Breitstein: All companies say reps should add value to the healthcare equation. Are these new approaches working? How can you tell?

Rosenthal: A relationship and ongoing conversation about the rep's products and services has to be present. With the constant realigning in the industry, it can be a challenge just to overcome that first hurdle.

Then we can see if the physician is satisfied with the relationship and values the time he or she spends with the representative. When those elements are present, at least at a basic, measurable threshold level, you could say there's value.

We started to do some research in 2004 around other options out there, and we tested several variables to understand what might work for us. However, I want to emphasize that the portfolio dictates a lot of what the structure of your sales force will be.

That's made the reps feel more accountable, because they have ownership over their practices in key physician relationships. And it helps us to be much more flexible in driving changes, and understanding what's going on, at the physician level. It's really been a good change for us—and other larger companies' experience has been consistent with that. Lilly and Merck have also been down that path.

COUNT ON ME

Herman: Accountability is not a new concept in pharmaceutical sales. But we're hearing more about it. Are companies using accountability in a new way?

Rick Keefer (chief operating officer, Publicis Selling Solutions Group): Accountability is what has generally appealed to high-performing reps in the specialty market. It's what attracts the high-performing rep to say, "Let me show you what I can do."

Now, in the large primary care sales forces, pharma companies are trying to assign product accountability and responsibility to one rep, rather than a pod or a multitude of reps. It's changing the model. We're now seeing a different profile of rep that companies are beginning to hire because some reps don't like that accountability. It's hard to hide.

Paul Stickler (senior director of sales, Ovation): I've seen that holding reps more accountable for their activity drives superior performance, and that performance is going to drive more value. It's a simple thing that really can make a big difference.

Breitstein: How do you make reps accountable?

Snow: I'd be careful about suggesting that it's only about the prescription. We care a lot about the quality of the call, and we recognize that it's a bigger world out there than just this rep/physician relationship and just driving a message and driving an Rx.