what philosophy do they use with physicians?
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What does the annual report say about a MCOs future, or its parent company?
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What specific systems are in use to control costs, and what criteria are used to determine prescribing?
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What type of "risk" is held by physicians, if any at all?
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How is the pharmacy benefit administered - is it a formulary or a "tiered" system?
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How multi-disciplined is the plan in pharmacy management? Does it have a separate Quality or Clinical department?
This is not an all-inclusive list, but you can see that it addresses the specifics of selling within a unique environment. In the end, there may be no "magic bullet." Training needs to accommodate the reality of the marketplace, even if it defies definition. A systems approach to understanding this data-rich business may seem an over-simplification, but it will offer your organization a basis to design a successful program.
Gerald E. Clor is a veteran of 22 years in the pharmaceutical industry. He has served as a Training Associate and was the Manager of Managed Care Education at Bayer Pharmaceuticals. Clor has also taught Introduction to Managed Care at the Graduate Level at the University of New Haven, in West Haven, CT. He is presently a Senior Region Account Manager and Regional Trainer for Bayer Managed Markets, West Business Area. He is based in Phoenix, Arizona.
This article was published in NEWSPOST MAGAZINE a trade publication affiliated with the National Society of Pharmaceutical Sales Trainers. Published May 2001 |
