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Brian Chapman is a partner at ZS Associates, a consulting firm specialising in the commercial side of healthcare, particularly issues related to sales and marketing. Based in Switzerland, Brian has been with the firm for 16 years, leading a team focused on medical device practice. What follows is an interview that has been edited for length and clarity.

Prior to Covid-19, medical technology companies have been stuck in a sales model dating back to the 1980s — teaching and supporting in any and every way needed by clinicians in order to safely use the products, including being physically in the procedure to share what they’ve seen before and help doctors make decisions in the moment.

Over time, clinicians have become more comfortable using the products, and procedures that were once new became routine as they were performed multiple times. Even though there are always new products and surgical techniques, what has happened historically is that as doctors and nurses became more comfortable with devices, medical technology companies have not necessarily pulled back on their support, so what they end up with is a fairly expensive way of getting their product to hospitals. We’ve seen a general trend of medical device companies asking time and again, how do we fix this? How do we become more efficient? How do we do something other than drive around a sales territory — all day — providing service?

Now, with Covid-19, sales reps are unable to get to hospitals, and a number of tools that are slightly ill-equipped to provide the same level of service as before have been put into action. As a result, med tech companies have found themselves asking — much like we’ve all been asking as we adapt to teleconferencing and working from home — how much of this is a vestige of history that we needed to get rid of, and how much of it is actually required in the future of the medical device industry? Overnight, companies have had to jettison their old standby approach — while already knowing that it needed to slowly change. The big question now is: what do we do when customers’ expectations are potentially different to what they were going in, and how do we either take advantage of that or adapt to those expectations?

Adapting to a tech-led telehealth model presents a number of challenges in terms of infrastructure, platform and logistics. There are obstacles that emerge when you look at plugging into a hospital’s wifi, although on the surface it may seem simple. Are the connections sufficiently secure? Information that might identify the patient needs to be carefully protected, and clinicians need to know they have control over who is viewing their procedures.

At the same time, different procedures may require a variety of platform solutions — for example, if you’re doing an orthopaedic procedure you have very different visualisation needs than if you’re doing a stent placement. It really depends on whether you need to see what the surgeon sees; do you need to plug directly into the visualisation, is there a programmer for the medical technology device, or are there other monitors that are critical?Potentially you end up with something that looks like the cockpit of an aeroplane. There are some procedures that are simple enough not to require a visualisation, and then there are others when there’s a definite need to see the surgeon’s hands. So one question, going forward, is whether there will be one platform that addresses all of these potential needs, or a range of platforms tailored to specific procedures.

The other important thing is the actual benefit of having a sales rep in the room. There is a physical aspect to their relationship with clinicians that needs to be retained or replicated in some manner in certain situations, for example when a procedure doesn’t have the right instrument set. Often the sales rep will have emergency stock with them in the process of moving product from one hospital to another — so there’s a logistical benefit to having them physically present for a procedure. If the relationship becomes purely remote that advantage is lost, and when we envisage a world where this type of service is not available, there becomes a need for these logistical and delivery elements to come from the supply chain.

We’re seeing the acceleration of a trend that was already happening, and we won’t be returning to the ‘normal’ way of doing things after the pandemic — but at the same time we should not be expecting that sales reps will never make physical visits or talk to clinicians in person.

“The future will see us striking a balance, and telehealth will free up a lot of time to focus on launching new products — products that simply never got accelerated because the focus up until now have been on the share gain and share protection.”

Many medical technology products already have remote monitoring and different ways of taking care of patients built into them, and those features have suddenly become very important. So what we’re seeing is a switching on of those features and them turning into a real benefit.

The optimist in me sees the focus of many companies working in this field shifting from providing routine service to enhancing the quality of the outcome and the cost of the procedure — all things that have been designed into products and services but which have not necessarily been unlocked until now. The cost savings are unlikely to be at the forefront, however, because in that sense companies are looking at savings of maybe a couple of percent.

What’s more interesting is being able to speed up the adoption of new innovations.

We’re going to need to work differently to get through the time that we’re in, but it’s not going to be so transformative that we’re headed for some dark dystopian world. What we’re seeing is a huge opportunity for some of the things that have been brewing in our industry to move a little bit more quickly — especially in the field of digital telehealth.