The new Bribery Act makes UK pharma companies legally responsible for any kickbacks their reps or distributors may offer to health officials anywhere in the world. Maxine Vaccine asks whether UK politicians who point the finger at traders can really be serious.

Compliance is the new CRM. In an era of globalised pharmaceutical trading, the UK Bribery Act and the US Foreign Corrupt Practices Act have sent a shock wave of pure terror through the industry. Basically, what the new legislation means is that a company is responsible what anyone acting on its behalf, even under contract, may do to advance its business. A local sales team or freelance distributor on the other side of the world might treat a village doctor to a bottle of whisky in return for a commission – and a biotech company in Cradley Heath might find itself fined out of existence. It’s scary.

According to a new Cegedim report 94% of life science companies now enforce corporate standards for spending on HCPs, while over half have a project team to address compliance issues. However, Cegedim warns that good intentions are not enough: without robust surveillance and reporting systems, those unmarked envelopes may slip through the cracks.

Closer to home, the ABPI Code of Conduct imposes very strict limits on the industry’s freebies and favours to its customers. Marcus Brigstocke raised some nervous laughter at last week’s Pf Awards by suggesting that pharma reps might moonlight as biro salesmen. The rules on hospitality threaten drug reps with wholesale loss of mates. Bourbons are completely banned. Only digestives are permitted, and they must be from Costcutters. In fact, you can offer branded biscuits only when selling generic drugs.

Compliance means more than just obeying those rules you know about in those transactions you personally carry out. You have to find out what all the relevant rules are and then apply them to every commercial interaction that touches your company. Being compliant takes proactive commitment, intelligence and good teamwork. Though when I put ‘Totally compliant’ on my Facebook profile I got some interesting messages.

So it was with some amusement that I read a recent newspaper story: the Conservative Party’s co-treasurer Peter Cruddas told undercover journalists posing as financiers that a minimum donation of £250,000 to Party coffers would gain them direct access to the PM’s policy unit. Make with the cash, he told them, and “things will open up for you”. In case they were unsure what that might be worth, he clarified the point: “It will be awesome for your business.”

Pardon my naive attitude, but WTF? The only part of ‘Foreign Corrupt Practices’ not implied by such promises is the word ‘Foreign’. Perhaps, before they legislate to rein in pharma industry reps, some of these politicians should look in the mirror.

It’s worth noting here that the private healthcare corporations currently in line for a share of the NHS franchise now the new Health Bill has become law are major donors to the Conservative Party, just as they were to Andrew Lansley’s campaign fund when he was Shadow Health Secretary. In addition, the BMJ reports that half of the doctors on the new CCG boards have financial interests in private healthcare companies that will be bidding to provide NHS services.

And meanwhile, we get stamped on for giving away a few biros. Are they having a laugh?

Maxine’s views are not necessarily those of Pharmaceutical Field.

Despite huge investments into CRM systems some pharma companies still struggle to get all of their staff to embrace and fully interact with them. Pf’s Iain Bate explores why, and what the future holds for technology in the industry.

There’s no doubt that technological developments have changed the way we live and work from year to year – maybe even from month to month in the 21st Century. But has the world of healthcare been travelling in the slow lane of the intergalactic highway?

The potential that technology offers to pharma, and the general world of healthcare, is enormous. But is the pharmaceutical industry, and its staff in particular, using it to maximise the returns of billion-dollar investments?

It would seem that technology is the ‘buzz word’ on the lips of a few of healthcare’s major players at present. The DH recently invited people to nominate their favourite health-related mobile phone ‘app’ – be it for keeping fit, to locate a hospital or chemist, or helping to manage an illness. Creative minds were also asked to design their own health app with a panel of DH judges deciding on their favourite from the most popular entries.

Health Secretary Andrew Lansley says it’s the Government’s intention to give people better access to information using modern technology and the exercise is a “unique opportunity for the NHS and those who develop apps to not only showcase their work, but to bring to life new ideas and realise true innovation in healthcare”.

As part of the DH’s technology revolution, patients may also soon be offered online consultations with their GPs using programmes such as Skype. Clearly the Government is embracing the convenience technology offers to patients, but are other sectors in healthcare as interested? It would seem there is still some way to go.

 

In two minds

Pf ’s 2010/11 annual Company Perception, Motivation and Satisfaction Survey suggests that not all respondents are completely convinced by the power of technology in the workplace. Although the Survey – which relates to 2010 and the early part of this year – found that nearly 90% of respondents have access to a CRM system, only 43% find time to use it in the field and more than a fifth of people fail to accurately record post-call reports with important clients.

Questions have to be asked as to why, despite multimillion pound investment and training by pharma companies, there remains a percentage of staff that still ignore the power and potential of the technology at their finger tips.

Results from the Survey reveal there’s no difference in uptake by key account managers, primary and secondary care representatives, those in primary care roles only, firstline sales managers and secondline sales managers and the use of CRM technology between differing age groups – although surprisingly 10% of respondents in these positions with less than two years of experience said they did not have a CRM system, compared to just 5% more experienced colleagues.

The launch of the iPad in March 2010 promised to revolutionise the way sales representatives, and those in similar roles, use CRM systems in the field. However, nearly three-quarters (70%) of respondents from the Survey are still presently sent out with laptops containing their customer-relationship systems.

When quizzed on what they’d change about the hardware which houses their system, the majority of respondents said that their CRM was too awkward to carry, with poor running systems an issue and that batteries ran out too quickly. Apple claims its second-generation iPad now enjoys ten hours of use away from a plug socket in the field.

Yet the switch to the latest convenient tablet devices may not necessarily be about high levels of investment, it may be down to maximising value for money as Paul Shawah, Vice President, Multi Channel Strategy, Veeva Systems explains. “I would say the life cycle of devices within the industry is generally about three years, sometimes a little bit longer,” he said. “When a company invests in new technology they typically depreciate that over that period, so they don’t want to replace it in the field for that time to maximise their investment.

“However, with the introduction of game changing technology like the iPad, this has changed. We see a number of our pharmaceutical customers are justifying the business case to move to the iPad even before their tablets are fully depreciated. This speaks to the business benefit that pharma expects to achieve from the iPad and the related applications only available on that device.”

A convenient shield

Despite technology eliminating mundane process in the workplace and offering the potential to assist employees and improve their efficiency at work, it has historically been used as a shield to mask poor performance and abused as a means to waste company time – a recent online survey by AOL found that nearly half of Americans (44.7%) rank surfing the web as their primary activity during the two hours they ‘waste’ each day at work.

But it would seem that a high number of respondents do value the opportunities CRM offers. Almost two-thirds (64%) said they always enter correctly the amount of customer sales they make into their CRM. But 21% admitted they fail to always report face-to-face meetings with clients. More surprisingly, over a fifth of participants said they do not always record the number of products they had sold to clients.

The lack of honest accuracy is surprising considering the amount of time spent using CRM systems each day. A third said they spend between one and two hours a day on their system with a fifth spending three hours or more on their CRM. During their time using the management system, more than half (55%) said that call reporting was the most useful feature.

Although respondents were less impressed with the KAM abilities of their software with only 19% believing it to be the most useful facility. When questioned about what they would change given the chance, 45% said they wanted an improved database, over a quarter (28%) called for their system to be overall more useful, and 18% said they would prefer their CRM to be easier to use.

 

The next level

But what of the future of CRM systems? Will they be easier to use and have improved customer databases? David Round, General Manager, UK, Cegedim Relationship Management, says the regular interaction we now have with technology means we’ve all come to expect the latest developments.

“End users are significantly more ‘technology-savvy’ than their counterparts of even five years ago,” he explained. “If anything, the challenge for companies is to ensure that they provide their end users with the types of technology that they use as consumers. It’s also important to focus on the usability of your software to ensure maximum use. Technology companies – and pharma – must work together to develop a better understanding of the interaction, to ensure it meets users’ needs in the field.”

One main reason that users have become more ‘savvy’ is down to the use and interaction with social media. Whether at home or at work, websites such as Twitter, Facebook, LinkedIn and most recently Google+ have driven an increased use of various forms of technology – especially on devices such as smartphones or tablet devices which reps are calling for in the field.

Pharma companies, both in the US and UK, have flirted with the idea of fully embracing the power social media harnesses, but at present are restricted by the PMCPA’s Code of Practice and by the FDA – who has again delayed the publication of its guidance.

The FDA says it is “difficult to provide a timeframe... due to the extensive work and review process, or ‘Good Guidance Practices’, which ensures that FDA’s stakeholders are provided well vetted guidances articulating FDA’s current thinking on a topic”.

Although the FDA may be unsure on how to direct healthcare companies, David Round believes the introduction, both professionally and personally, of social media has had an impact on staff and their expectations.

“For the modern professional person, much of their everyday life is conducted online – for example on shopping, utilities, insurance or booking a holiday – and many users then want the same level of capability from the tools they use in their job,” he added.

Dan Goldsmith, General Manager, Veeva Europe, agrees there has been a significant shift in the way we operate and interact due to our experiences online through tagged posts or hash-tagged searches. But although the 800 million users on Facebook – more than half which ‘log-on’ every day – and 175 million people on Twitter have no problem saying hello to friends, pharma finds it more difficult reaching out to people.

“Social media create a new avenue for healthcare dialogue and will only continue to pervade our lives,” said Dan. “Consequently, I believe that pharma faces two challenges. The first is to decide how to participate in the online dialogue with stakeholders and then to create those interactions through the channels we’re all familiar with, such as Facebook and Twitter.

“The second is to figure out how to leverage the model of social dialogue internally to support stronger collaboration and more focused communication among employees. Already, we see some companies taking advantage of the latest social business tools to connect employees with one another and to access and share information in real time.”

Clearly CRM solution providers understand the potential modern technology and social media platforms offer to companies. Whether pharma and its workforce get fully up to speed on the intergalactic highway sooner or later remains to be seen.

In recent years the German government has introduced a series of reforms designed to radically cut the costs of drugs. With VBP being considered here in the UK, Dr Arnim Jost explains how these measures have affected pharma companies in Germany.

As the biggest pharmaceutical market in Europe and a price reference point for other European markets, success in Germany has always been essential for pharmaceutical companies. However, recent changes in legislation have combined to make Germany an increasingly tough challenge even for the pharmaceutical originators delivering innovative new drugs.

Germany was one of the last countries in Europe to allow pharmaceutical companies to determine prices. Now, with an estimated goal of cutting €2 billion from pharma spending, that is changing, with even new drugs facing tough value assessments before prices are set. With the UK Government considering the adoption of VBP, with fees negotiated on the scienti­fic assessment of a drug’s clinical value, once the Pharmaceutical Price Regulation Scheme expires in 2013, the impact of this change in Germany will be keenly watched by pharmaceutical companies in this country.

Price pressure

Since 2007 and the introduction of GKV-WSG (Gesetzliche Krankenversicherung-Wettbewerbsstaerkungsgesetz), which allowed public insurers the chance to negotiate discount agreements with pharmaceutical companies for generics and off-patent products, companies have seen prices erode.

These public health insurers represent 90% of the population of 82 million, and hence have signi­ficant influence. Over the past twenty years there has been significant consolidation of these organisations, from 1,100 in 1990, to 226 in 2008, and 155 today.

Within the next three to five years that number is set to fall further to just 50. For pharmaceutical companies this consolidation is a double edged sword: there are fewer organisations to target and understand; but each insurer has a far greater buying power and can drive ever stronger discounts across the market.

Price pressure increased in 2010 with the GKV ÄndG (Gesetzliche Krankenversicherung-Aenderungsgesetz), which demanded mandatory discounts for non-reference price products to increase from 6% to 16%, and introduced a retroactive price freeze for all non-reference price products from 1 September 2009 until 31 December 2013, a move expected to save €1.15 billion, according to Policy.io.

Innovative overspend

At this time, pharmaceutical companies were at least allowed to set prices for innovative new products after a drug’s introduction to the market. However, this changed in January 2011, in response to €32 billion spent on medicines by the public health insurers in 2009, creating a signi­ficant deficit.

With the Health Minister claiming innovative drugs were responsible for the overspend, a new law was passed which limits the amount that pharmaceutical companies are allowed to charge for new prescription drugs.

AMNOG (Arzneimittelmarkt-Neuordnungsgesetz) demands pharmaceutical companies provide a value dossier within three months of the product launch, demonstrating the medicine’s cost and bene­fits. If a new drug is found to have additional medicinal benefits, its price will be negotiated between the manufacturer and the insurers within a year.

However, maximum prices – reference prices, in Germany called “festbetrage” – will be set for drugs which do not have any additional benefits over an existing drug.

Evidence based

The implications for pharmaceutical company market access strategies are significant. Market access has now shifted towards justifying the price, towards conducting cost benefit analysis and evidence based medicine. Of course, for the first three months of any product’s life there is little opportunity to undertake evidence based assessment.

Companies in Germany are, therefore, now involving business units, including sales and marketing, up to 12 months before a product launch to create cost benefits dossiers and prepare the value arguments for the medical and pharma-economical experts within the regulatory bodies G-BA (Gemeinsamer Bundesausschuss) and IQWIG (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen).

Companies now need access to greater depth of information regarding the decision makers within G-BA and IQWIG to determine the on-going strategy for this value-based assessment.

Indeed, this process requires far greater information resources – from therapy data, to information about comparable products and product costs. Pharmaceutical companies must now analyse the entire health chain, from diagnosis through therapy to rehabilitation to assess and demonstrate the true potential value of the new product.

They are not, however, as yet able to work effectively with hospitals to ensure drugs are used appropriately in order to achieve the expected benefits. Unlike the UK, where the NHS is being actively encouraged to co-operate with pharmaceutical companies to promote research, innovation and better practice, in Germany the boundaries between health provider and pharmaceutical company are still strong, with hospitals looking to optimise their own working practices without pharmaceutical co-operation.

Clinical autonomy

At primary care level, meanwhile, clinicians have limited opportunity for any strong decision making. Whilst the UK is now pushing hard to reinvigorate the role of clinicians within the health service, clinicians in Germany continue to lose decision making power. GP prescribing is strongly led by the discount agreements between pharmaceutical companies and the public insurance companies: if a prescription does not reflect the agreement, it will be automatically substituted by the pharmacist when it is fulfilled – unless the GP has specifically requested no substitution.

Similarly within secondary care, there is a lack of clinical empowerment. Many hospitals are part of purchasing groups, which has increased buying power, but limited the decision making options for both individual doctors and hospital pharmacists.

However, there are signs of a new level of interaction between pharmaceutical companies and health care services in Germany on the joint development of innovative services. Whilst in the past pharmaceutical companies were constrained from negotiating contracts direct with hospitals or doctors to deliver such services, over the past two years there has been a evolution towards more integrated healthcare contracts that have evolved beyond basic discounting towards shared risk models based on the joint delivery of services – most notably within diabetes.

Moving forward

Given the emphasis on the reduction of drug prices across Europe, the evolution of cost saving on pharmaceuticals within the German market is notable for any similar sized market place, such as the UK. From initial focus on generics, with reference pricing and discount agreements to the impact of AMNOG on the new chemical entities, every aspect of the pharmaceutical market has been affected.

Indeed, despite the market size, this new price point has resulted in companies deciding not to launch new products in the German market due to the problem this would create across Europe with reference pricing: get it wrong in Germany and a pharmaceutical company could end up with an unsustainable price point in many other countries.

The biggest test for pharmaceutical companies in Germany in the coming months will be to understand the challenges created by AMNOG and to determine how best to create the value dossiers. To date, only one product, Merckle Recordati´s Pitavastatin, has passed the examination of the G-BA, but without the approval of a pre-price, there’s only the allocation of a reference price – so the industry has no real evidence of how this process works, or how successful companies will be.

However, with 15 products currently under review, this model will become far clearer in coming months. Market access strategies must be supported by a new depth of information relating to this value-based decision making, most notably granular visibility of the key influencers within G-BA. Armed with this insight, pharmaceutical market access teams will be able to refine their information analysis and determine how best to disseminate the value message to the market.

Dr Arnim Jost is General Manager, Germany, and VP REGION D-ACH, for Cegedim Relationship Management.

The amendments in the Health Bill to the commissioning landscape may have
been small but they are significant for pharma. David Round (pictured) outlines the
implications of these changes to the care pathway and the new opportunities
for joint working.

The dust is beginning to settle on the amendments to the Health and Social Care Bill and it is now time to assess just what the changes in commissioning structure will mean in practice. How will the renamed Clinical Commissioning Groups (CCG) approach the creation of care pathways? Will there be much change from the model used by the previous Primary Care Trust (PCT), or will these new organisations opt for a ‘business as
usual’ approach where possible in order to simply get commissioning processes up and running in a timely fashion?

And what opportunities does the increasingly local focus on commissioning provide pharmaceutical companies to deliver added value services over and above drug products
that are increasingly viewed as a commodity across the NHS?

For pharmaceutical companies the good news is that the changes to the Bill, following the ‘pause and listen’ process, are not overwhelming. The coalition Government has accepted
many of the recommendations of the NHS Future Forum but the essence of the shift towards greater local commissioning remains the same.

The newly created GP Commissioning Consortia (GPCC) remain in place – albeit under the new name of CCG to reflect the inclusion of nursing and hospital consultants on the main board. The pressure is also off CCGs to be ready for the 2013 deadline – although those that are ready will be able to proceed with their commissioning plans sooner. In areas where CCGs are not ready to undertake commissioning duties, the National Commissioning Board will take over from the PCT Clusters for an interim period.

There is also a move towards greater local accountability, with CCGs now required to consult with a raft of new local bodies, including Clinical Senates – responsible for ensuring
CCG clinical plans are robust and meet local requirements – local NHS Commissioning Boards, and Health and Well Being Boards.

New constellations

All of these groups will have an influence on the evolution of the care pathway and must, therefore, be considered within the pharmaceutical market access strategy. Clinical Senates will work alongside the existing clinical networks – such as cancer networks – to ensure CCGs take local and disease specific requirements into consideration. If the Clinical Senate believes that care pathway plans are not good enough it can recommend the NHS Commissioning Board steps in before the CCG is authorised to act as a commissioning group.

As yet, the makeup of these Clinical Senates and local NHS Commissioning Boards is not clear. However, with the continuing exodus from PCTs, there is no doubt that some familiar names will reappear in these new roles.

It is also clear that there is a fast developing gap between the most advanced CCGs and the rest. Some, indeed, have already set their clinical priorities and are looking at care pathways. Within this process, these CCGs will have taken into account the views and concerns of local clinicians and local clinical requirements. The difference now is that there will be formal bodies in place to undertake that local clinical accountability.

For pharmaceutical companies the message remains consistent: market access strategy success will depend upon gaining an in depth insight into not only the CCGs and the speed
with which they are progressing and embarking towards clinical decision making, but also understanding the new influencers within the Clinical Senates and local NHS Commissioning
Boards.

Understanding the mission

However, there is one change to the Bill that also presents significant opportunities to pharmaceutical companies – the decision to place medical research at the centre of the
NHS mission. Under the amended proposals, ­The Secretary of State for Health will be given a statutory duty to promote research, while the new CCGs will be actively required to encourage research, innovation and the use of scientific evidence through their decisions.

This move is fundamental, and addresses criticism that the original Bill did not encourage doctors to make use of improved therapies or the latest evidence on clinical best practice.

For pharmaceutical companies, this shift in emphasis opens the door towards more innovative, cooperative working; and for embarking on joint working initiatives with CCGs. It also ensures doctors and pharmacists will continue to be involved in research projects, from clinical research to patient care, patient outcomes and procedures.

Indeed, some of the CCGs are already actively seeking more opportunities to get involved in programmes and projects that can deliver better patient outcomes by reconfiguring patient services. These leading groups want to work with pharmaceutical companies on research projects that could, if successful, be rolled out across a number of CCGs and allow them to deliver care pathways that meet budgetary constraints.

One big leap

For pharmaceutical companies this will necessitate a new approach. It may require a shift in budget towards a significant up-front investment in developing a new service within a
CCG with a view to recouping that investment further down the line when the service is successful. Fortunately, with companies no longer able or willing to spend money on certain promotional items and activities due to ABPI code changes and the new Bribery Act, there are opportunities to redirect funds towards such programmes.

Key to the success of such joint working is openness: both pharmaceutical companies and the NHS need to clearly understand the benefits to both sides of the venture. ­The  pharmaceutical company cannot simply put in a new service in order to improve product sales; that will not work in today’s NHS. The emphasis must be on implementing a service
that raises the profile of the disease area, which in turn leads to an increase in the whole market – generating additional sales – but reduces the overall burden of the disease on the
local health economy. For the NHS, there will be an investment in resource that effectively identifies certain types of disease earlier, enabling cost savings through improved preventative care.

There is a valid concern amongst smaller and medium-sized pharmaceutical companies that they simply cannot fund joint initiatives on this scale. Feedback from the NHS suggests that companies will be encouraged, even expected, to band together to create a joint working partnership.

Looking into outer space these changes are significant. But they are also taking place within an environment of increasing financial constraint. It is essential that pharmaceutical companies understand the genesis of change; to identify the changes in care pathway and patient pathway that are occurring as a result of natural budgetary restraint and those that
are a direct result of the shift in commissioning structure.

Armed with this insight, companies can ensure messaging remains valid and effectively targeted and reflects the changes that can and are being made by CCGs. Messaging must
reflect the huge pressure on CCGs to reduce costs whilst also improving patient outcomes. And it must recognise the fact that many of these organisations are and will be looking
for partners that can offer innovative solutions and services – from specific procedures to drugs or devices – proven to meet these objectives.

It is those organisations that can take that messaging, that can identify and engage with the CCG vanguard and, where appropriate, embark upon joint initiatives that can be extended over time that will be well placed to meet the needs of increasingly local
commissioning policies.

David Round is the UK General Manager of Cegedim Relationship Management.

Analysing the performance of sales representatives has never been more important to pharma. David Round, Cegedim Relationship Management, explains the importance of Customer Relationship Management (CRM) and business intelligence in tracking and improving KAM activity.

In the good old days, performance measurement was about coverage and frequency, sales volume and value, and various other activity-based measures. The customer base rarely changed and pharmaceutical companies had a consistent approach to tracking representative’s performance. Those days are long gone. Yet despite the widespread adoption of Key Account Management and the challenges of meeting the needs of a now constantly changing customer base, some companies are still reliant on more traditional measures.

Over the past decade, the pharmaceutical industry has endured/embraced numerous changes, not least the shift towards the Key Account Management (KAM) model. Yet despite the declining relevance of ‘coverage and frequency’ in today’s highly complex sales environment, there is still no consensus across the industry as to how best to measure and manage performance.

The traditional model was straightforward and adopted by pretty much every company, irrespective of therapeutic area. It was a relatively simple process to determine the right message and assess the required frequency of visits to influence prescribing. But it was not always satisfactory – not least given the inability to directly match activity information to a specific end sale.

The good news is that now the industry can measure absolute performance against definite success factors, such as whether or not the product is on formulary, providing a far more tangible link to KAM activity. The challenge is trying to find meaningful performance measures to support a sales process that could last for 18-months and is specific to the requirements of the local health economy.

Local empowerment

The KAM model is indisputably harder to measure. It is complex, multi-layered and involves numerous individuals within the team. Pharmaceutical companies need to put in place a way of supporting KAMs within the local health economy, co-ordinating the many individuals and tasks required to deliver the key account plan and understanding how best to drive the process through a number of key milestones towards defined end goals, such as progression through the stages of local drug approval process.

For companies that can leverage strong CRM and business intelligence technology, there is an opportunity to attain unprecedented granularity of performance information. In this multi-discipline environment, the CRM system is fast becoming the key repository for KAM information, from the key account plan and the SWOT analysis, through to tactical plans, including the required engagement with specific individuals within the local health economy. It is the source of information for defining the internal resources required to undertake these tactical requirements and, critically, provides the central platform to track the progress of the key account plan towards specific milestones.

Today’s business intelligence technology allows pharmaceutical companies to build on that CRM system to track performance at several levels. From the task/action level for each individual user, through to the performance against the business objectives set for each account, and up to the overall account ranking, which demonstrates performance towards the end goal.

Using dashboards at each level provides the KAM with an immediate insight into the status of tactical actions that need to be carried out to achieve the overall account and strategic objectives, and how the performance of these actions is affecting or could affect the longer term performance and account status. Furthermore, by using traditional red, amber and green to highlight the action status, a well designed dashboard can make it far easier to prioritise activity and minimise the chance of action slippage which could damage the entire team’s performance. For example, has the medical scientific liaison engaged the local Key Opinion Leaders or stakeholders; or the KAM attended formulary meetings?

Determining performance measures

This visibility of activity, and the ability to track performance in real-time is key in enabling the pharmaceutical company to ensure the key account plan is progressing. With a 360 degree view, companies have a fantastic platform to achieve excellent performance management. The challenge for pharmaceutical companies today is to determine the relevant metrics.

And this, to date, has been a stumbling block for many companies: simply measuring performance against the rest of the industry is no longer relevant. In this brave new world, every pharmaceutical company has a different value proposition and supporting strategies that reflects specific therapeutic areas and the individual local health economy.

The performance measures must reflect that value proposition. However, since value propositions vary between therapeutic areas and within different local health economies, companies that opt to impose one set of performance metrics across the board risk fundamentally constraining the KAMs. Metrics must be set within the context of each specific account plan, and then rolled up to measure performance within the overall market strategy.

With this local empowerment, pharmaceutical companies can then truly enable KAM through full local budget management. KAMs can include budget information within the CRM system, from the cost of promotion meetings to grants and sponsorships, providing a single, central resource that can deliver key insight into the effectiveness of budget management within the overall context of performance against business goals.

Adding sales data provides pharmaceutical companies with the ability to assess performance from a P&L perspective within a local health economy.

New measurements

After decades as the primary way of measuring performance – both internally and against the competition – it is no surprise that activity measures are still in place. This is an easy crutch to lean on. But if organisations really want to create highly efficient, functional KAM structures, the measures need to change and support KAMs in day to day, as well as long-term, account management.

The market has fundamentally changed; these traditional measures will not be replaced with another standardised industry measurement of KAM performance. The key question is: just what will success look like under this KAM strategy to your organisation? Pharmaceutical companies must determine those measures of success that reflect the corporate strategy – and put in place methods of tracking movements towards that success.

Deploying the right technology is critical. True KAM tracking and performance management cannot be achieved without excellent CRM and business intelligence tools – the processes are simply too complex and involve too many different people. But ultimately, it will be the ability to monitor the soft and hard measures that reflect local/account level objectives that will be key in this evolution from the familiar industry standard approach to performance management to one that is highly tailored, highly specific and flexible enough to reflect the demands of a constantly shifting customer base.

David Round is General Manager of Cegedim Relationship Management.

With the introduction of new mobile technologies advancing on a seemingly daily basis, David Round explains how pharmaceutical companies are perfectly placed to gain real value from the digital explosion.

Digital technologies can transform marketing from a push to a pull activity. From QR barcodes enabling healthcare professionals to request an edetail or download an app, to the use of social media to improve patient adherence, there is a huge opportunity for pharmaceutical companies to pioneer and deliver innovative solutions that provide quantifiable value to both healthcare professionals and patients.

However, it is important to remember that the technology is just a facilitator, another tool in the marketing mix, and one that must be tightly integrated with every other customer communication channel – critically, companies need to ensure that all these interactions are monitored, measured and integrated with the CRM system.

Digital audience

Digital marketing is fast becoming a core component of the overall marketing mix. But just how effectively are pharmaceutical companies exploiting both new technologies and new trends in healthcare professionals’ behaviour?

There is growing evidence that healthcare professionals are increasingly using smartphones throughout the day. A survey of 175 UK doctors by d4 revealed that 82% own a smartphone. When asked how they use the phone at work during a typical shift, 88% of respondents said they use them to communicate with other colleagues, 59% said they access information on the internet or intranet, while 30% use work related software apps.

Indeed, the global market for medical apps for mobile phones doubled in 2010, reaching almost $85 million, according to market research firm Kalorama. These apps typically focus on productivity and workflow processes, data management and information/education. Examples include apps that serve as drug references, help manage diabetes, record exercise schedules and update health records.

There are also a number of innovative solutions now being developed that are gaining huge traction with healthcare professions, from an app that allows an iPhone to operate as a single-lead electrocardiogram device, to remote diagnostics and the increasingly infamous iStethoscope app, which uses the in-built microphone to monitor patients’ heartbeats.

Creative challenge

So, just what is the value of developing such apps to the pharmaceutical industry? Considering the iStethoscope app has been downloaded by more than three million people, the opportunity is significant – and far outstrips the value of any number of pens or memory sticks. A pharmaceutical company that can come up with an app that gains that level of market traction puts any other marketing activity in the shade. But there are other opportunities. Pharmaceutical companies increasingly use social networks such as Twitter and Facebook to monitor and improve patient adherence, for example; while new technologies such as QR barcodes can be used to drive healthcare professionals towards a number of information resources and services, both online and face to face.

The challenge is to stand out from the crowd. While new technologies make it easier and cheaper to reach the audience, companies require a new level of creativity if digital marketing campaigns are to be successful. And timing is key. Look back to mid-2010 and the first iPad details gained fabulous response and recall rates from doctors fascinated by the attractive, innovative and brand new technology. But one year on, and several hundred iPad edetails later, the novelty is gone and recall rates have dropped. The challenge for pharmaceutical companies is to balance innovation and creativity against perceived value and the cost of creation.

Is it possible, for example, to leverage existing information to create an app or drive a new campaign? Will that be relevant if delivered via a smartphone or does the company need to create totally new material? Who is the target audience and what is the best way of reaching that audience – a mix of traditional and digital techniques will still apply.

Furthermore, the pharmaceutical industry must recognise that for the first time ever this information is being consumed in a very different way. In the past, a medical paper was received and read as a medical paper. But look at the figures: 82% of doctors have smartphones. They receive a massive range of offers and information – from new trainers to house details – via that device, as well as professionally relevant information. This changes the attitude and puts pressure on pharmaceutical companies to be as innovative and creative as any other business to consumer organisation: the line between consumer and healthcare professional is blurred in a digital environment.

Closing the loop

Critically, companies need to ensure that all these interactions are monitored, measured and integrated with the CRM system. A representative needs to know not only that the doctor has received a visit in the last three weeks, been sent a paper, or attended a conference, but also that he has downloaded an app or requested an edetail. Failing to link the digital channel to the rest of the organisation would undermine the investment already made in creating the 360 degree customer view.

One of the key technologies to enable this is the QR barcode, which uses a smartphone’s in-built camera capabilities to read a unique code as a way to provide a direct link to a web page or App Store. In addition, codes can include the details of a specific doctor, enabling companies to track response and automatically tie in activity to the CRM system to ensure the 360 degree customer view includes every aspect of digital activity.

Codes can be printed on a variety of surfaces and collateral, including journal ads and personalised direct marketing material. The healthcare professional simply scans the code using the smartphone, clicks the link and is automatically transported to the material, making it incredibly easy to provide access to both information and apps.

This technology can also be used to replace the traditional response card. Rather than ticking a box for a representative’s call, medical paper or patient materials and sending off the card to a fulfilment organisation, companies can use QR barcodes. Scanning the barcode will bring up a page that includes the individual’s details and an option to request a number of services, from medical information to booking a visit or an edetail. The process is streamlined, quick and easy for healthcare professionals and minimises the delay between information request and delivery.

New opportunities

For any pharmaceutical company looking to assess how best to communicate with a fast changing healthcare professional audience, digital marketing has clear value. But it is a challenge. Not only are there a raft of new channels to consider, but these are incredibly powerful ways of communicating with both professionals and patients if exploited to their full potential.

At the same time, the NHS is asking the pharmaceutical industry to take an even stronger role in defining the care pathway and drive down costs. Clearly the effective use of digital marketing could and should have a role to play – not least in improving patient adherence. Digital marketing offers pharmaceutical companies a faster way of communicating better with healthcare professionals. The key is to understand just what information/service needs to be communicated, from promotions to elearning, coaching about drugs and the use of apps for diagnostic testing.

Every company wants to leverage digital marketing; it is exciting and the opportunities are limitless. It will be those companies that can map innovation to genuine business challenge or market requirement that will truly leverage the new digital opportunity.

David Round is General Manager of Cegedim Relationship Management.

Despite significant investment from pharma, mobile technology hasn’t yet become the great enabler. But David Round, General Manager, Cegedim Relationship Management, explains why the arrival of new technologies combined with a technically savvy user base may finally realise the objectives of a highly productive, informed and informative mobile sales force.

The caricature of the flash banker with red braces, a Porsche 911 and a mobile phone the size of a brick may prompt laughter now, but for the pharmaceutical field force of the early 90s, the adoption of new technology was far from amusing. It was almost 20 years ago that the first pharmaceutical companies unveiled their new secret weapon: the laptop. With the vision of transforming productivity by providing representatives with the ability to exploit downtime between visits to doctors, mobile access to the ETMS system was meant to herald a brave new era. The reality, as those representatives still in the business will remember, was somewhat different.

As heavy and unwieldy as a small suitcase, and with a battery life measured in minutes rather than hours, few representatives embraced these new machines. Whether too embarrassed to be seen carrying one of these new devices, permanently injured from toting them around, or simply in fear of being mugged for a machine that cost upwards of £4,000, the vast majority of representatives refused to use the laptop in front of the doctor.

Furthermore, in a far less technologically aware age, there was huge reluctance across the field force to adapt to this new way of working. Yes, individuals could access corporate information from the laptop but, in those pre Wi-Fi and broadband days, they had to go home and slot the laptop into the docking station. Waiting for the modem to tunefully – and often unsuccessfully – dial up was time consuming; data transfer rates were painfully slow and, given the general lack of commitment amongst some representatives to update information within the ETMS, data value was somewhat limited.

Customer Barrier

And so it has continued. Even when the first, somewhat shaky and unconvincing, talking head videos appeared on laptops a couple of years later, with a Key Opinion Leader (KOL) waxing lyrical about the value of a new therapy, pointing the way towards an e-Detailing future, many remained unconvinced.

ETMS systems have been replaced by CRM software, enabling pharmaceutical companies to have far better information about customers and stakeholders, and to track interactions and map performance. But even when laptops finally became light and reliable, and the stigma associated with using them in public disappeared, the concept of mobile CRM has struggled to gain favour with representatives, certainly within the sales visit.

Representatives are undoubtedly gaining value from a world in which accessible Wi-Fi and excellent mobile communications enables real time access to corporate information anytime, anywhere. But some are still struggling to introduce multi-media e-Details, PowerPoint presentations or Excel based health economic models during the detail: the process of opening and booting up the laptop and searching for the presentation before passing it over to the healthcare professional completely breaks the interaction.

The detailing process has to be a seamless experience; any messaging or presentation must be able to be delivered without interrupting the flow or creating a barrier between the rep and the customer. It is OK to plug the laptop into a projector to inform those at a meeting, but within a personal interaction, having to hand over the laptop to look through a presentation can create more problems than it solves.

New Tools

So, what must change to enable the vision of mobile CRM to be realised? Over the past 12 to 18 months, a number of factors have come together that will, finally, enable effective representative mobility. Heard it all before? Well consider this: today’s field force is highly technically savvy. Representatives are already using their Blackberry, iPhone and Android devices to send emails and update their Facebook pages. There is simply no technology resistance any more. And this applies to the healthcare professionals as well.

With the arrival of devices such as the iPad, e-Detailing suddenly becomes viable. There is no need to boot up, or undertake time consuming searches for the right presentation: a tablet can be handed over to an individual who instinctively knows how to use and interact with it. This allows the representative to concentrate on the interaction and the reactions of the customer, rather than pressing buttons to find the next slide in the presentation.

This technology is also inherently flexible, allowing the representative to choose from a raft of e-Detailing material, from fully interactive multimedia presentations to PowerPoint or simple PDF data sheets, to meet the needs of diverse opinion leaders based on both role and drivers. The availability of CRM applications on the iPad has fundamentally changed the dynamic of customer interaction.

When you add this detailing support to the benefits that are already being attained from real time access to CRM information on the move, suddenly the pharmaceutical companies can finally see the chance to realise a twenty year old vision.

Perfect Storm

The timing could not be better. There is a rapidly changing customer base with another new set of customer types. Yet opportunities to interact with new stakeholders are as rare as hens’ teeth right now! Individuals need to be as well prepared as possible through excellent background research and understanding. Representatives have evolved into Key Account Managers (KAMs) who need to be incredibly well informed about local influencers, strategy and KOLs. And they need to be flexible: even when a KAM gets an appointment there is no guarantee in this fast changing NHS that the meeting will go ahead with the same person. Representatives have never needed more access to information, or to feel confident that information is up to date.

With the raft of mobile devices now available and excellent communications, individuals can always gain access to the latest research on an organisation or individual; they can use the CRM system to track interactions across KOL networks; and they can use tools such as Near Me, which provides a graphical view of individuals locally who could fit in with the call plan to maximise productivity. They can also collaborate effectively across the team – sending requests for additional information, such as research studies, direct to the relevant team member whilst in a meeting with the customer.

This dovetailing of demand with technology is driving significant adoption rates for mobile CRM, with pharmaceutical companies developing ever more innovative solutions that include e-Detailing and multimedia interaction with healthcare professionals. Critically, there is real commitment from the field force to use these CRM systems because they are gaining quantifiable value from the information.

No longer do pharmaceutical companies have to bend activity to fit the technology: the mobile technology is available, the CRM solutions are in place and, critically, the field force is skilled and comfortable. The market has finally reached this perfect storm – all the components of mobile CRM are now in place to realise the pharmaceutical company vision of a highly productive, totally mobile field force.

David Round is General Manager of Cegedim Relationship Management. Cegedim provides value added information, CRM and marketing solutions to the pharmaceutical industry.

The reforms outlined in the Health and Social Care Bill have been described as the most widespread and significant since the NHS’ inception in 1948. With change well under way, Michael Sobanja, Chief Executive of the NHS Alliance, and David Round, General Manager of Cegedim Relationship Management, piece together the implications for the industry.

While the Bill still awaits parliamentary approval, there are few significant changes to the original White Paper published in July last year. The time for waiting is over: for the pharmaceutical industry, the market environment is being significantly redrawn.

There are four key changes to consider: the transfer of the public health function to local authorities; the introduction of GP commissioning on a comprehensive and industrial scale; the broad development of an autonomous provider sector, from the creation of Foundation Trusts to the growing role of the private sector; and, the role of the newly created oversight bodies, including the independent National Commissioning Board, Monitor, the economic regulator, and the Care Quality Commission (CQC).

These changes undoubtedly create a far more fragmented customer base for the pharmaceutical industry. But that is not the only challenge. With the NHS’ shift away from measuring process indicators towards measuring outcomes, the industry will also need to think carefully about developing new product messaging which aligns with the changing needs of its customers.

Expanded customer base

The most fundamental change for pharmaceutical companies is the shift in commissioning. While this will continue to take place at multiple levels in the health service, as it does now, the number of organisations involved in commissioning is increasing, most notably in moving responsibility away from Primacy Care Trusts (PCTs) to local clinicians. A large number (141) of pathfinder GP consortia are already in place, providing coverage for approximately 50% of the population by April 2011; with numbers expected to reach 200-300 by April 2012.

However, there will still be national as well as local commissioning. The new National Commissioning Board will have a responsibility for specialised services commissioning, taking over that role from the abolished Strategic Health Authorities (SHAs). It is likely that some GP commissioning groups will team up with others and pool budgets, and some will act similarly with local authorities.

It will also be important for the industry to understand the new role of local authorities in the provision of public health. Whilst it would be easy to perceive the shift of public health responsibility to the local authorities as little more than a change in employers and accountability, there are other considerations.

The new Health and Wellbeing Boards, designed to bond local authorities and local GP commissioning consortia, will be relevant to the industry. Local authorities will retain an overview and scrutiny function for the health service – although it is far from clear how this will be carried out; and new health watch groups are being created to enable the local population to engage with the critical decision-making about local services.

Pharmaceutical companies, especially those that can link their products to the improved health of the population, must now consider local authorities and these associated mechanisms as critical customers.

New messages

While the pace of change across the NHS will be extraordinary, it cannot be consistent. There will be significant differences to understand, from the speed of creation of the 200-300 GP consortia, to the strategies these adopt. While many will be forced by the financial pressures on the NHS to take a cost first approach, all will look to follow the Government’s outcome led model as well. The precise mix will be a matter for local decision, leading to varying prorities within a widely drawn national framework.

For example, recent studies of diabetes patients in the south of England has revealed that despite the current process measures of care pathways and QOF, some people diagnosed with diabetes are much more likely to experience a lower limb removed today than others. In addition to the impact on the patient, this is a cost to the health service of an extended stay in hospital, significant drug requirements, plus the cost of community care post operation. There is also a knock-on effect on the local authority and overall economy, from a reduction in contribution to the treasury to the cost of disability benefits and social care provision, which is a key consideration for the new Wellbeing Boards. This is a good example of unwarranted variation in the outcomes of care which will be a prime focus in the future.

Taking an outcomes led approach, a GP consortia is likely to look for a diabetes care that, while possibly more expensive up front, significantly reduces the likelihood of amputation and therefore delivers a far better long-term outcome for patient and the wider public sector budget.

Pharmaceutical companies therefore now have to think about products and value propositions in new ways. Firstly, what is the real outcome of prescribing this product? Secondly, what is the implication of more patient choice and more emphasis on patient experience? Thirdly, how does this drug reflect the financial challenge that faces the health service – what is the system impact? These are three basic value propositions that may not be used currently by the pharmaceutical industry.

New skills and structure

The pressing issue for pharmaceutical companies planning to adapt to these extraordinary changes is how best to structure teams and what skills are required. Can the remit of the public affairs teams be expanded to support the new regulators such as the CQC and Monitor? And, from a representative perspective, can the same people successfully deliver the clinical messaging required to support outcomes focused consortia and also undertake tough negotiation with those concentrating primarily on price? Should pharmaceutical companies focus attention only on those GPs directly leading in the GP consortia – perhaps 1,000-2,000 out of over 30,000, or is there value in also working closely with their peers?

It is certainly unlikely that any company can afford to expand staffing numbers to meet these diverse requirements. Instead, the emphasis is likely to be on the creation of teams of multi-skilled personnel; individuals who are able to adjust their approach according to circumstances. Critically, these individuals will not only have to be able to pick and choose the most relevant messages from, perhaps, ten created by the company, but they must also be empowered to make local judgements as to how those arguments are deployed, to whom, when and how.

This is a very different model for the pharmaceutical industry and one that will demand not only new skills, confidence and responsibility, but also access to excellent local information. In this fast moving marketplace, there is a clear need to understand which consortia are leading the way, whether there is a geographic variance, which consortia have a cost focus, and which are prioritising long-term outcomes. Without this information, it will simply be impossible to enable empowerment or respond to the diverse approaches of these key GP consortia and local authority decision makers.

Future contacts

There is no doubt that over the next 12 to 18 months, large numbers of managers will leave the health service. But many of the existing relationships that pharmaceutical companies have built up over the years will still be of value. Some individuals currently working in PCTs and SHAs will undoubtedly reappear at GP consortia, national commissioning or regulatory level.

The key for pharmaceutical companies is to keep up to date with these changes, look for market intelligence and work on relationship management with this raft of new Key Opinion Leaders – some of whom will be new, others familiar. No company will be starting from a zero base of contacts, but it will be those companies that work hard to understand the pace of change within consortia and invest in re-messaging to support the outcomes framework, that will be best placed to proactively manage the transition.

David Round is General Manager of Cegedim Relationship Management. Cegedim provides value added information, CRM and marketing solutions to the pharmaceutical industry. Michael Sobanja is Chief Executive of the NHS Alliance – the only organisation that brings together PCTs and GP practices, clinicians with managers and board members, and NHS primary care with its patients.

Regulatory compliance will be a major challenge for the Life Science industry across Europe, a new report says.

The 2010 European Trends in Aggregate Spend, Transparency, and Disclosure Report found that 93% of respondents are concerned the changes will significantly impact the industry’s image, citing data identification, consistency and quality as major concerns.

Bill Buzzeo, Cegedim Relationship Management Vice President and General Manager, Global Compliance, said the worries of respondents are “no surprise” in a “rapidly evolving industry that is presented with stiffer regulatory requirements”.

The report covered a range of current topics including the concept of transparency and how the European regulatory climate compares to the more mature US model.

Results revealed that Life Sciences companies are investing in compliance and assessing policies and procedures to meet government requirements. However, it also raised concerns about timing and the need to extend monitoring beyond traditional sales and marketing functions.

“It came as no surprise to learn that the greatest concern is the changing compliance landscape and how this will affect daily processes and the image of the industry as a whole,” stated Mr Buzzeo.

“Life Sciences companies need a way to respond to a rapidly evolving industry that is presented with stiffer regulatory requirements in addition to extreme competitive pressures and market access challenges.”

Immunologists, orthopaedic specialists and diabetes specialists are the most pharma-accessible healthcare professionals in the US, a new study has shown.

It was also revealed that 23% of doctors refuse to see any pharma company representatives and half of those surveyed require advance appointments to be made.

The Physician Access survey, conducted by SK&A, A Cegedim Company, has been going for three years and is based on telephone interviews with more than 237,000 medical sites representing 680,000 physicians.

It was found that most US doctors (98%) are visited by up to 20 pharma sales professionals per week or one every two hours. Of all the practices surveyed, those with the lowest access rates tended to be larger, owned by hospitals or health systems, or had fewer daily patients.

“As prescribers become busier and less accessible, understanding physician access preferences is critical to successful sales and marketing resource planning, and execution,” said SK&A’s Dave Escalante, Vice President of Data and Information Solutions.

Specialty physicians were found to be less likely to grant sales reps access than general practitioners. The least accessible physicians were diagnostic radiologists (92.1% no-see rate), pathologists (91.8%) and neuroradiologists (90.6%).