Everyone in pharma is talking about key account management – but what does being a KAM mean for the sales executive?

What is key account management all about? Perhaps an anecdote will help...

A travelling salesman was on the road and stopped in a small Somerset town. There appeared to be no hotel and the local pub had no rooms available. So he drove out to the nearest farm and knocked on the door. An ageing man answered. The rep explained his problem and asked if the farmer had any rooms available. “Sure,” the old man said. “My 19-year-old daughter normally lives here but she’s away at college, so her room’s free.” The rep nodded and turned back to his car. “Hang on,” the farmer said. “I said there’s a free room.” “I’m sorry,” said the rep, “I’m in the wrong joke.”

The point is that a traditional sales rep has a well-defined script, a known role, within which certain messages and behaviours are taken for granted. The rep just has to make contact and deliver the message. That’s why he or she is the butt of so many jokes. It’s also why the traditional sales role is disappearing from our information-charged world of informed customers and organisations that make decisions on a committee basis.

Read the joke again and think of it as a metaphor for a modern business relationship.  The farmer’s spare room stands for the technological and human resources the customer can draw on. The farmer’s daughter being in college stands for the customer’s new education and range of business contacts.

To employ a technical metaphor, if the traditional sales executive is a plug looking for a socket, the key account manager is a USB flash drive from which a wealth of complex information can be downloaded. The KAM is not only addressing a plurality of customers but representing a plurality of company perspectives: sales, marketing, research, finance and management.

You’ve heard of cloud computing. Key account management is cloud selling – a way of bringing together the best elements of your company’s business strategy with the key aspects of the customer organisation’s business strategy. That classic business cliché, my people will talk to your people, is at the heart of KAM.

Meeting the family
Key account management assumes that the individual customer belongs to a complex buying environment – he/she is influenced by a range of people and uses a range of information resources. The appropriateness of this model to the NHS is obvious – and while the current NHS reforms affect the structure and workings of key healthcare accounts, they certainly do not dilute the need for such accounts. The KAM has to work with the purchasing system by identifying, and building relationships with, its most sensitive points of contact.

Identifying the decision making units within the customer organisation and working strategically to maximise your company’s impact on them is half of the battle. The other half is directly or indirectly bringing the key elements of your own company into contact with the customer organisation. This is where new technology comes into its own: nothing will make connections better than well-presented information that conveys the richness and immediacy of your business case. Tablet computers and smartphones also make the co-ordination of KAM within your own company swifter and easier.

As many pharma companies have found out, simply creating a KAM role in your sales team and expecting that to make all the difference is foolish. KAM is a function of the whole company – which seeks to meet the needs of patients via the health systems that provide treatment. The product reaches the patient via a treatment pathway that the health system develops according to its clinical and financial priorities. That pathway and the reasons for it are what the company needs to understand and change.

Looking after people
Pf spoke with Paul Curbbun, National Key Account Manager at Rosemont Pharmaceuticals. Before taking on his current role, Paul was National Hospital Manager for the same company. Before that, he was working in FMCG and other sales sectors – where KAM has been prevalent for two decades. So Paul is the KAM who came in from the cold.

On how his working life has changed, Paul says: “My life hasn’t got any easier or any harder. The only thing I’ve cut down slightly is the mileage. I’m at home more than before because I tend to use home as my office. For instance, this morning I’m spending two or three hours at home preparing before going out. There’s a lot more reports to put together as well as analysis of sales.”

On the changes in his customer base, he observes: “As NHM, I was seeing everybody – pharmacists, nurses, doctors, therapists. That’s all gone now, and what I’m seeing is mainly the buyers from the key groups, from specific retail groups to wholesalers. A lot of what I’m doing is building up business partners.”

What KAM is all about, he argues, is looking after customers: “Nothing feels better than when you’ve asked for something and you get that something. It’s about not letting people down. It’s truly looking at their business and your business and linking the two together for the benefit of both.”

That contrasts with the traditional pharmaceutical sales role of hammering the product and the marketing message. The key account manager needs to identify opportunities and develop solutions, using the company’s product portfolio to optimal effect. “Whatever the account needs – it’s that simple.”

Don’t be a stranger
Rosemont Pharmaceuticals specialises in oral liquid medicines for people who have difficulty with tablets. Their products include a formulation of the diabetes drug metformin. With a clear USP and well-defined patient population, surely this is a case for traditional product-based selling? By no means, says Paul: “It’s critical that when a patient needs an alternative, a patient gets an alternative. So from a key account point of view, you can make sure our products are where they need to be, so that patients get the right medicine and, most importantly, there is continuity of supply.”

For the sales professional, Paul states, the difference between KAM and their previous approach depends on how well they did the latter. “If you’re making calls for the sake of it, just to tick a box, obviously that’s a long way off – but if you’re going into an account with complete business focus, asking what it needs, closing the loop whenever an opportunity arises, you’re well on the way to a KAM role.” Sales professionals who analyse their sales and construct a business-focused customer database are also showing KAM awareness.

For the sales manager, the key to effective KAM is empowering the sales team to manage and take ownership of their accounts while guiding them to optimise their work as a team. KAM is not a solo activity. Paul remarks with some bafflement: “Something I could never get my head around was the fact that you often had four or five people selling the same drug over the same area. If you were devising a business model tomorrow, that would certainly not be it.”

In fact, KAM is so integral to modern business that it’s worth asking why the pharmaceutical industry avoided it for so long. The answer lies in its assumption of a difference in professionalism and consciousness between seller and buyer. For decades, pharma regarded its customers as business-naive people fixated on the patient relationship. Hence the adoption of ‘persuasion’ techniques such as NLP.

Times have changed, and bad business habits now carry too high a price. As the NHS – with its emphasis on cost-effectiveness and generic prescribing – becomes more like a business, and the industry – with its emphasis on patient-centred medicine and disease area knowledge – becomes more like a doctor, a shift from sales transactions to commercial relationships is essential for both. KAM is pharma’s only way in from the cold.

Pf’s Iain Bate examines how contract sales organisations are taking their place among the industry heavyweights.

There can be little doubt that pharmaceutical employees – in particular sales and marketing executives – have taken some metaphorical hefty blows in recent times. All of pharma’s biggest heavyweights have announced ‘austerity’ measures as part of widespread job cuts across the majority of divisions in recent times.

Whilst pharmaceutical CEOs have enjoyed champion pay rises, the humble employee at ground level has been unable to duck and weave away from the dreaded knockout blow. As a result, the job market has been on the ropes. However, candidates searching for a career in the medical sales industry do not have to throw the towel in just yet.

The employment market has suffered many bumps and bruises in recent years – but Contract Sales Organisations (CSOs) are leading the fightback. Now regarded as a leading contender for those looking for a prolonged career in the medical sales industry, CSOs continue to punch above their
weight in a challenging environment.

Pf spoke to four leading CSO companies to provide a blow-by-blow account of how contract organisations have boxed clever in recent years. Why have they gained in popularity despite the employment market suffering a bloody nose? And what does the future hold for the contract sales movement?

The gloves are off

In the modern working environment, when uncertainty accompanies everyday challenges, the flexibility CSOs offer clients is a major attraction. “The fundamental driver is the requirement for an increase in flexibility from our biopharma customers,” says Helen Molloy, HR Director at Quintiles Commercial. “This is nothing new – but what has changed is the nature of that flexibility. It’s not just about numbers of people, it’s about expert teams with specific skill sets and evidence tailored address local priorities.

“Customers are increasingly looking to partner with us to help navigate challenges around proving cost effectiveness and long term value of a drug to a wider range of stakeholders. We are moving away from what has historically been seen to be the fundamental core of our services, and into much more specialised areas.”

Flexibility is certainly an attractive proposition for clients who have slimmed down sales teams yet still require the prowess to impress customers. However, flexibility isn’t the only factor driving CSO growth. Specialist skills are now required by clients to outwit the opposition. “Contract sales organisations are moving away from large-scale build, high noise proposition and are becoming much more specialist,”
says Emma Busby, Project Director at CHASE. “Organisations are demanding to have specialist skills and capabilities either to be equitable to their teams, or, in most cases, to offer more opportunity and more value within their teams. Their key objective is to heighten the level of capability that they have got on their headcount team.”

Pharma’s increased reliance on contract methodology is now reflected in the number of candidates turning to CSOs to develop a career in UK medical sales. “CSOs are becoming the only way into the industry,” says Emma. “We work with many blue-chip companies to provide an influx of trainees every year. Again those people go through organisations and develop. The trend went away from that for a few years, but it’s definitely coming back now. Companies recognise they need high-quality sales engagement. We can regurgitate skills but fresh attitudes and capabilities coming in will actually challenge the status quo.”

At a time when, as far as job security is concerned, pharmaceutical representatives fear the next barrage of punches, CSOs are doing more than ever to provide a shot at the big time in the industry. David Alexander, Contract Business Unit Team Leader at Star, says there are a number of reasons why CSOs have gained
in popularity recently. “Security, variety and skill development are key,” he said. “Working for a CSO
means people can move from one assignment to another and gather experience with different companies,
in different therapeutic areas and with different customers over time. Transferable skills and flexibility
are important qualities in today’s environment and working with a CSO will help people profile both.”

Swapping gloves

That value is also being recognised by clients seeking to boost sales at various stages of a brand’s life cycle. With the industry well on the way to manoeuvring itself away from the traditional sales model to a sophisticated fighting-fit key account approach, contract sales organisations are perfectly placed to augment teams or, in some cases, replace them. “A CSO can help do both,” says David. “It can either enhance a team or, if necessary, it can replace it. You can either have a bolt-on campaign, where contract reps target specific areas in fixed time periods, or, you can replace an entire team with a CSO key account team, enabling flexibility and resource in particular areas of the UK. This allows clients to be much more outcomes-focused.”

The next round

But what next for contract sales organisations? Will pharmaceutical companies decide to completely
shed their entire headcount and outsource functions to specialist organisations? Andy Holgate, Business
Unit Director from Ashfield In2Focus, believes this may be the case. “Contract sales organisations are expanding into new areas,” he says. “The model for CSOs in the next 20 years could be where pharmaceutical companies simply concentrate on research and development and strategic marketing and finance. Contract sales organisations will, potentially, then do all of the rest. I think that is the trend that CSOs are driving towards.

“We may be in a bit of a perfect storm at the moment where pharmaceutical companies, many of whom are being squeezed from above and are tinkering around the edges, are considering outsourcing services in areas where they would never previously have allocated external resource. Contract sales organisations are extremely good at being able to help pharma companies, and other clients, differentially resource people when and where they want them and when and where they don’t, be that in sales or other value-adding roles.”

In an austere environment when pharmaceutical companies are fighting against a whole host of external
pressures, it’s difficult to see how contract sales organisation will fail to grow in the coming years. The powerful combination of being an inviting proposition for individuals seeking a career in medical sales industry, and strategic allies for companies in need of flexible and specialist commercial expertise, CSOs are rapidly establishing themselves among the industry heavyweights.

A local information strategy is key to successful account management. The data is out there. Rhiannon Thomason explains how turning information into insight is all about context.

Despite reforms that appear to encourage decision-making and accountability at a local level, the UK health service remains a national one. The Health & Social Care Act actually strengthens the centralised power-base and, via the NHS Commissioning Board, issues a series of top-down directives that will cascade to a local level for implementation. Rumours of the death of the ‘N’ in our NHS are grossly exaggerated. But for Key Account Managers across the UK pharma industry, what happens at a local level is perhaps the prime focus. There is much talk of the need for ‘local health intelligence’. It is indeed a vital commodity. But it is important to draw the distinction between information and insight. The former is readily available. The latter is hard won and impossible to achieve in isolation. In the battle for local health intelligence, context is King.

The NHS is awash with data. Nowadays there is much more information available and the health service itself is increasingly placing useful data into the public domain. Examples such as QOF data, Joint Strategic Needs Assessments, HES (Hospital Episode Statistics) data, the Atlas of Variation and Public Health observatories provide a rich seam of information from which sales and marketing professionals can develop appropriate local messages. They combine to form a complex matrix of information. The challenge for KAMs is interpreting it and understanding what it means in their disease area and in their locality. There is variation right across the system.

In primary care, QOF data has become increasingly important. NHS customers are being tasked to reduce unnecessary hospital admissions, and the financial incentives from a local practice perspective are significant. But as the transition towards Clinical Commissioning Groups continues, practices know that they cannot work in isolation and that they must prove to the wider organisation that they are achieving their targets.

For the industry, QOF indicators have become a catalyst for improved customer engagement. Proactive sales professionals are no longer targeting GPs with messages based only on the clinical benefits of their products. They are instead identifying key local decision-makers and attempting to demonstrate how their product can impact a service, reduce hospital admissions, save a locality money and improve patient care.

Clearly, QOF data has become a strong lever for account managers to understand how their product can help customers meet their targets. In isolation however, the data can only take you so far.

When used in combination with other available information, a much more powerful package of metrics can emerge.

Sales professionals need to build the bigger picture of what is going on at a local level, to understand how their products can make a difference. This depends upon drawing together all the various strands of information, and developing value propositions based on the local context as a whole.

• How is each local health economy constructed? Which organizations are operating within each locality? What are the roles/responsibilities of each and how do they engage with one another? Who are the key stakeholders?
• What is the community profile? How many patients are there? What are the deprivation and ethnicity breakdowns?
• What is the patient pathway? What services are provided, by whom and how are patients managed?
• What is the cost of hospital activity? How much does each group of patients cost each locality?
• What are the outcomes? How much is each locality spending and how well are they managing each group of patients? How can the outcomes be measured?

The trick for pharma is to be able to use all of this information intelligently, in combination. Much of it is publically available, but without the knowledge and understanding of how it translates into what you are trying to achieve, it could, in a worse case scenario, send the sales professional in the wrong direction.

Variation in care
In a complex environment where context is everything, it is important not to lose sight of the bigger picture on a national scale. Many of the challenges being faced by local commissioners on the ground are around the treatment of diseases identified as national priorities. The implementation of commissioning plans at a local level largely cascades down from the key domains laid out in the NHS Outcomes Framework. The challenges manifest themselves in the local variations in care that are widely highlighted as being in need of redress. Once again, these local variations – if intelligently assessed – provide pharmaceutical companies with a powerful market access opportunity. Companies that can demonstrate that their products, not just their messaging, are aligned with local need will significantly increase their chances of uptake.
A good example of how the national agenda is driven by addressing variation in care at local level, is the treatment of diabetes.

Diabetes – a mini case study
The national picture
An estimated 3.8 million people in England have diabetes, with 2.45 million QOF registered patients. This is forecast to rise to 4.6 million by 2030. Diabetes and its complications costs the NHS around 10% of its annual spend. £725 million a year is spent on diabetes medication (8.4% of NHS drugs spend), and an additional £600 million is spent on diabetes-related hospital activity. An estimated 80% of the NHS’s £9.8 billion UK diabetes bill is spent on treating diabetes complications. It is predicted that diabetes will cost the NHS £16.8 billion by 2035.

National and local initiatives
As part of QOF, practices are to be encouraged to provide lifestyle advice and annual glucose checks to everyone judged as high risk from the age of 25 – even those with normal HbA1c levels. NICE is piloting new QOF indicators that promote tight cholesterol control in diabetes.
The introduction of insulin pumps instead of injections, as well as educational programmes such as the DAFNE (Dose Adjustment For Normal Eating) course are good examples of local initiatives to combat diabetes.

Local variation
NHS Hampshire has the highest number of diabetes patients on the QOF register (54, 761). Hospital admissions (inpatient, outpatient and emergency attendances) are costing NHS Hampshire £3.7 million each year – one of the highest of all PCTs. However, its cost per thousand patients is low – ranking 113 of all PCTs. It also has the lowest death rates from diabetes. Therefore, although it has the highest number of diabetes patients, NHS Hampshire appears to be managing its patients well.

NHS Kingston has one of the highest diabetes spend per thousand patients in England. Compared to other PCTs in its SHA, it also has a higher number of Finished Consultant Episodes, longer lengths of stay, higher emergency admissions and the lowest elective admissions. Compared to NHS Hampshire, this suggests  that NHS Kingston could be managing its diabetes patients more optimally.

Lessons for pharma
The diabetes example outlined above provides a clear indication that a one-size-fits-all approach to pharmaceutical sales and marketing will no longer work. The apparent variation in care between two diverse PCTs highlights that every local health economy has different needs. A diabetes KAM working in Hampshire could not relocate to Kingston and challenge stakeholders there in the same way, with the same proposition. The situation, and the opportunity, in each PCT/CCG is totally different. The ensuing approach must be similarly distinct.

A local information strategy is critical for Key Account Managers engaging with today’s NHS. Understanding local dynamics is critical, and the information to facilitate this is increasingly within reach. The key is joining it all together and placing everything in context. It’s a mixture of local and national. Top-down directives issued at national level are providing important indicators by which local commissioners are measured, and are in turn are becoming powerful levers to help pharma develop value propositions that align with local need.

The data is out there. But success is in understanding the difference between information and insight. After all, context is King.

Rhiannon Thomason is Business Development Manager, Cegedim Relationship Management.

US and European pharmaceutical sales and marketing executives believe that the current business model is ‘broken’, according to a new survey.

More than two thirds (68%) believe that pharma’s current sales model needs to be rejuvenated to face current industry challenges.

Danielle Rollmann, a partner in Booz & Company’s global health practice, says industry is in the “eye of a hurricane of change” and companies need to “identify and focus” new capabilities needed to succeed.

The survey, conducted jointly by Booz & Company and National Analysts Worldwide, asked 156 sales and marketing leaders, most with global responsibilities, how the industry can adapt to face a changing healthcare environment.

If found that respondents noted that growing healthcare prices along with the need to highlight value and outcomes were the greatest challenge faced by sales representatives.

More than half of respondents now expect to invest heavily in marketing to key accounts and payers to counter these challenges. New pricing approaches, new service models and new partnerships with clients were also highlighted as being important.

“Those of us who work with pharma companies to develop and implement commercialisation strategies know very well the challenges of maximising asset value in this new environment, where both key customers and customer expectations are being redefined,” said Susan McDonald, CEO of National Analysts Worldwide. “We’re not surprised to hear people acknowledge that they can’t count on doing ‘business as usual’ and that they’re looking for new ways to gain traction.”

Respondents said the strategies which they believe will be the most important moving forward include:

• Organising sales and marketing activities around diverse stakeholders
• Taking a more creative approach to customer relations and partnerships
• Effectively demonstrating value through outcomes to clients
• Innovatively using digital media channels.

“Virtually everything is changing in the model and the market,” commented Rolf Fricker, a Munich-based partner at Booz & Company. “In response, most respondents say they plan to spend more on all their target marketing activities. Yet this is not aligned with what pharma is doing and needs to do at a company level. The companies that focus, prioritize, and follow a coherent strategy will be the winners.”

With so many pharmaceutical companies undergoing some sort of restructuring plans as a result of mergers, acquisitions or simply cost-cutting measures, field force worries immediately turn to job security. Apodi’s Tony Swift discusses valuable ways to ensure your job isn’t one under scrutiny the next time the axe is wielded, and how to progress in the new pharmaceutical world.

In the past a competent sales representative could look forward to a long and secure career in the same or similar role, often with the same company. For the more ambitious representative it was also possible to climb a well-defined ladder towards seniority – as field trainer, sales manager, sales director and beyond.

However, much has changed. Sales representative positions have reduced dramatically and the ladder to seniority appears far more difficult to climb. Job security and traditional long-term career planning is disappearing into oblivion. The situation is just as precarious for those half way up the ladder, in first or second-line management roles, and restructuring is affecting job security and career planning throughout companies in the industry.

These seismic changes are not temporary. We are seeing a transition to a new world order in the pharmaceutical industry where:

• Traditional career paths are disappearing
• Management roles are fewer and are just as susceptible to restructuring
• Employees can no longer rely on the organisation to develop their careers – career and personal development is an individual’s responsibility
• The company needs to provide support and experiences to individuals to learn new ways of adding value to the customer and the company itself
• Creative expertise to address the new NHS is in huge demand by pharmaceutical companies. This presents an enormous opportunity for representatives and managers who may currently be worried about their long-term future in the industry.
  

Personal development
I recently interviewed a number of successful pharmaceutical industry executives to assess how they addressed the issue of personal development. Almost all of them stated that they could not have solely relied on the organisations they had worked for to either fully develop their skills or, indeed, their career.

In the majority of cases these successful individuals had made a decision to take personal charge of their careers. By keeping abreast of changes in the industry, anticipating new developments and consistently reviewing and updating their skills and relationships, when changes did occur in the industry or company, they were often well placed to take advantage of the new opportunities these presented.

At Apodi, our resourcing division sees first-hand the changing dynamics of the marketplace. Quality market access and key account managers are much in demand and are, at times, very difficult to recruit. There are also lots of sales representatives looking for jobs, with many believing they now have to look outside the industry to secure their future. However, representatives who are aware of the changing dynamics and have adapted their skills are now often successfully obtaining those market access and KAM roles.

Taking charge
One conversation with a successful executive led to a more in-depth discussion about what sales representatives can do if they want a long-term career in the pharmaceutical industry. The executive detailed the steps he had taken, and I believe this serves as an interesting case study for those unsure about their prospects in the industry. He said: ”It quickly became apparent to me that to take charge of my career I had to focus on a number of key areas.” To summarise, these were:

• To develop a clear view of the future of the industry and the likely impact of this on an existing position and potential future roles
• Be successful in a current role –  believe that new opportunities will only arise following success
• Find a systematic way of increasing knowledge, skills and relationships – do this to differentiate yourself from colleagues.

The future
In a previous article, Leading the way – Pharmaceutical Field, September 2011, I mentioned a couple of quotes. One was from a leading member of the NHS responding to how pharmaceutical companies could more actively engage with the health service. They said: “Don’t just bring pills and gadgets in the future, bring us value added solutions that drive the QIPP agenda with a documented and robust cost/benefit analysis.”                                   

The other, by Sir Ian Carruthers, NHS Chief Executive Innovation Review Team, stated: “The pharmaceutical industry needs to think more in terms of working in partnership with the NHS rather than just sending in the sales force… the NHS needs your disruptive contribution to help NHS reform, but too few companies are coming forward.”  

Despite such prominent views from the NHS, many companies are still sending out sales representatives with a very limited agenda – primarily delivering some key messages about a particular product. Indeed, some observers believe that the pharmaceutical sales representative is one of the world’s most underutilised resources! And, given the limited ambitions of each visit, it is perhaps not surprising that HCPs are continuing to reduce access.

To counter this, companies are deploying key account managers whose role is to provide value over and above the ‘noise’ associated with a traditional rep visit. We believe there will be a gradual merging of the functions of sales representative and KAM in the future. This means that everyone representing a company in the field will need to operate to KAM principles and provide significantly more value than before. Indeed, our research shows that historically excellent representatives have effectively operated to KAM principles, irrespective of the training and direction received from head office.

Current success
Whilst each sales representative has key performance indicators (KPIs) to meet – often merely call rates, we believe that individuals need to focus on providing added value to their customers and their companies irrespective of their targets. By taking a more strategic view, identifying the key stakeholders, delivering and developing solutions with the help of their company’s marketing, medical and promotional functions, representatives will become a more valued partner to both parties.

Representatives can only do this if they are experts in their products, the therapy area concerned, the care pathway and the local healthcare economy. Additionally, they will need knowledge of best practice and potential solutions.

Unfortunately, to some this may be perceived as going ‘beyond brief’ and will sometimes result in knockbacks. However, we believe the risks attached to this are far less than continuing with the limited role noted above. The risks of a representative failing to distinguish themselves and failing to provide real value will leave them susceptible at times of restructuring, and with fewer skills needed to attract jobs in the new healthcare economy.

Using initiative 
Fundamental to taking charge of your career is to take responsibility for personal development. A colleague told me about how he had done this successfully with a process that included the following:

A) Yearly audit – produce an annual plan that addresses the following:

• I am currently known for…
• Next year I want to be known for…
• My personal development last year included…
• I currently differentiate myself from my colleagues by…

B) Quarterly plan – each quarter produce an action plan:

• I aim to develop a more in-depth knowledge of the product, therapy area, care pathway and local healthcare economy by…
• I will develop closer relationships with key stakeholders in my company by…
• I will develop closer relationships with key customers by…
• I will develop a better understanding of best practice and consider the most appropriate solutions for my customers’ problems by…

C) Quarterly assessment – assess the potential to drive value into internal/external customers against the following parameters:

• Do I demonstrate more than financial value to key accounts?
• Have I increased the number of internal/external relationships where I add real value?
• Do I possess specialist knowledge that I can share with colleagues/customers to add value?
• Have I influenced any changes to the benefit of the company or customers?

This learning and knowledge was primarily delivered through personal research using books, magazines and the internet. My colleague also constantly suggested projects that he could work on, even in his own time, that he felt could transform the value being provided to customers. Many of these were rejected, particularly initially, but eventually he developed close enough relationships with people in the company who recognised the value these projects might create. These projects were a very valuable learning tool and a superb way of displaying his talents.

In summary
Pharmaceutical companies are looking for new and innovative ways of providing value to customers. As decision making within the NHS increasingly shifts to those regularly interacting with the end user (patients), the opportunity for primary care representatives to adopt a more customer-centric approach based on KAM principles grows exponentially.

The advantages of this may lead to less complicated field force structures, reduced costs and additional value added for customers. With such developments, companies will be in a better position to assist each individual in developing their careers to meet the demands of the new healthcare economy.

Tony Swift is the Managing Director of Apodi. He may be reached on tony.swift@apodi.co.uk.

UK pharma companies are not doing enough to help medical sales professionals succeed in the modern environment, new qualitative research has shown.

The study, designed to understand the real world challenges of field-based executives, indicates that the working practices of UK pharma sales executives have changed dramatically in the past three years.

The combination of a maturing KAM model, the emergence of joint working and an increasing reliance on iPad technology, is driving a radical shift in the NHS/pharma relationship – and is forcing medical representatives to develop new skills to thrive in the new environment.

But many sales professionals claim that they have been given inadequate support to help them prosper in an evolving marketplace, and that some employers remain reliant upon traditional training methodologies to see them through, despite rhetoric to the contrary.

The findings are the result of the first phase of an ongoing research exercise by Pharmaceutical Field, and follow a series of one-to-one interviews and roundtable discussions with existing sales professionals in the first two months of 2012. “Early indications, from what will be a sustained research programme throughout 2012, are that, across the board, the role of the medical sales professional has evolved considerably,” says Chris Ross, Editor of Pharmaceutical Field. “In 2008, when we conducted a similar exercise, whilst the term Key Account Management was beginning to gain traction, the concept of joint working with the NHS barely merited a mention. But it would seem that both aspects are now playing a central role in the day-to-day work of the medical representative. The problem is, too many argue that the training they are given to manage relationships with their local health economies – and indeed the metrics upon which they are judged – mirrors that of the traditional drugs rep. And when it comes to joint working, the majority of respondents are describing confusion on both sides of the NHS/pharma equation. The industry clearly has work to do in this regard.”

The 2010 launch of the iPad, along with the subsequent introduction of similar mobile devices, has revolutionised customer communications for many industries – and it would appear that pharma is also beginning to enjoy the benefits of digital technologies, albeit slowly. It is estimated that around 25% of UK medical sales professionals are now using iPad or equivalent to detail their products to customers – and this is very much in line with Pf’s research. A fifth of those canvassed have been issued with mobile devices and are using them with customers. Feedback suggests that HCPs find multimedia presentations more engaging and memorable. One regional account manager, from a medium-sized UK pharma company, said: “Gaining time with customers remains one of our biggest challenges, and it’s not unusual to be given just a few minutes in a corridor or a hospital canteen. Making the most of that time is imperative. We’re finding that detailing our products via the iPad has a much greater impact than printed leave-pieces, and the customer experience is significantly improved.”

Despite this, representatives from some of the smaller pharmaceutical companies that have taken part in the study still appear to be using traditional detail aids – and believe that it will take some time before the use of tablet devices in the field reaches a critical mass.

The Pf study also indicated an increasing number of medical sales professionals are choosing to work on contract, rather than on headcount at mainstream pharmaceutical companies – with job security cited as one of the key factors.

There has been a lot written about the industry’s apparent move to Key Account Management and its impact on call rates and targeting. David Round provides a welcome break from the rhetoric and concentrates instead on the facts.

Mark Twain famously said that people often use statistics as a drunk uses a lamppost: for support rather than illumination. But when used properly, data can be incredibly illuminating – not least for the UK pharmaceutical industry. And analysis of pharma’s ongoing modification of its sales and marketing model is well worth putting under the spotlight.

In the past few years, experienced pharma commentators have looked in vain for evidence to support an inexorable, yet often anecdotal, march towards Key Account Management (KAM). The rhetoric said that pharma was taking a more sophisticated approach to sales and marketing activity and, in the process, delivering a more efficient and effective commercial model using a targeted KAM methodology. But the reality, and indeed the numbers, seemed to suggest otherwise.

The UK pharmaceutical industry may have taken the surgeon’s knife to its collective sales force and cut back on the volume of field-based staff. It may also have rebranded its sales representatives as ‘Account Managers’ and encouraged them to take a more measured approach to targeting key customers. But, until very recently, the number of GPs being seen by medical sales professionals across the year remained as high as ever – belying the claim that companies were moving away from the apparently inefficient ‘share of voice’ model that had served them so well in the past. Critics claimed that the traditional sales rep had simply been issued an Account Manager’s business card and given the accountability and autonomy to be more selective in targeting key customers – as well as a call rate target that was directly at odds with the KAM philosophy. And the statistics did little to quell the debate.

Data from Synmetrics, Cegedim Relationship Management’s activity benchmarking tool, shows that between December 2009 and December 2010 – and in the thick of widespread opinion preaching the gospel according to KAM – 92.7% of UK GPs had a face-to-face call or meeting with a representative from a pharmaceutical company. This indicates that, far from adopting a more considered approach to targeting its customers, the industry was still carrying out almost blanket coverage of GPs. What’s more, the 2010 data merely continued a similar trend from the years that preceded it – with annual industry coverage in the past decade consistently reaching over 90% of the total prescriber population.

But the past 18 months seem to represent a watershed for pharma sales operations in the UK. Something, it would appear, is happening. In the 12 months from July 2010 to June 2011, Synmetrics data show that the number of GPs who have had a face-to-face call or meeting with an industry representative has dropped to 85% – a fall of some 7%. Alongside this, in the first six months of 2011 the total number of GPs who have had a similar contact has slumped to 73%.

Whilst the half-year figure may not be wholly indicative, the July 2010 to June 2011 full-year data appear to represent a trend. And upon closer scrutiny, it’s a trend that’s been developing incrementally over the course of the past decade. Figure 1 shows that the total number of contacts on GPs has, apart from an uncharacteristic spike in 2008, been gradually declining since 2001.

Contact is classified as either a traditional face-to-face call or a meeting, and analysis of the contact rates for each of these methodologies is equally revealing. The number of face-to-face calls (per rep, per day) has been steadily falling year-on-year. Conversely, the number of meetings (per rep, per day) has gradually risen – and in fact grew disproportionately between 2007 and 2008. The Synmetrics data show that there are more meetings taking place today than at any point in the past ten years; and that, crucially, in 2010 the number of meetings per day overtook the number of face-to-face calls for the first time.

Significantly, the number of face-to-face calls being made each day has halved over the course of a decade. That’s a pretty spectacular statement. So spectacular that it’s worth repeating just to reflect on it: the number of face-to-face GP calls, per rep, per day, has halved since 2001. This has nothing to do with field force size and the fall in the number of representatives – it’s literally the number of calls per rep.

Moreover, data shows that 17,000 GPs – around 35% of the total population – have not received a face-to-face call in the past twelve months. In truth, this is another staggering revelation: the bread-and-butter, conventional pharma approach of face-to-face engagement between GP and representative has reached a point where more than a third of GPs have not received a call in the last year.

And so the ‘real world’ data are piling up. There are now fewer representatives, who are collectively making fewer calls. There’s an increase in the number of meetings, but a significant drop in activity, with daily call rates halved and over a third of pharma’s traditional customer population not receiving a single face-to-face call. It is a breathtaking decline, but it has not just happened overnight.

The implications
So what does all this mean? Does the 7% drop in GP coverage over the last 12 months provide the first conclusive evidence that Key Account Management is beginning to take hold in the UK? Or does the incremental decline in contact activity over the course of the past decade merely confirm that customer access, for reasons that are well documented, has shrunk considerably? Have GPs increasingly decided to close their doors to industry representatives, or have pharmaceutical companies taken a more measured approach and chosen not to target them? Drawing a distinction between the two is difficult. It’s most likely to be a combination of both factors.

What we do know, of course, is that the industry’s customer-base has broadened extensively in the past few years with the emergence of a new breed of decision-makers – loosely classified as payers. As a
result, pharmaceutical companies have been forced to balance activity between traditional customers and more influential stakeholders in medicines management and commissioning functions. With GP call rates
falling by half it would be easy to assume that sales professionals are spending up to half of their time refocusing on payer engagement. But this may be too simplistic a conclusion. The payer population has rapidly earned a reputation for being difficult to access, and building relationships with the new stakeholders is widely accepted to be a long-term process that will take time and effort.

However, it would be disingenuous to conclude that half a sales professional’s day is being spent calling upon payers, and to use this presumption as the ultimate proof that Key Account Management has finally
established itself is probably a leap too far – it would perhaps be more realistic to assume that the effort and preparation required to see these payers is what is taking up a greater part of the sales professional’s day.

Yes we KAM?
It’s still too early to make definitive claims that the KAM model is firmly embedded in UK pharma. The indications are that the approach is beginning to take shape, but there is perhaps still some way to go before companies finally feel confident enough to entirely let go of the traditional share of voice model. But while that transition continues, the need for a more sophisticated approach to targeting customers remains as strong as ever. Pharma companies need to use all of the available data to drive their promotional plans, and use every available channel to reach their customers.

The industry needs to be as targeted as it can be, and sales professionals must be as smart as possible in their approach. Quantity is being replaced by quality. As the number of daily contacts being made continues to decrease, it’s vital to make sure that every face-to-face call or meeting actually counts. As
Account Managers are encouraged to develop their own call plans and become more accountable for their
own business, the need for robust and effective data to help make informed targeting decisions in the process is paramount.

Statistics can, of course, be used to provide reassurance and justification for a decision; but when considered more carefully, robust data can stimulate much greater illumination. For UK medical sales professionals, gaining access to information that enables you to shine a light on all of your customers and establish which ones provide the greatest potential, could make the difference between staggering around in the dark and giving your sales figures that extra spark. Don’t allow yourself to become the drunk at the lamppost – it only ever leads to a headache the following day.

David Round is UK General Manager, Cegedim Relationship Management.

The switch to Key Account Management is one more companies are introducing to tackle current challenges. Apodi’s Tony Swift highlights the principles of effective execution and making a strategy work for a smooth transition.

More and more companies are now addressing the changing healthcare market by transitioning the sales process from one which primarily involves representatives engaging with healthcare practitioners on a ‘one-to-one’ basis, to the establishment of Key Account Management (KAM) teams.

The rationale for this change is irrefutable. Access to GPs is increasingly difficult and the ‘customer’ now represents a series of more complex accounts with numerous stakeholders and influencers. Furthermore, decision making is both at a national and regional level and there is now a greater need than ever to focus on local healthcare economy needs and requirements.

As a result, pharmaceutical companies have established, or are in the process of doing so, KAM teams in which individuals have increasing responsibility and autonomy in addressing the needs of their customers at a local level. Some pharmaceutical companies have even taken the model further and given team members, or a small collection of them in a specific locality, P&L responsibility – essentially establishing micro business units within the team itself.

 

A different approach

Some years ago it could have been argued that any company transitioning to the KAM model was differentiating itself from the competition. This argument is much more difficult today because most pharmaceutical companies have moved, or are moving this way – in short, almost everybody’s doing it.

However, there is still a key source of competitive advantage in this environment – and that is to actually make the new model succeed.

Our research, and the feedback we have received from companies trying to adopt the new model, is that the execution process is much more difficult than originally anticipated. The type of feedback we receive often includes the following observations:

• Account managers do not appear to be acting in any materially different way than the sales representatives of the past
• They are adopting the new model at vastly different rates with a small number leading the way and the rest struggling to come to terms with the new strategy
• The move to more local autonomy is creating confusion about the role of the centre and its interaction with the decentralised function.

 

Difficulty of execution

So why is it that so many companies are finding the execution process more difficult than anticipated? The primary reason is that there is often an underestimation of the scale of the organisational change required.

For instance, many sales functions in pharmaceutical companies have historically been based on a traditional command and control structure. Here, the sales management instructed sales representatives on which HCPs to target, how many times they should be called on and exactly what to say during any meeting with them.

Within the new model however, many of these individuals are now faced with adapting to a new environment where decentralisation, decision making, autonomy and P&L accountability are now among the order of the day. Given the above, managements’ task of transitioning the organisation from the old to the new model requires considerable skill, focus and expertise.

 

A decentralised approach

Many management commentators argue that decentralisation is a panacea for all ills. If executed effectively, in an appropriate environment, this structure can deliver enormous benefits to an organisation. However, the move towards decentralisation often creates a number of serious problems which, if not addressed directly and quickly, will significantly impact on performance.

These problems are as follows:

A lack of expertise: a decentralised structure almost always requires an increase in expertise in the key roles within the structure. For example, increased knowledge will be required by employees AND management to solve problems, address more complex customers and, in effect, run businesses – particularly if P&L account responsibility is part of the role.

Inertia: many employees enjoy going to work in an environment where they understand exactly what the day will bring; the common challenges they always face and, in exceptional circumstances, being able to refer any unusual problems to their line manager. In a new environment where their decision making authority is increased, many employees will be reluctant to do things differently and may continue behaving much as before.

Lack of responsibility: the new environment is a scary prospect for some people. The last thing they want is more responsibility and a fear of failure and an inability to work in the new way paralyses them – again leading to ineffective execution.

At Apodi we have looked at specific pharmaceutical companies that are struggling with the implementation of KAM teams and researched the reasons for their difficulties. In every single example, one or more of the problems outlined above was prevalent – and in most cases all three problems coexisted together.

In fact, some of our own executives have reported their own first-hand experiences of working with companies in which the almost evangelical zeal and enthusiasm of top management continued unabated whilst chaos reigned and they failed to achieve an effective transition.

 

The way forward

As we have seen, the execution process can be difficult. And because of this, it is critical that a clear procedure for managing an effective transition is implemented. This process needs to address the following:

1. Identify clearly the strategic intent of the company, including the projected benefits of changing the model and how these are to be measured

2. Given the strategy noted above, clearly identify the role of the centre and the role of the decentralised units and how these might evolve over time. In our view, companies are often too ambitious in managing the transfer of responsibilities from the centre to the divisions or KAMs. Clear standard operating procedures need to be driven from the centre in the early stages and KAMs need to understand the rules that they are expected to work to. Think carefully about giving newly formed KAM teams P&L account responsibility. It may be better to transition to this over time, and in some cases, not even to go this far

3. Identify very clearly the roles and responsibilities of management and KAMs at all stages in the change process

4. Given the roles identified in the new structure, carefully recruit the appropriate personnel. Implement a training and development programme focussed on areas such as the role of Key Account Management, the implementation of a complex sale, general business disciplines and other skills

5. Management need to quickly identify any KAM team member who cannot make the leap to the new world of working and deal with this appropriately

6. Instil best practices across the whole KAM team by establishing effective coordination and information sharing processes

7. Establish effective incentives to drive the performance required

8. Put in place appropriate controls, feedback, learning and corrective action processes to improve performance. Key to this is the management team that drives KAM performance. This team needs to be highly experienced and knowledgeable about the requirements of KAM teams and how to manage a change process.

 

Leading the way

As ever, the role of the leader is absolutely critical in driving through the changes to address the needs of the new healthcare economy. Whilst the development of a sound strategy is critical, it is also the relatively easy part of the process. In every pharma magazine, nearly all consultants and most competitors will support the notion of moving towards a KAM driven business.

However, it is the effective execution of this transition that the leader should focus on. They will also invariably experience many of the challenges that are common to such change programmes, such as internal politics, resistance to the new way of operating, lack of appropriate skills within the team and so forth.

It is because of this that a leader needs to draw on commonsense business disciplines to be successful. It is also crucial that the immediate management team are able to do the same. Therefore, before embarking on the process, it is important to make sure that the management team is capable and ready to execute change.

As I noted at the beginning of this article, many companies are implementing similar strategies. It is therefore logical to assume that, everything else being equal, it is the company that has the management capabilities to execute these changes most effectively that will gain a competitive advantage over its competitors.

 

Tony Swift is the Managing Director of Apodi. He may be reached on tony.swift@apodi.co.uk.