ACC certified industry training

Interacting With Doctors: Rules of

Engagement

Society for Pharmaceutical and Biotech TrainersWednesday, June 12, 2013 4:00 p.m.-5:30 p.m.

Agenda• Context of 21st Century Care• Building Value-Based Relationships• Validating the Message with Sub-Specialty

Certification • Proof of Concept

The changing context of medical practice

• Since 1998, physician reimbursement in the Medicare program has not kept pace with the rising costs of practicing medicine (SGR- BBA 1997)

• To keep pace with rising expenses, physicians have had to see more patients in less time- primary care doctors typically see in excess of 30 pts per day

• This means that there is less quality time for pharma rep encounters

The changing context of medical practice

• In the fields of cardiology and endocrinology over 50% of physicians are now hospital employed

• Hospital contracts frequently limit physician contact with pharma representatives

The changing context of medical practice

• Senator Grassley’s Physician Payment Sunshine Act is implemented 8/2013

• Financial payments from industry to physicians will be posted on a CMS website after a 45 day review period where physicians may contest what is reported (honoraria, meals, gifts, grants)

• Pro Publica and other media watchdog groups will be free to digest the data and present it in whatever format they choose

Bridging the Gap• Everything begins with relationships

– First with front desk people and office managers– Next care extenders– Finally with physicians

• Read the tea leaves– Is it a bad day– How can you help?

• Know your stuff – What does this doctor/practice need?– How can you bring value to their patients?

Principles of Effective MD-Industry Relationships

• Listen- don’t tell• Observe- don’t sell• When in doubt- listen• Always remember that the common goal for

industry and physicians is providing value for patients

Bringing Value to the Physician/Pharma Relationship

• Learn the specifics of sampling for each of your practices– Know your product’s shelf life– Don’t sample with soon-to-be out-of-date

pharmaceuticals– If you think some of your previously sampled

meds are out of date, say so– Help with accurate documentation

Bringing Value to the Physician/Pharma Relationship

• Know what your physicians do• Understand the types of patients they see• Do your homework

– Talk shop with colleagues inside and outside your company

– Read your doctor’s CV– Google your doctor on line

Bringing Value to the Physician/Pharma Relationship

• Know your disease process• Know your package insert• Know your black box warnings• Know your drug and where it fits• Let your doctor educate you as to how he/she

uses your product• Never bad-mouth someone else’s drug

Bringing Value to the Physician/Pharma Relationship

• Know your financial support programs for indigent patients like the back of your hand

• Do everything in your power to facilitate the physician in getting your drug to appropriate patients whether they are wealthy or indigent

• If you bring value for a physician’s patients, the physician will value you and your products

Patient Impact

• In spite of SGR, surging hospital employment and the Sunshine Act, there are many opportunities for positive relationships between physicians and pharma professionals

• This relationship will always be a win-win if patients are impacted positively

• The litmus test for any interaction should be: Will this physician’s patients be healthier because of what I do?

How Can You Validate Your Message ?

• Get sub-specialty certification in your product’s disease state – You can’t sell your product effectively without

understanding how and why physicians use it– You can’t sell your product effectively without

a global understanding of the disease state it treats and the other drugs in common use

• Work on your own presentation skills

How Can You Validate Your Message ?

• Use sub-specialty training/certification to advance your knowledge and prove that you are not out of your depth

• Use sub-specialty enduring materials to show that you understand the context of use for your product

• Have a goal to learn something new about your product and your disease process every day

Why Set Standards for Pharma Rep Clinical Knowledge?

• To improve the quality of the pharma/physician interaction

• Increasing pressure to be efficient and effective with rep/healthcare professional time

Why Standards for Pharma Rep Clinical Knowledge?

• There is a heightened awareness of what is, and is not, appropriate interaction

– PhRMA code– OIG Compliance Program Guidance for Pharmaceutical

Manufacturers– Sunshine Act

• There is wide variation in company training situations and therefore; potential for wide variance in competency

• Heightened competitiveness in the industry worldwide

What about Medical Device Sales Teams?Coalition for Best Practices in HCIR Requirements

• Mission is to streamline the healthcare industry representative (HCIR) credentialing process for all stakeholders, while meeting the common goals of patient safety and confidentiality, through the development of industry recommendations and best practices

• Committed to open and ongoing dialogue between industry and health care providers to facilitate safe and confidential patient care by ensuring continuing access to advances in medical technology.

Coalition for Best Practices in HCIR Requirements • Members of the coalition:

– Joint Commission– Trade and Professional Associations; Non-profit

Organization – Individual Company (i.e., supplier, vendor, VCO) – Healthcare Industry Representative not otherwise

represented above – Healthcare provider or healthcare organization (i.e.,

hospital, physician group practice)

AMA Research on Pharma Rep Impact

• The following slides are from a survey done by the AMA

• The survey sampled a variety of medical specialties

None

1- 3

4-6

7-10

More than 10

28.5%

39.2%

16.4%

8.2%

7.8%

How often do Sales Reps call on your practice per week?

How often do you actually interact with a Sales Rep per week? week? 1-3 times

4-6 times

7-10 times

More than 10 times

I do not interact

59.5%

24.4%5.8%

4.5%

5.8%

What is the average length of time spent with a Sales Rep?

Less than 5 minutes

6-10 minutes

11-15 minutes

16-20 minutes21 minutes or more

Pharma Rep has been Trained and Certified by a Major Medical Society

No influence at all

Minor Influence

Some Influence

More Influence

Influenced Greatly

11.8%

16.3%

35.3%

21.6%

15.0%

72% said training was more than a minor influence

Multiple Sources

• The following slides are from a survey done by Publicis Touchpoints Inc in 2010 and is a Sermo Physician Survey, “What Physicians Want”

• The survey questioned over 250 Sermo physicians. All physician specialties were included in the survey.

Survey says:

Physicians clearly respected field sales representatives who were highly trained, experienced, and adept at having clinical discussions that added value to their practices.

Clinical Studies

Physicians are hungry for clinical conversations with salesrepresentatives that are based on clinical studies andevidence-based medicine (EBM).

Specialists

Physician respondents have a clear preference for specialty sales representatives.

ACC Conducted Its Own Primary Research

Methodology:

• Conducted online survey with CardioSurve panelists

• Survey live February 9 – 28, 2011

• 160 cardiologists participated in the survey

31

Satisfaction with Salesforce Knowledge

15% 46% 34% 1%3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Total

Don't know Not at all satisfied 2 3 4 Extremely satisfied

• Approximately, two out of three (64%) cardiologists have indicated that sales representatives they engage with have definite room for improvement in terms of their scientific and clinical knowledge.

32

Desired Knowledge

4%

3%

6%

27%

41%

53%

66%

68%

70%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Not applicable

None

Other

Knowledge of the different practitioner roles in thetreatment of cardiovascular disease

Knowledge of cardiology practice needs

Cardiovascular disease state knowledge

An understanding of the goals of patient treatment

Knowledge of scientific guidelines

Awareness of clinical studies in cardiology

• It is most important for sales reps to be aware of clinical studies, scientific guidelines and the goals of patient treatment.

Q: Which of the following qualities in terms of scientific and clinical knowledge would be most important for an industry sales representative to have when meeting with you? Please select all that apply. (n=160)

33

Likelihood to Meet ACC Certified Sales Rep

21% 48% 29%1%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Total

Don't know Much less likely Somewhat less likely

Neither more nor less likely Somewhat more likely Much more likely

The ACC is developing an "ACC certified" training program focused on cardiology scientific and clinical knowledge for industry sales and marketing individuals. A sales representative who successfully completes the program will receive a certification from the ACC that attests to their scientific and clinical knowledge of cardiology based on an ACC-established educational standard.

77% more likely

Q: Generally speaking, would you be more or less likely to meet with an industry sales representative who has been ACC-certified through this program? (n=151)

• Clearly cardiologists favor an “ACC certified” training program and three-quarters (77%) say that they are more likely to meet with a certified industry sales representative.

What are medical societies doing to assist industry partners?• Building on their core competence and experience of

offering high quality clinical education

• Creating training to compliment company’s existing training programs

• Working with leading companies to identify gaps in clinical knowledge

What are medical societies doing to assist industry partners and their members?

• Setting the standard for the level of knowledge expected

• Creating unbiased clinical programs taught by board certified physicians

• Identifying standards by specialty

What are medical societies doing to assist industry partners and their members?

• Monitoring the content

• Providing access to copyrighted enduring materials that facilitate the teaching moment

• Evaluating knowledge to assure the standard has been met

Standardizing Programs Across Specialties

Program structure• The basic program and each specialty module is

broken down into the following parts:– Pre study work– 2-day or 2.5-day case-based classroom

teaching component including interactive activities

– Nightly homework– Exam– Post-program continued access to cutting

edge information through society meetings, periodicals and web access

Graduate Status

• Oversight by National Society

• Identified as meeting the standard by practicing physican members by the “graduate” designation

• Designated in specific disease states

Content Development

• Oversight by National Society

• Work Group of leading physicians from across the US

• Experts in specific disease states

Faculty

• KOL’s• Must be associated with a leading medical

school or teaching hospital• Physicans who actually practice medicine

Disease State• Focus on treatment challenges of patient-related issues from

the physician’s point of view

• Understanding:– Diagnosis

• Tools such as guidelines, algorithm, appropriate use criteria

– Treatment• Decision making processes

– Management• Comorbidities

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Class of Recommendatio

n

Recommendation

Level of Evidence

Discussion/Supporting Information

Reading ACCF/AHA Guidelines

Case-Based

• Real life situations- participants diagnose and treat conditions

• Breakouts• Interactive teamwork sessions

Left Atrial Appendage(LAA) via TEE (Video)

Experiences

• Simulations

• Taped Cases

• Actual Patient Symptoms

Auscultation: Heart Sounds in the Initial Assessment

Barrett MJ. Heart Songs 3. http://www.cardiosource.org/Certified-Education/eLearning-and-Products/Heart-Songs-3.aspx. Updated 2011. Accessed June 27, 2011.

Attributes of an ideal disease-state training program

For the learner:– Curriculum is rigorous– Information is relevant to their needs– Provides dialogue with practicing physicians – Improves relationships with customers– Program delivers additional benefits upon graduation

Attributes of an ideal disease-state training program

For the pharmaceutical, biotech, device partner:

– Sales team can improve credibility with their audience– Program can be adjusted for specific needs– Information is relevant and up-to-date– Travel time/cost is minimized– Delivered by a not-for-profit Professional Medical

Society

Attributes of an ideal disease-state training program

For the practicing physician:– A sales representative that:

• Understands the disease state• Focuses on patient needs • Can talk about individual cases and issues• Has been trained by a specialty society