Disease Management Selling:
Propaganda or Panacea?

Edition: September 2002 - Vol 10 Number 09
Article#: 1310
Author: Sheila Dunn

It took four weeks, but you've made it past the person at the front desk at Main Street Medical. You've explained to the practice administrator who you are and why your company is different from the rep/company she currently buys from. You're making progress toward that first order, hoping to avoid a bid list.

During your last visit, you introduced a product to help reduce complications for patients with chronic diseases. The practice manager appeared interested, and made an appointment for you to speak with the head doctor who could approve "capital" equipment purchases. Congratulations!

Now comes the fun part. You have about five minutes with a busy physician. Your two objectives are to get the immediate sale and provide him with enough valuable information to open the door for future sales opportunities.

The traditional approach to present this product is to say something like: “Doctor, I'd like to show you a new Hemoglobin A1c test.” The rep who already has the business in that account might be able to get away with this opening, but you can't. Here’s what can happen:

You (trying to penetrate new account): “Doctor, I'd like to show you a new test for Hemoglobin A1c.”

Doctor: "We don't do Hemoglobin A1c."

You: Umm….Duh…..(You're sweating heavily and wondering if this means that he doesn't order HgBA1c on his diabetic patients. Perhaps he doesn't have any diabetic patients. Does he send out his HgbA1c's? Does he think he'll go to the poorhouse if he tests in-house? Maybe he’s petrified of CLIA inspections.)

Manufacturers Lead the Way

What the heck is disease management selling anyway?

In the late 1990s, it was touted as a new technique that could remedy sagging equipment sales. Unfortunately, like SPAM®, no one really knew exactly what it was. It's taken years to figure it out. (SPAM® is still a mystery!) But for those manufacturers and distributors that have changed sales techniques to implement it, disease management is paying off.

For diagnostics manufacturers, disease management is all the rage. In boardrooms across America, new technology is developed and marketing strategies are devised for helping physicians better stabilize

patients with common chronic diseases. And distributors are expected to move these products by using a disease management approach.

If you'd like to master this process, read on to find out exactly what diseases and products are hot, what disease management selling entails and how to work it into your range of sales techniques.

Some companies, such as Bayer Corporation, direct their primary care product lines toward managing diseases such as diabetes and kidney disease; others focus on prostate cancer, colon cancer, osteoporosis and heart disease. One thing they all have in common: These are all common, chronic diseases.

A chronic disease is one that develops slowly and continues throughout life, usually worsening over the years. The most common chronic diseases in the United States are heart disease and diabetes. The most common reason for office visits in the United States? Hypertension.

One diagnostics manufacturer, Cholestech, approaches every aspect of its business – from research and development to sales and marketing – from a disease-management standpoint. Cholestech VP of Sales and Marketing Timothy Still says the company's goal, “to be a leading provider of diagnostic tools and information for immediate risk assessment and therapeutic monitoring of heart disease and diabetes,” will be achieved through its commitment to disease management solutions.

"We begin with a need, a physician’s need to diagnose and manage the two most chronic and deadly diseases in America, and we set out to fulfill that need," says Cholestech Marketing Manager Brett Finkelstein. "We start with disease management and translate that down through to our sales team, and they take this approach with them into every interaction with their customers. That’s how manufacturers like Cholestech approach our business, and that is how the top echelon of distributor representatives approach theirs."

Disease Management Is Key in Diagnostics Industry

Says Inverness Medical Innovations CEO Ron Zwanziger upon his company's acquisition of Wampole Labs: ''We have now added another key strategic piece in our planned progression toward a preeminent position in the field of chronic disease management."

The Nuts and Bolts of Disease Management Selling

Sales reps will find that they are more successful approaching physicians about how a product manages a disease than only about how it will yield a return on investment. Doctors enthusiastically adopt technology that helps diagnose or monitor a disease state or screen a high-risk population. These types of tests are considered clinically necessary, even imperative, for doctors to have in a primary care setting.

If a distributor rep can speak to how a product affects the doctor's business and bottom line, and to how it brings the doctor better, more efficient disease management…now you're talking the doctor’s language. Doctors aren't necessarily looking to buy a device; they're looking for help making better diagnoses and managing chronic diseases.

If physicians aren't hearing about disease management from you, they're certainly hearing about it from their patients. Drug manufacturers are forcing the disease management issue on physicians by marketing directly to consumers, and doctors are taking advantage of diagnostic tools to manage disease because their patients are demanding it. We may soon see diagnostic companies marketing directly to patients: "You might have this problem. Go see your doctor. He has a test for it."

Disease Management Hits Hollywood

Lauren Bacall, Kathleen Turner and Rob Lowe have jumped on the disease management bandwagon by raising consumer awareness of diseases that are - surprise! - commonly treated with a prescription drug. The star gets a lucrative endorsement deal by being associated with a campaign to bring hope to the afflicted. The drug company gets a famous, trustworthy, smiling face that delivers the "awareness" message of asking their doctor about a disease.

Practical Strategies

Consider trying the two disease management approaches below to generate interest:

Approach 1. You (trying to penetrate new account): We just began carrying a new diagnostic tool to help office-based physicians stabilize diabetic patients according to the new ADA recommendations. It's generating real excitement in the medical community because it usually results in fewer patient complications. I wanted to be the first to let you know it's available. Do you manage many diabetics? What tools do you use now?

Doctor: About one-fourth of our patients are diabetic. We send them to an endocrinologist if they're chronically out of control or to the hospital lab for testing. What new tool are you talking about?


Approach 2. You (trying to penetrate new account): In the last few months I've been working with [Practice Manager] to better understand your practice. I understand you manage a lot of patients who have undergone cardiac surgery, so I thought of you when I learned of a new diagnostic tool for patients on Coumadin. Patients really appreciate getting their results and dosage adjustment while in the office.

Doctor: Thanks for thinking of us! What is it?

Can you see the difference? Instead of moving into features and benefits (ho hum), assuming that the doctor has a clinical need for the test, try the disease management approach. It shows that you've taken the time to learn about the important issues of this particular medical practice and are offering a helpful solution. You'll more likely make it to first base by engaging their interest and showing concern for them.

Work with manufacturer's reps to create the same type of interest-generating questions to generate excitement about other "hot" tests like CBCs, PSAs, and the like. Once you've gotten the customer’s interest sparked about the clinical reasons for testing, CLIA and reimbursement become secondary and easy-to-overcome objections.

When to Use Disease Management Selling

Disease management selling is most useful for new kits or instruments meant to either diagnose a disease or to help patients with chronic diseases maintain their health and avoid life-threatening complications. For instance, diabetics must maintain stable glucose levels in order to avoid blindness and amputations.

Disease management is also the best strategy to sell diagnostic tests that help keep patients stable on long-term medication, such as anti-hypertensives and cholesterol-lowering medication.

You don't need a PhD to learn the basics about common diseases. In fact, we all know people who have them. The types of diagnostic tools used for disease management range from simple, straightforward tests for common diseases (Table 1), such as lipid panels, to more esoteric applications for specialists, such as tumor markers, cardiac markers, endocrinology tests, allergy and autoimmune disease tests.

(Hot tip: Physicians will soon be clamoring for high sensitivity CRP, and manufacturers are rushing to develop the technology on a CLIA-waived platform. It's a common lab test in Europe, but has been slow to take off here. Recent U.S. newspaper and journal articles are touting high-sensitivityCRP as the new test of choice for predicting heart disease.)

Let the Data Do the Talking

To justify doing a particular test, manufacturers use the latest clinical guidelines published either by a specialty society, such as the American Heart Association or the American Diabetes Association, or by the U.S. government. Nine times out of ten, doctors are unaware of these guidelines, so the subject must be approached tactfully. But because most doctors are data-driven in their decision-making process, a salesperson can't simply state that the latest guidelines recommend doing a particular test every month to monitor treatment or disease progress. Either hand the doctor a hard copy of the actual guidelines or print one off your laptop for him. Be sure to permanently affix your name, company name, and telephone number to every page you hand out!

Complete the sale the traditional way: Once you've gotten their interest, you can go back to traditional selling approaches – demonstrating and financially justifying the purchase.

Distributors on the Bandwagon

A few distributors are aggressively promoting disease management as a selling strategy; others are ignoring it. For most, disease management is still in its infancy, but the few that have driven it down to the field sales level are seeing tangible results.

Cholestech's Finkelstein confirms that distributors who use the disease management approach "have moved beyond simple account management and bring value that goes far beyond just supplying commodity items. They have solidified their relationship with that doctor and become a trusted advisor and business partner."

PSS's commitment to disease state management is evidenced by SRx, a solutions selling program. Begun in late 2000, SRx has involved significant commitment to training PSS reps about diseases, indications for testing, and new selling strategies. Over the past 18 months, SRx has consistently outperformed traditional sales within measured specialties threefold at improved margins.

John Sasen, executive vice president and chief marketing officer of PSS World Medical, has spearheaded PSS' commitment to the disease management concept. "Customers today need more than products, they need solutions,” he says. “They are faced with both a reimbursement crunch and increased regulatory pressure, so their operating expenses are rising while revenues are falling. Our sales reps have to be able to explain how products fit within the physician's clinical and business goals rather than simply demonstrating products."

Adds PSS Vice President of Strategic Sales Scott Helfrich, "Actually delivering solutions to physicians is harder than it sounds. SRx focuses on disease state management and helps to ensure successful execution in terms of delivering solutions. Not only does it change our selling approach. It positions our sales representatives as true consultants in the eyes of our customers".

But does it work? "Our customers have responded positively in that we have experienced increased growth in both sales and profit within specific specialties,” says Helfrich. “Physicians prefer to transact with salespeople who are knowledgeable about their specialty, who understand the common disease states encountered within that specialty, and who know about and can properly position solutions to meet the challenges and issues associated with the treatment of those patients.

"Training our sales representatives to effectively sell solutions is a multi-step process,” adds Helfrich. “Breaking the training down between information and execution is key. The balance between knowing your customers (information about their specialty, disease states, patient volume, reimbursements) and execution (tactical selling skills) is crucial to our success".

Disease management not only requires a commitment from upper level management; it is expensive to implement. It's also the cornerstone of Moore Medical Corporation's approach to selling diagnostics. Mark Florence, Moore’s vice president & general manager for primary care sales and marketing, says, "By focusing our product offering and multi-channel marketing campaigns on diabetes, cancer, heart disease and other life-threatening ailments, we are able to provide a powerful combination of customer and patient support." Florence recently began an intensive disease-management-based sales training program for inside and outside sales reps.

Caligor is also focusing the disease management approach. Michael D'Armiento, top equipment salesperson at Caligor, shares his three steps for successful disease management selling:

1. Reading up on current articles about new tests and new applications for old tests.

2. Checking the indications and frequency limitations of the physician's office to see if there will be a realistic application.

3. Reviewing the net return of the test by analyzing the reimbursement and the cost per reportable result.

D'Armiento says that understanding disease management helps him with his overall presentation by "showing physicians that I understand the applications for the tests and analyzer being presented. I believe this gives the physicians a sense of confidence in me and what I'm presenting. Winning someone's confidence is half the battle in laboratory sales, and gives me a distinct advantage over the competition."

Being able to understand the applications of certain tests gives D'Armiento a rapport with physicians. "For example, understanding the benefits of how [high sensitivity] CRP works in regard to heart disease management or how a third generation TSH can help in thyroid monitoring builds the physician's confidence in me and my sales program, making it easier to sell tests and equipment."

Tom Cook, an Orlando-based McKesson account manager, uses the disease management approach with some accounts because "it's a real attention-getter.” First, Cook learns exactly what is clinically important from his "guinea pig" accounts – those first-responder types that will usually try anything new and then come back and share with him how the product improved patient care. He then takes this clinical information and uses it to sell diagnostics to other accounts. He's had the greatest success with protime, hemoglobin A1c and lipid panels using this strategy.

David Wiley, a territory manager for Caligor in Tennessee, doesn't use the "D" word and says he's never once heard a doctor speak the word "disease management." According to Wiley, "It doesn't mean a hill of beans to a doctor, so don't mention it. Just know how a product fits into the concept of disease management. The doctor already knows what it's all about."

Billy Boros, sales leader for PSS in Eastern Virginia, is responsible for 14 salespeople who began using the SRx program over a year ago. A few of his reps have used it to get face time with doctors, warm up cold calls and increase equipment sales. He says it's a great tool for making professional presentations, and he jokes that " SRx makes us sound like we know what we're talking about" when we discuss disease states with a doctor.

Despite these glowing testimonials, don't be misled into believing that all distributors are adept at disease management selling. Some major players haven't even begun to devise selling strategies based on disease management. And, manufacturers of diagnostic tests for all but the most common diseases could be doing a much better job. In fact, most manufacturers' reps are more adept at features and benefits selling than disease management selling.

The vast majority of distributor reps that I spoke to for this article admitted (anonymously, of course) that they hadn't a clue how to sell the disease management concept. They added that the belief that their doctors were interested only in the bottom line underscores their apprehension about discussing disease management with them.

The Bottom Line

Do you need to use a disease management approach to be successful in medical distribution? No. You can build good relationships and take orders for commodity items without learning and addressing what is most important to your customers – patient care. After all, medical facilities will always need supplies. But if you want to set yourself apart as a true professional and an invaluable partner to that practice, then you must learn about the diseases your customers deal with and offer solutions to help them better diagnose, treat and monitor those patients.

Understanding the tests you sell and how they actually improve disease management and patient care will give you a decided advantage over your competition. The key is to perfect your presentation using a disease management approach. So, take the time learn it, master it, and integrate it into the way you run your business. Try it….it works!