The force awakens?

Intelligent resourcing – what it means and why it’s important for companies

What is a pharmaceutical representative for? It’s becoming a question I’m hearing a lot these days.

As we come into the post-pandemic reckoning and look at the state of the industry as it now works, the old model of blanket coverage of a country with a noise-generating, call-rate-driven clinical salesforce does seem at a far remove from what is actually happening on the ground, and what is proving to be effective.

The old model assigned reps a territory, bid them to contact (compliantly) as many prescribers as they could with a stake in their drug, and then turn them – through repeated contacts, educational sessions and required and desired information – from awareness to advocacy.

Almost every part of that model no longer stands up to scrutiny. Furthermore, what even is a territory in this day and age?

Even without the issues around basic access to customers, in the new world, blanket coverage with massed teams of reps delivering the same message to all simply isn’t possible.

Each territory, now definable as an Integrated Care System (ICS), varies in demographics, aims, issues, KPIs, stakeholder groupings, organisation and decision-making arrangements. Meanwhile, local market access rules and a set of cultural differences, mean some are still receptive to industry, whereas others don’t see any value in engagement.

As for the ‘prescriber’ stakeholder group you’re targeting, this can have hugely varying composition, and differing levels of influence between traditional prescribers, treaters, pharmacists, medicines optimisation, those in charge of pathway transformation, finance, and clinical management.

What do call rates mean? Some client companies are informing Wilmington that the average customer call rate has dwindled to something like two or three contacts a week. Much of this work is actually virtual in any case and does not require the rep to be in a particular place.

We talked to Leslie Galloway, head of the Ethical Medicines Industry Group, who said “historically, in this industry, 60% of success has been turning up, 30% knowing your stuff and 10 per cent your personality and persuasiveness. Now the 60% has just ‘gone’ – there’s nowhere to turn up to. So, the other elements need to be that much stronger.”

Is industry making the best use of its resources? The answer to these issues may lie not in removing salesforces, but simply making better use of them, undertaking research and using data to get what differing areas need and providing the right mix of approaches to sit well with each.

This requires a new way of thinking about how salesforces and additional staff are organised, what they’re trying to achieve, and how they are then supported with other marketing, sales and education channels.

My colleague Julian Snape, Director of Commercial Optimisation at Wilmington Healthcare, puts it like this: “What is the sales headcount of your company? Let’s say it’s 25. The temptation is to then shoehorn a structure into that 25-person constraint. But across each segment you’ve created across the UK, do you really have 1 /25 of your market potential?

“What you actually need to do first is to consider how the customer is structured. Think about the 68 systems in the UK (42 in England, 14 in Scotland, 7 in Wales and 5 in Northern Ireland). Each has got its own characteristics and requirements, and a company can work with this by using lots of different functions and strategies for each.

“What does each system need? These needs will be driven by the market environment, the access to care, the local challenges. They’re all going to have different varieties and extents of challenge and that will require different localised strategies.

“For example, you might have two ICSs that have very similar market prescribing volume. However, the prevalence of disease could be very different. That can tell you that the rate of treatment prevalence is different – so one of ICSs has a challenge in getting patients treated and getting the most value out of a pathway. That requires different messaging and the company to be talking about the patients and the pathway, not the drug”.

So similar market volumes potentially tell very different stories about the approach required. Different systems, different approaches. You could add further complications – such as how a system reacts to industry approaches.

Julian explains: “Whoever has the budget for promotion might reasonably think – we need to have a clinical salesforce, we have 12 territories, so we need 12 salespeople. But you might actually only need 6 instead of 12 because in half the areas it’s not appropriate to use a salesperson.

“Some of these ICS don’t like industry. They’re not accessible in the traditional way. Take Derbyshire, which is very difficult for industry to engage with. There’s no point in going in with a traditional clinical salesforce. You need MSLs, where the work is solicited not promotional.

“And in some areas, it could be more cost effective to disregard the clinical specialist and use targeted digital marketing work instead.”

Intelligent resourcing (IR) looks across a whole range of metrics and tells you what your resource use should be. These metrics can include how ICSs compare in terms of maturity, attitude to innovation, openness to industry partnership, and what the burden of disease is like.

IR involves detailed profiling of these attitudes, performance indicators and environmental factors, overlaid with prescribing volumes, market share, formulary and guideline status. The access to care issue can be built in, as can waiting times, and uptake of care, to give a much richer picture of how each system needs to be resourced.

There is ‘the what’ – what will resonate with each ICS? And then there is the who – who are the people you need to deal with to gain traction for this resonant message.
How would this work in oncology? There may be several thousand licensed prescribers working in the prostate cancer space, for example urologists and oncologists, and these would normally be in the sales universe of a company with a prostate cancer drug.

The company might do some modelling and find 4000 contacts a year. They’d divide by frequency number and come up with a sizing model for how many people they’d need to service these 7000 individuals.

However, what is not known to many companies is within that universe, which ones are actually treating prostate cancer. This might only be 1000 people out of that 4000, which means that the efforts of many of the staff in this model are effectively being wasted.

Even within the 1000, how do you know not only who the KOLs are, but who the most important KOLs are to target the most amount of time and energy?

Julian Snape described the nuances of a system such as Frimley ICS and its potential as a territory if IR is used.

“Traditional resourcing would look at Frimley ICS and say… there are this many customers there, it’s not big but needs a certain per cent of your fieldforce – it’s a highly innovative place after all, an early adopter of new treatments – there’s a good chance you’ll get good market share quickly.

“It’s a simple environment with one major trust. They’re really into early detection of disease, access to patients, improvement of outcomes… so you think – good gig. However, Frimley doesn’t really like the Industry…

“But key in Frimley is pathway optimisation. I’d approach them in a market access led initiative to work on pathway development, alongside digital engagement and MSLs. The ultimate aim might be to improve the formulary status and move it along the guidance. That can be KPI’d, then inputs fed back into the plan.

“I wouldn’t use a clinical sales specialist. I’d go for a community detection project that could rationalise referrals – i.e., only people that have gone through a community referral programme should be referred for a certain disease - appeal to their sense of innovation. That’s the kind of nuance you need to make headway in this kind of system”.

Julian made clear that no two systems were alike in how this process would play out. “Greater Manchester is the opposite to Frimley. It’s a huge ICS with lots of providers. It has good levels of partnership with industry, plenty of inroads and access points, and does therefore provide opportunities for clinical sales.

“What you’re trying to do is apportion the most intelligent resourcing mix for each ICS.

“Some areas may not be worth doing much – not innovative, small market, share is low, not interested in industry – then you’ve got a robust and granular understanding of why it’s like that. If you’ve got all that then you can robustly say the cost of investment is too high.

“There’s nothing wrong from pulling back from an area if it’s no good for you.”

It seems to matter very much where pharma’s resources are put around the country – what mix of clinical salesforce, MSLs and digital marketing and education is deployed, and in what volume – as well as what story they are telling, and what customer need they are responding too.

Intelligent resourcing is showing a way forward with all this, and has already helped many of Wilmington Healthcare’s clients better understand and engage with a shape-shifting NHS.

Oli Hudson is a consultant at Wilmington Healthcare.
Go to wilmingtonhealthcare.com