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A. Douglas Bender is an associate professor of management in the School of Business Management of Widener University, Chester, PA, where he teaches graduate courses in managed care organizations and strategic management. He is president of Swarthmore, PA-based Thayer Group, a management consulting company that has worked with physicians and physician practices for more than 15 years.
The pharmaceutical representative and the physician.
The current relationship between pharmaceutical representatives and physicians varies from total rejection on the part of the physician and refusal to meet with the representative, to a tolerant acceptance of the representative's role, to (in rare cases) a collaboration and partnership between the two parties. Traditionally, this has been a strained relationship because of the physician's wish not to look like a captive of the pharmaceutical industry. The relationship is also clouded by the notion held by many policy makers that the industry marketing practices exert too much influence on prescribing.
The delivery and funding of healthcare has drastically changed over the past several years, and with healthcare costs rising at double-digit rates, new ways of approaching patient care must be explored. This will demand that stakeholders in the healthcare industry work more closely as partners in finding better ways to deliver care at a reasonable cost. The parties need to focus on common goals, despite the fact that each group has its own agenda based on self-interest. The goals of quality care, access to care, improved health status and cost-effective care are common to most stakeholders, and these values should serve to form the basis of partnership.
With more than 60,000 representatives visiting physician's offices each year, a partnership strategy may be one way to differentiate one representative's approach from another's.
Let us begin exploring the concept of physician/representative partnerships with the simple idea that the pharmaceutical representative is not simply a salesperson. Though reps are judged on territorial sales, they must focus as much on what they have to offer in the potential partnership as they focus on assessing performance. In the broadest sense, the representative may be considered part of the healthcare team, with the objective of improving quality of life and quality of care for the patient. The rep's goal and that of the physician partner is the same: improving the health status of the patient. This concept should drive the relationship.
To be a knowledgeable member of the healthcare team, the representative must have more than product knowledge. The representative must also possess or have access to information that is important to the success of the physician and his or her practice.
Physicians are facing a world of uncertainty, with declining reimbursement, more paperwork hassles, frustrated patients and higher practice costs. Many see themselves at the bottom of the food chain, frustrated with the direction of care and a world that does not resemble the one for which they prepared.
However, many physicians are beginning to recognize that their role may be changing and that this change will require their leadership and the effective management of their practices and their patients. These "lightning rod" physicians and medical practices are potential partners in leading and bringing about change. They are not threatened by perceived conflicts of interest, but focus on learning how to provide better care that is cost-effective and to develop their practices as efficient and productive organizations.
As practices grow and physicians achieve more of a leadership role, they need partners and information. The keys for the representative are to:
• Know your local market. This means following what is going on in healthcare on national and regional levels. Identifying the players and their relationships can help the representative create a business and delivery model for a region that focuses on how the different stakeholders work together and how this might change in the future. This exercise helps the representative understand local industry dynamics and thus appreciate the strategic perspective of a potential partner.
• Know your potential partner. There is much information to be obtained from the practice itself, materials in the office and the practice's Web site, if there is one. Local newspapers may have news about the practice and the physicians. The physicians themselves, the employees and the office manager may also share information with you.
• Analyze your potential partner. It is helpful to know the patient mix (Medicare, commercial and Medicaid) and how the practice is reimbursed (what is the mix of fee-for-service, capitated and discounted fee-for-service payments?). It is also important to look at the state of development of a practice. A new practice working to establish new relationships among its physician partners is at a much earlier stage of development than a mature practice with a solid organization and practice infrastructure, and its needs are different. The early-stage practice is interested in survival, while the older, more mature practice is more concerned about its long-term future and strategic direction. The representative's presentation and partnership plan must be sensitive to the needs of each practice, and these needs will change with time.
There are many different partnership projects and programs that can be initiated. In each case, they must meet several key criteria. For instance, each project or program must achieve one or more of the following:
•Â Enhance the ability of the physicians to deliver better care.
•Â Contribute to the physician's learning.
•Â Help create improved relationships among providers.
•Â Improve the staff support in the practice.
•Â Contribute to better patient care and patient compliance.
•Â Produce outcomes that are measured and documented.
•Â Form a basis of further learning.
•Â Pass the test of "how does it play on the six o'clock news?" â in other words, does the program or project meet the interests of both partners?
It is important that each project or program be carefully planned, with agreed-upon goals for each partner. Further follow-up actions should be taken to ensure long-term value to the physician and the practice. It is also important that the results and outcome of each project or program be documented with a focus on lessons learned, specific goals met, and thoughts and ideas about the next step.
The following are a few examples of partnership projects:
Physician practice development. Many times, practices need help in coming together to create a new organization. Physicians need help in creating these organizations, particularly in integrating practices and their values and policies. The representative can channel help to these physicians by identifying professionals capable of guiding them through the process.
Practice planning. While strategic planning has not been accepted by most physician groups, with the changes occurring in healthcare, more practices are beginning to create strategic plans to guide their decisions and to take greater control of their future. There are professionals who can help physicians in this effort, and the pharmaceutical representative can provide material to physicians to help them think their options through.
Staff training and development. There are always needs related to staff training in the areas of leadership, team-building, communications, quality management, front desk management and patient management. Providing the physician with options for topics and programs can be very helpful. More and more physicians appreciate the fact that the quality of their staff is critical to the successful management of their practices, and that the development of this staff knowledge and infrastructure is something they need to offer their employees.
Diagnosis and treatment. Many drugs require new diagnostic procedures and clinical follow-up. Helping physicians introduce these tests and follow-up procedures into their practice can be helpful to the physicians and the staff in providing improved care to specific patients.
Bringing together primary care physicians and specialists. Many drugs are prescribed by both primary care physicians and specialists. A joint program with a group of primary care physicians and specialists working on common treatment protocols can be helpful in bringing these two groups together, but more importantly, it will establish standards of care and joint expectations. This helps when a patient is referred to a specialist by a primary care physician, improving the quality of care given the patient and increasing the confidence of the patient. The follow-up treatment is also improved when the patient is returned to the care of the primary care physician.
Chart audits. More and more physician practices are being monitored for compliance with specific disease management programs and are being measured in terms of how well their charts are documented. With many plans, physicians' reimbursement is increased if they comply with these documentation standards. The representative can offer a grant and a protocol to pull representative charts for patients receiving his or her products, evaluating the documentation and giving feedback to the physician.
Pharmacoeconomic considerations. More and more physicians must make judgments regarding the indications for the use of a drug and the cost. As the cost of drugs increases, as does their portion of total healthcare spending, these decisions will be looked at more and more closely. The representative should provide information to the physician to help guide these decisions.
Topic-specific conferences. At the local level, conferences on topics that relate to specific problems being encountered by physicians should be considered. Topics might include the electronic medical record and automation of the office, measuring quality outcomes, contract negotiation, the role of the hospitalist, and creating productive medical practices. This is not simply importing a speaker, but working with the speaker to create an agenda that relates specifically to the needs of the local physicians, with follow-up learning and application.
Creating an account plan can be very helpful. The following is a brief outline of an account partnership plan.
Key players in the practice: The key players can include the president of the group, the committee chairs, the medical director and the practice administrator or office manager.
Characteristics of the practice: These include size, type of practice, ownership, patient/payer mix, history of the group (new or old, or recent spin-off of hospital), degree to which they are committed to quality and patient care, competitive position, marketing strategy (are they aggressive in pursuing new patients?), and overall practice strategy and direction. This information can come from the practice, as well as others in the community.
Needs of the practice: These are the problems facing the practice and available opportunities. For example, is the practice experiencing growth pains? Are there opportunities to grow the practice in new ways?
Response: Based on the needs of the practice, what can the representative learn about the unique requirements of the practice, and what programs are offered by his or her company to help meet the different needs and requirements? In other words, how can the programs be tailored to the needs of the practice?
Implementation plan: This is a set of actions to be taken to get a plan in place.
Follow-up assessment: This is critical. Changes in the initial plan may be required as more is learned about the practice.
The current healthcare environment and the changes that we anticipate in the future will put more and more pressure on physicians and their practices. The pharmaceutical representative is ideally suited to offer assistance to the physicians and their staff in coping with many of these issues. To do this, the representative must understand the unique situation the physicians find themselves in and know how to approach these issues. In this way, the two partners â the physician and the representative â can work to improve the quality of care that patients receive. PR