How reps can deliver greater value while growing their lab business.
By Jim Poggi
For me, there are few experiences as exciting and rewarding as presenting a new test to a customer, having them adopt it and finding out later how valuable they found it for their practice and their patients. I am sure those of you who focus your time selling lab solutions feel the same way and can reflect upon a few examples in your own career. We get a sense of accomplishment from helping these clinicians select tests that are in line with their staffing capabilities, lab expertise and the budget of their practice to provide their patients with improved diagnostic and treatment options.
Obvious examples include specifically meeting the needs of pediatric practices, men’s health and women’s health practices. There are core tests that make sense for nearly all practices including urinalysis, fecal occult blood, respiratory tests, diabetes and lipid tests, but there are also tests such as PSA for men and cervical and breast cancer screening tests for women that require more in-depth understanding of the practice and the patients they serve. But sometimes, those of us who are firm believers in point-of-care testing wonder if we are the lone voice working to explain the value to clinicians. With the proliferation of information on the internet, television and other media, I am convinced we are not only not alone, but that there are several influencers at work we need to think about and capitalize upon.
With a little creativity I believe we can uncover and take advantage of the help these “hidden persuaders” are providing us. In the process, we may even be able to solve the mystery of increases in demand for current tests or customers asking us to provide tests we have not previously discussed. In this discovery process, we need to ask ourselves whether we are listening enough to the practice, and to “the signs all around us”. This column will examine other influences that may very well determine which tests your physician practices are interested in, sources of information that may be driving demand for tests your customers are currently ordering from you, and why you sometimes are asked “the head of the practice wants to know whether your company offers a test for (something we have not discussed before).” I hope to open your eyes to some of the influences we should be listening to and figure out how we can deliver greater value to the practices we call on while growing our lab business and customer respect as a valued consultant.
Prominent influencers
One of the most prominent influencers of both patient and clinician behavior is TV. Every day we see TV ads asking the audience to “ask your physician if one medicine or another is right for you.” From my vantage point it is not so much the prescription medicine I pay attention to. Rather, it’s what the ads say about which tests may need to be performed prior to using the medication or which side effects may occur that could be subject to lab tests.
A couple of examples will make the point. There are multiple drugs with ads on TV, radio and the internet for psoriatic arthritis and psoriasis. These are novel medications, and each one reminds the viewer of two things: use of this medicine may expose the patient to risk of tuberculosis, and is not recommended for patients with a compromised immune system. This is a “twofer” in my opinion: if you offer tests for tuberculosis and/or immune system tests as simple as total protein, albumin and A/G ratio, you have options to offer. But, offer to whom? While rheumatologists are a clear target, treatment of these patients is migrating to internal medicine and other practice specialties. These treatments are growing in popularity rapidly, offering novel ways to treat and relieve these conditions while offering us a chance to explore companion testing opportunities.
At the same time, there are at least two new drugs targeted at treating type 2 diabetes. Lest we forget, diabetes is a growing problem in the U.S. Diabetes alone contributes to 25% of health care system costs directly, with 37 million Americans diagnosed with diabetes and another 96 million estimated to be prediabetic, having blood sugar or hemoglobin A1c levels above normal but not yet at the level required to be diagnosed as diabetic. That represents roughly 40% of the total U.S. population. So, any significant treatment advance that improves outcomes for type 2 diabetes is bound to get attention.
What’s in it for us? The ads clearly point out that one of their benefits is a reduction in hemoglobin A1C. As these drugs become ever more popular for treatment of type 2 diabetes and also increasingly used as part of a weight loss program, there is significant opportunity for us to make sure A1C testing is performed on these patients. Our customers need to provide a baseline followed by monitoring of A1C levels along with other clinical signs and symptoms. Is your A1C business growing with no apparent connection to your recent efforts? I wonder why. Actually, I don’t wonder why. It is more likely than not a result in the increase in use of these type 2 diabetes medications. Asking a few questions of the clinicians you call on is warranted. “Are your patients asking about the new type 2 diabetes drugs? Have you begun prescribing them? How are you currently assessing their baseline A1C levels and monitoring treatment program progress? We have multiple choices available to provide rapid and accurate A1C levels. We also offer several other diabetes related tests including routine urinalysis, creatinine and albumin/creatinine ratio testing. We can provide you with a full range of tests needed to diagnose and manage your type 2 diabetes patients. Can we set aside time to discuss these options?”
As a counterexample, we are all familiar with the decrease in prothrombin time testing (PT) based on the use of newer anticoagulant medications. Beginning about 10 years ago, use of these new agents has reduced the need to perform PT testing significantly. From a patient and clinician perspective, this is certainly a positive step forward. But, what is changing from the perspective of coagulation testing we need to think about? First, once again COVID-19 provides part of the answer. The CDC estimated that at least 146.6 million Americans contracted COVID-19, with over 7.5 million hospitalized. What does this mean to us? From a coagulation testing viewpoint, medical researchers have determined a causative link between COVID-19 and excess coagulation, sometimes leading to stroke. This certainly provides a case for careful monitoring of former COVID-19 patients, especially the elderly, for coagulation as well as organ testing (liver and kidney especially).
In addition, newer medications widely promoted in the media may also lead to further testing opportunities. Certain new anti-depression medications indicate an increased risk of stroke. Prothrombin testing, along with testing for platelet aggregation studies and lipid testing, may well make sense for patients on these medications. It is worth your time to begin asking more questions related to patient management post-COVID as well as thinking actively about how to open up discussions with your customers about newer medications they may be prescribing and related needs for lab testing.
Home testing
Finally, the law of unexpected outcomes leads us to home testing, and how increased patient accountability for their health may be leading them to ask questions of their health care providers related to tests they perform at home. Pregnancy and urinalysis have been with us for years and are often gate keepers leading to physician appointments and either confirmation or reflex testing to further understand the patient condition and the most appropriate treatment program. No doubt, home testing for COVID-19 will fall into this category. Newer tests for home STIs and abused drugs are likely to result in additional patient visits. Each of these situations can lead to further lab opportunities as long as we stay mindful of the “signs all around us” and take the time to open up new and unique conversations with our customers.
The skilled and successful lab consultant recognizes the signs all around us early and tailors their customer conversations to include not only the time honored discussion points related to point of care testing, but to also open the door to discuss and consider new opportunities as they arise, whether from advances in prescription drugs, changes in incidence of chronic disease states such as type 2 diabetes and the emerging trend of patients being more engaged in their health care and asking questions of our mutual customers.
Be aware of the signs all around you, think creatively about how they influence the needs of your customers, ask the right questions, and engage in novel dialogue with your customers. This level of creativity will be noticed by your customers and set you apart as a leader in the field. Be informed, ask the right questions, and be a leader. Your success depends upon it.