Using Value Delivered to Offices as a Key Metric of Sales Force Performance

By John Moran, Center of Excellence Leader, Commercial Optimization, IMS Consulting IMS Health

Physicians continue to cut back on time spent with pharmaceutical sales representatives in the office during practice hours. This is in response to increasing patient loads, escalating administrative requirements, and tighter formulary restrictions. IMS Health physician research conducted in the first half of 2009 indicates that physicians are giving office access to fewer, select reps on the basis of who delivers more value to the physician and staff. Physicians define value in very specific ways, and these vary according to the physician's specialty, size of practice, geography, characteristics of patients under care, and certain personal preferences.

A three-year longitudinal analysis of IMS value metrics shows that value received correlates more strongly with prescribing preference and market share than traditional sales force effectiveness (SFE) metrics, which overemphasize the mechanics of the rep-physician interaction. Do your reps understand the behaviors that earn them the right to join the office's trusted circle of reps (what we call becoming an "insider")? And do they consistently put these behaviors into practice?  Reps not experienced in what it takes to become an insider require enhanced training and resources. By identifying the primary drivers of value for distinct segments of physicians, and adding these to activity metrics, U.S. sales forces can reverse the gradual decline in strength of relationship with physicians and achieve greater field productivity.

In this article, IMS explains the new drivers of office value; how these should be used to train, manage, and measure rep performance; and what sales and marketing teams can do to accelerate uptake of the right behaviors in the field.

Traditional SFE Programs Fall Short in Generating Value for Customers
It's helpful to put SFE measurement in historical perspective. Since the early 2000s, when more systematic evaluation of sales forces using physician research was coined, companies have invested millions in understanding the quality of their selling effort. Today, just about every major U.S. pharma or biotech company evaluates SFE by gathering physician feedback about rep interactions. Typically, a company will spend $3 to 5 million per year to capture and analyze these data. This does not include the cost of internal resources to manage, interpret, and communicate results, and it also excludes the opportunity cost of focusing the field on things that do not drive market share.

According to commercial executives interviewed about SFE initiatives, few have been able to point to significant ROI on SFE initiatives. Executives identify two primary reasons for this: one, research findings are not specific enough or geographically focused to be actionable; and two, these findings do not inspire the confidence and trust of the sales force. Given this disappointing track record, managers have lowered their expectations of SFE. What was originally implemented as a tool to drive rep productivity and measurable share gain, has become comparative research that provides general "strategic" insights about physician interactions. Worse, there is a proliferation of published industry rankings of sales forces, which is usually broken out by primary care and specialists, and leaves managers with contradictory insights about who really is performing well and why. Commercial organizations clearly need better metrics and analytics to explain and predict market share, which generate specific guidance for improving performance.

Focusing on the things that your customers value most and implementing actions to improve your delivery is an exciting way to re-energize SFE and deliver stronger, more improved ROI. Companies focused on transforming SFE into value for the customer are surpassing their competitors. To understand how leaders are making this transition, four obstacles that these companies have overcome are detailed, followed by recommended steps to begin a customer value program designed to increase rep productivity.

Today's Selling Environment Has Changed Dramatically – So Why Haven't the Metrics?
SFE, or customer effectiveness, metrics were largely developed when companies deployed selling models heavily weighted to reach-and-frequency. With few exceptions, these metrics have not kept up with the sweeping change in how prescribing decisions are made or forced upon prescribers. Companies that rely solely on traditional SFE metrics are not leveraging all the information that exists about physicians, reimbursement, patients and group practice influences.

Figure 1. Take Stock of How You Currently Track Sales Force and Customer Effectiveness

1. How many of the metrics have been set based on historical notions of what used to drive prescribing behavior?
2. Have these metrics been statistically tested to determine if they move share today?
3. When was the last time you interviewed physicians to get their perspective on what reps should be measured on?
4. Are you using a methodology that relies on physicians' "intent to prescribe", not today's advanced patient level data, as a way to predict impact?
5. Are you measuring customer performance at the local level and communicating these results to district managers?
6. What significant actions have resulted from your SFE measurement program in the past 6-12 months?

A rigorous, high-impact, customer value-based approach considers the questions above to establish a cross-functional discipline of excellence.

Figure 2. A Higher Standard of Evidence

"...mere experience is not enough for the advice givers of the future. They're going to have to offer a higher standard of evidence, including data, analysis and fact-based insight." Tom Davenport writes in a recent Harvard Business Review article.

Value Obstacle 1: Considering SFE to be a Process Check Rather than a Competitive Differentiator

The first value obstacle is organizational mindset. The goal of SFE research should be to find ways to increase market share locally - either at the territory or district level. While seemingly obvious, many organizations do not make share gain the driving force behind SFE measurement. Often, the research objective is to measure how well reps are complying with process steps, such as the use of certain tools. Physicians are treated as "process inspectors," reporting what takes place on a call, how frequently reps execute these actions, and how this compares to competitors. This is particularly true of "detail quality" or "quality of interaction" programs, which are the most commonly implemented SFE initiatives.

As customer metrics, they do not tell the full story of how prescribing can be impacted. They can not paint an accurate picture of where your reps stand with physicians – because the equity reps have built over time is not measured. Without capturing the customer's interests and unmet needs, the commercial organization is not able to develop specific, clear-cut actions that will significantly influence prescribing behavior. Recently, IMS was asked to assess value delivered of a specialist-focused U.S. sales force operating in a major product class. The product class included several branded competitors and a generic agent. The Company traditionally tracked how frequently reps used visual aids and articles, as well as reps' ability to communicate the materials. These metrics were established as key performance indicators (KPIs), along with several others. Both marketing and sales leadership believed strongly that reps that used materials more frequently were "top performers," and had implemented POA actions to emphasize usage.

Using a value-based approach with its customers, the company learned that, despite its relatively high use of materials on sales calls, competitors did a better job of helping specialists understand patient types and optimal therapy for these patient types. Using this feedback, a regression model of prescribing patterns was developed. This revealed that helping physicians understand patient types and optimal therapies was a key driver of market share, and that if the company were to improve performance on this metric to the level of the top competitor, it was worth 3.5 TRx share points. Frequency of use of materials had no statistical correlation to market share.

Figure 3. Comparing a Traditional SFE Metric to its Value-Based Counterpart

Classic Traditional Metric:
Use of a visual aid which discusses the brand's ideal patient types

Converted Into A Value-Based Metric:
Helpfulness of the rep in explaining the ideal patient type(s) for the product

1. Which of these metrics would you want your reps to score higher on? 
2. Which of these metrics would physicians want your reps to score highest on?
3. If your organization just learned (with proof) that better education about patient types drives share, do you think you could build a case for new action?

The value-based metric does not just capture the activity of the rep, i.e. pointing to the sales aid; it goes deeper by assessing whether reps are achieving the intended outcome, which is to educate physicians. The value-based metric captures the sum total of discussions and tools used over time by the rep to further the physician's understanding. It measures the rep's level of achievement in moving physicians to a state of understanding about a critical aspect of patient care and the product. Equally important, physicians want this type of help from reps, so value-based metrics align physician needs with brand and selling objectives. When value-based metrics and activity metrics are taken together, however, it can be determined if the use of visual aids is contributing to the physician's understanding, or whether it is of little use. Ultimately, the aim of any SFE or customer effectiveness program is to find new ways to influence prescribing. Winning companies in the future will have commercial teams focused on this objective, with less emphasis on monitoring selling process steps.

Value Obstacle 2: Generating Significant Amounts of Data, But Little Proof

One sales leader at a top 20 U.S. company summarizes the shortcoming of traditional SFE measurement well: "We see the SFE metrics swing up and down, but we don't see any corresponding impact on the business – either for us or for our competitors."

To prove that traditional SFE metrics are causal to market share requires that key promotion influences, such as share of voice and managed care access, are controlled. Most SFE research stops short, or only uses a limited amount of data, to control for these influences. A sophisticated analytics design is not typically implemented along side physician surveys. Without evidence for success and a reason to believe in the results, support wanes. Traditional SFE measurement is weak in its ability to predict impact and show how scripts can be increased. Methodology and data advances, coupled with better understanding of physician motivations, can be leveraged to give sales teams a competitive advantage.

Value Obstacle 3: Not Making Findings Relevant for District Managers

It is difficult for traditional SFE to build a compelling case for change in local geographies. Brand or region level findings may be adequate for brand teams that want information on message effectiveness, but these insights are unable to generate local manager support for improvement programs. Region and district managers may feel that national results do not reflect their local market situations, or managers may feel they are already addressing the issues identified. In either case, these managers are not compelled to take action.

While traditional SFE research struggles to build a compelling case for change, there is a deeper issue here. Conclusions and recommendations from traditional SFE studies can be risky. Inaccurate findings can cause a sales force to steer away from true drivers of prescribing, leaving competitors to discover and act on unmet physicians needs. The wrong choice wastes valuable field resources and reduces confidence in future effectiveness programs. Perhaps the greatest cost of traditional SFE measurement isn't the cost of the research, but the lost revenue from not pursuing true, verifiable drivers of prescribing.

Value Obstacle 4: Not Paying Attention to Relationship

We estimate that fewer than 5 percent of U.S. commercial organizations routinely track their biggest intangible asset – relationships with physicians. Companies instead develop assumptions about what is important to relationship-strength and prescription writing. Through extensive tracking research with thousands of physicians, IMS has identified four categories of rep behavior that help explain relationship strength and ability to influence prescribing:

1. Building a mutually beneficial relationship (physicians seek reps that are valuable to them and their practice)
2. Removing prescribing barriers (commercial organizations needs to understand why prescribers can't write their brand and to remove these obstacles)
3. Engaging in valuable information exchange (physicians and staff value learning and a perception of objectivity)
4. Customizing information, tools, and resources to the practice (this drives access and additional opportunities to be valuable)

IMS then delved deep into these categories, using a number of specific attributes and behaviors that practitioners consider important. Because these behaviors capture the value being received by physicians, they are more meaningful predictors of relationship and share. In IMS's client work, we find that a small subset of these metrics rise to the top as being most causal to market share change, when considering new-to-brand prescribing, using anonymous patient level data (APLD).

How to Better Equip Reps to Enter the Physicians' Inner Circle

1. The role of the representative must be defined in terms of value delivery
Reps who deliver high value have more advanced and different skills compared to traditional selling model reps. Understanding the key drivers of value is critical for each specialty area, so that skills can be tuned to exact customer needs and motivations. For example, in one specialty area, we found that changes in three skill areas were required to improve value delivery.

Figure 4. Skill Adjustments to Enhance Value Delivery

2. Commercial organizations need to shift focus from rep activity to value received by prescribers
Value delivery is not just the responsibility of the sales organization. Marketing, managed markets, and analytics must be equally involved to provide reps with the tools and information needed to be successful. In helping clients make the transition to value focus, IMS works with each commercial function in creating outputs that contribute to the field's ability to execute on the key value drivers.

Once value tools are created and rolled out, commercial organizations must shift their measurement focus from "what reps do" to "value received by prescribers" by:

• Measuring the built-up equity in physician relationships, not just the perceptions and events of the last few calls
• Using a scientific, advanced analytics design that leverages new-to-brand scripts and managed care indices, to identify the true drivers of market share and predict impact of improvement
• Understand differences by specialty, since drivers are likely to vary
• Measure and track at the district or territory level to gain field-wide buy-in

3. Create a business case to drive the implementation of value-focused execution
Because of the limited impact of traditional SFE programs in the past, many sales and marketing organizations are skeptical of new measurement and tracking initiatives. Since a customer-value focused program goes beyond general information to provide specific market share opportunities and quantifies the impact of improving, a business case can be reviewed with commercial leaders to drive organizational commitment.

Figure 5. Annualized Incremental Value of Improving Top Metrics

In Closing
While physicians today are providing less access to their practices than ever before, they are allowing entry to a select number of reps who they believe are providing true value. A customer value program focused on the items valued most by physicians and designed to increase rep productivity can achieve significant results. Despite four common value obstacles, specific steps can be taken to re-energize SFE and deliver ROI. Companies committed to transforming SFE into value for the customer are gaining entry into "inner circles" and an invaluable leg-up on the competition.