Zimmer Biomet VP on Covering the Territory

The mission at Zimmer Biomet is about mobility – restoring the capability to use your bones, joints and supportive tissues. That covers a lot of territory.

But Brad Thomas covers even more. He sees his job as making sure the company’s skills are in place to assist customers and patients in every way possible.

Brad has been a medtech executive for his entire career, having served at Wright Medical Technology, OrthoMatrix, and in several positions at Medtronic, including Director of Marketing for spine and bio-logics products, before coming to Zimmer Biomet as VP.

What this journey taught him was that you have to do a lot more than just make sure the geographic territories are covered. You need every kind of expertise and service in place to satisfy customers’ and patients’ needs. Brad has identified ten distinct areas that are vital:

Sales team: Assess the number of feet on the street to support all facets of the sales support model.

• Clinical support: Sales staff should sell, clinical should help support surgery.

• Product availability: From design to manufacturing to delivery, every aspect is important to ensuring the customer is served.

• Implementation components: This is about the ways the message gets out there. What is the best way to introduce your products to the customer? Is it an in-service? A demo? Drop-off literature?

• Warehousing: Efficiency is the key here. Every implant in the field but not being used only contributes to an E&O and robs money from your business.

• Distribution: Proper forecasting and planning with good metrics will allow you to save on costly distribution measures. You never want to deliver an incomplete set!

• Reimbursement: One of the best ways to grow a new product is to find a way to increase reimbursement or help the hospital capitalize on available funds.

• KOL development: Early adopters are usually the leaders who push the envelope, trying to find the best way to treat their patients. These relationships are the laboratory to help grow your business in the long term.

• Patient funnel: Once you have a right-sized sales force, properly trained and motivated, use all the tools available to help drive more patients into the funnel.

• Competitive routes: Always look over your shoulder, as the competition keeps us on our toes. Always anticipate how you would compete against yourself. Write yourself a 100 million dollar check – how would you use that to compete against your business?

Many companies do red team/blue team exercises to draft an experience, and then immediately draft the counter experience. Although it is found more in cyber security, we did this type of scenario planning while I was at Medtronic Spinal and Biologics.

THE MISSTEPS THAT EDUCATED HIM

Brad shared some of the learning experiences that helped him formulate this list. “As a marketing leader at OrthoMatrix Trauma, we were passionate in getting the word out about our new and somewhat unique product,” Brad says. “We needed sales, and we thought our product’s qualities would lead the conversation. Within weeks after launch, we quickly realized that we did not have properly trained clinical sales support, not enough inventory, and poorly designed distribution models. We fell into the trap of not developing the geographic coverage first but skipping to Step 3, New Product Launch, first. This set us back six months in the critical early stages.”

At Medtronic, Brad was part of a large acquisition team, but didn’t have the proper sales force or a distributor with market coverage. “And we underestimated what it would take to properly integrate them into the company, as they were quite competitive at the time. That was another lesson learned.” Regulatory and new product launch absorbed too much of their efforts, instead of getting the right people in the right locations.

“Education and training of sales reps are essential to the company’s success, because you want the sales reps to be a proxy for the company,” Brad says. “We always have limited budgets, and training sometimes falls into the category of being a ‘necessary evil.’ So it behooves us to make sure we have the optimal audience.”

By focusing on the audience, Brad has been able to “Effectively secure the right number of reps and support people in a geography, or limit the geography based on the number of reps available. They are the face of your company and you only get one chance at a good first impression. So you must train your reps, all at once, after you have the critical mass of reps in the same room. Don’t piecemeal the training.”

KEY LESSONS FROM BRAD’S EXPERIENCE

Brad shared with us some of the major learnings that inform his current leadership role:

Manage Your Audience to Maximize Bang for Buck

Brad says a lot of your efficiency is about audience management. If you are going to put a surgeon or an SME at the podium to talk, extend the impactful by maximizing the people in the room.

“If you are going to spend the time and effort to invite a surgeon faculty, draft an invitation, rent a meeting space, supply a catered meal, set up a demo, etc., you should really try and maximize your attendee list. Don’t limit yourself. Often times we schedule an event and hope the sales reps bring in the attendees, when we should be actively recruiting the right profile of customer to these events, and really holding the sales rep or area manager fully accountable. A training event that goes on half full is a really missed opportunity.”

Expand Who You Educate

In the course of any educational initiative, bring people from the office. Bring people who you would not normally think can help you.

“Every time I do a cadaver lab with one or multiple surgeons, I invite three to four people from customer services, a similar number from the product team, and the regulatory team, and someone from finance,” says Brad. “All those perspectives will be vital in advancing the progress of your product.”

He offered a personal example. “I was invited to a cadaver lab early in my career, as a production employee. At 19 years old I was amazed at the opportunity, but more importantly I noticed that we were scrapping implants for very minor out-of-tolerance issues, but these same implants were perfectly suited for use in a cadaver lab. Once I saw how the implants were utilized, and learned what features were critical, I started saving scrapped implants and giving them to the marketing department for sales promotions and cadaver lab usage. This eliminated their need to use finished products and saved their budgets hundreds of thousands of dollars. It got to where the sales team would advise the marketing team what they needed, and the manufacturing team would collect anything out-of-spec and send it to sales instead of scrapping and recycling the products. This was possible only because a person who saw products going into the scrap bin realized these products had a use for sales and marketing after seeing them used in the cadaver lab.”

Include Your Silent Partners

Another important factor: “Every industry and every situation has silent partners – operating room personnel, the head nurse or the circulator or central sterile. These are people you need to build a relationship with. One of the most important ways for a salesperson to be successful is for them to have ‘access.’ This may be getting past the front desk, past the head nurse, or past the hospital administration. Every surgeon has a gatekeeper, intended or not. The more partners you can make in the hospital and the office, the more access you can have to the customer.”

Focus New Product Launches on Growth

Brad has found the most success with new products has been where there is focus on the growth portion of a launch. Otherwise you may end up with a usage change, but no growth.

The goal with new products is not to switch from Product A to Product B, but to continue supporting Product A, and get additional growth with Product B, whether it is a new product or new type of product.

Medtronic Sofamor Danek realized this issue and was really strong in providing best-in-class clinical data and evidence to help grow the motion products early in the game. It was ultimately the powerful compelling data that helped surgeons adopt these new therapies and use them in conjunction with their more standard therapies – instead of switching over wholesale.

Identifying early adopters is another important tactic. They will be the foundation on which future growth is built.

You also need to ask the right questions: How many reps are needed? Where do they need to be? Where is the competition keenest? Do you have a highly differentiated product? Do we need national coverage or want to stick only to a limited territory? Should we target the large universities – the Mayos and Cleveland Clinics – or is it better to focus geographically, on certain cities?

“Many years ago in the spine implant business the market was trying to bifurcate, between fusion and motion technologies,” Brad says. “Millions of dollars in R&D and regulatory were spent. But the doctors who were doing fusion procedures simply converted to motion technologies, with limited growth in patients, and mostly a growth in cost. Early on, the few companies who were early movers could have positioned the motion products as an early intervention device, and not just a substitute for currently accepted fusion devices. The crossover from fusion to motion would have been acceptable, but with additional patients in the system it could have grown the overall market.”

Market development

Once a product is launched, the main focus is on market development. “This is one of the most expensive components, the hardest to tie to ROI, and the most important to marry with a tiered execution plan for long term success. Whether you are trying to increase reimbursement, drive customers from one therapy to another, trying to drive more patients to seek treatment, investing in tradeshows or creatively partnering with hospitals and physicians, market development is the most costly side of the equation.

“Don’t start execution in market development until you have the right number of sales reps that are trained with the instrumentation or implementation in hand to capture the market. Don’t spend four million dollars on a pizza commercial in the Superbowl if you don’t have the ability to produce or sell the pizza.”

The key areas in market development, Brad points out, are reimbursement, driving patients, tradeshows and other promotion.

If you don’t do market development in a thoughtful and systematic way, you run the risk of throwing money away. “Overly large tradeshow booths, direct to consumer advertising, changing surgeons’ personal surgical techniques, and the like all require thoughtful strategies and very strict guidelines. Be careful not to mix effective product training with sham training focused only on increasing sales.

“Once you have enough sales reps and products to effectively cover the market, those reps and their customers are trained, and you have provided a new product that meets the market needs, only then are you ready to grow by increasing customers. Again, switching from one therapy to a new therapy does not provide lasting growth. Grow your business by increasing the number of patients where possible.”

It is critical to plan market development activities, and strategically execute them, to extract the biggest benefit. This includes increasing reimbursement, driving therapy to patients, doing DTC marketing.

THE CHALLENGE OF CHANGE

Product sales and marketing are nothing like the ‘90’s and 2000’s. The days of “features and benefits of my widget over your widget” are a thing of the past. Many companies have really good products on their third, fourth or more generations/iterations. We now need to look at the consumer being just as educated as our surgeon customers. I think you would be hard pressed to find a surgeon who has not had a patient come in carrying some print-out from Dr. Google. In the past 25 years I have seen a continual patient mind shift from the “white coat” belief to a more data- and outcomes-driven re-quest. Patients are more educated than ever!

As a sales or marketing leader in your organization, remember the process and try to keep it as straightforward as possible. New product introductions should drive more revenue, not switch over from one product to another. Education and training can be immensely more powerful when it is also offered to ancillary staff and internal employees, not just surgeon installers. Do not spend limited resources on market development until you have enough feet on the street or installation kits to reap the benefits. And never underestimate your customer (surgeon) and their customer (patient). Make sure that everything you do is ultimately making their lives easier and living longer fuller lives. It is such a wonderful time to be in medical device business!