Think you’re under pressure? Your customers are more under the gun than you are. That’s because payers – including insurers and employers – are demanding a better return on their investment. That may put more pressure on them – and on their sales reps, but it also spells opportunity, pointed out Tom Schwieterman, M.D., medical director for Midmark Corp., in his presentation at the 2011 HIDA Conference & Expo, “4 trends that will dramatically change the way your physician customers do business.”


The four trends are:


  • Cost containment and solutions that promote operational efficiencies will be in demand.
  • Doctors will look for new solutions that promote wellness and improve outcomes within their patient population.
  • Patient-centricity will take hold, and most patients will participate more fully in their own care process.
  • Data will hold immense value. Health informatics will need to be a core competency of physicians.


They’re not exactly new concepts, said Schwieterman. After all, who hasn’t heard expressions like “A penny saved is a penny earned” and “Information is power?” Nevertheless, they’re stronger than ever, and sales reps should pay attention.


Cost containment solutions


Cost-containment in care delivery will be the new norm, said Schwieterman. Reimbursement is not going up, only down. Consequently, your customers are looking for ways to boost their efficiency and minimize unnecessary costs to deliver high-quality care, he said.


Those ways include an increasing reliance by doctors on mid-level practitioners, and alternative types of care delivery, such as group visits and virtual care. “When the incentives for the job change, the methods and tools for doing your job change,” said Schwieterman. “Why see a patient and occupy your expensive staff and office resources when you don’t have to?”


How should sales reps respond? Three ways:


  • Know your customer and understand how they get the job done. Identify areas of inefficiency and offer solutions, and seek out adaptive behaviors within their workflow that can be improved. “Count clicks, observe bottlenecks, identify outdated processes.”
  • Help your doctor become a team leader. “Get to know the rest of the care team now and learn their roles,” advised Schwieterman. And keep in mind that when you solve a problem for a mid-level provider, you solve a problem for the doctor.
  • Don’t regard e-visits or virtual care as the enemy. In fact, as less complicated cases are handled remotely, cases of higher acuity and complexity will remain in the office.


Outcomes are king


Payers are preparing to reimburse providers on outcomes of care, not utilization, said Schwieterman. Increasingly, doctors will be measured – and paid – based on certain performance measures, such as mortality, complications, readmissions and cost-per-case.


Being paid on outcomes will require doctors to take on more risk, a new concept for most. Reps can help them reduce risk by presenting solutions that have been proven to lower the cost of care while improving quality. That means, of course, that reps must know the clinical impact of the products they sell, as well as other reasons why their products are valuable. “Some solutions prove more valuable to your customer because of their ability to prevent a complication, avoid another expensive CPT code, or simply allow better predictive analysis – risk assessment – to take place,” said Schwieterman.


Patient-centric care


Evidence is building that doctors who engage in patient-centered care use fewer healthcare resources, said Schwieterman. And those savings can be big – as much as 50 percent in a single year. Patients who are engaged in their care consume less healthcare and experience fewer errors and complications. Indeed, experts say that as much as 80 percent of healthcare decisions are made by the patient himself or herself, such as food, lifestyle, exercise, etc.


How can physicians cultivate a patient-centered approach to healthcare? By taking time with their patients and asking simple questions about their family life, nutrition, exercise habits, interpersonal relationships, current emotional state, etc. Most important, the physician has to sit still and let the patient ask questions.


Implications for the sales rep include the following:

  • Products and services that engage patients in their own care will be essential to helping physicians control costs and improve outcomes.
  • Products or services that focus on improving outcomes for the 10 percent of patients who consume the majority of healthcare costs will be in demand.
  • Reps are in a position to help physicians do what will be increasingly demanded of them in the future – build strong relationships with patients, sell treatment programs and playing the pay-for-performance game.




Who hasn’t heard Peter Drucker’s famous quote, “You can’t manage what you can’t measure”? Problem is, as an industry, healthcare remains far behind other industries in measuring its performance, said Schwieterman. “In a utilization-based system, there are few mechanisms to measure outcomes, compliance or value-for-care rendered,” he said. As a result, spending is all over the map from geographical region to region, and outcomes do not correlate.


But that’s changing, as the country moves away from utilization-based reimbursement. Need proof? Look at insurers – including Aetna, United/Ingenex and Humana – that have purchased informatics companies in order to implement new quality-based payment measures.  


Predictive analysis algorithms for managing risk will become more important, said Schwieterman. For doctors, “knowing who is at risk, what type of patient costs you money, and where to allocate your precious resources will be important,” he said.


These are not just theoretical concerns for the sales rep, said Schwieterman. In fact the rep can do the following:

  • Know why connectivity of your devices matters to your customer. Understand the data your equipment generates and how it can provide value in reducing the cost of care.
  • Understand how your products can help measure and influence outcomes and improve patient engagement. If your solution generates information that can help patients stay well longer or get better faster, you need to sell that attribute today.
  • Understand the analytical and information-oriented issues facing your customers. These emerging issues will important success factors in the future.


It may be a new environment for physicians and their sales reps, but it’s one that’s full of opportunity, said Schwieterman. But he offered one word of caution. “Your customers are struggling to make the transition from utilization-based rewards to outcomes-based rewards. This will take time and won’t happen overnight. There will be confusion.” So be patient.


 For more from the December issue of Repertoire, visit


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