A conversation with Greg Flynn, Ashfield Healthcare US

UDG Healthcare plc is a global provider of outsourced services for life sciences and healthcare; from its Dublin, Ireland headquarters, this publicly traded company manages business units and services in 50 countries, employs more than 8,000 and passed $1 billion in revenue in 2016. UDG Healthcare’s Ashfield Healthcare division, now celebrating its 20th year in business, provides field and contact center sales teams, healthcare communications, patient support, market access, audit, advisory, medical information and event management services to more than 300 healthcare companies.

Recently, UDG Healthcare announced the appointment of Greg Flynn as regional president of Ashfield in the US, responsible for commercial, clinical, medical information, pharmacovigilance and market access operations. Previously, he was regional president in Japan and representative director of CMIC Ashfield, a joint initiative between CMIC Holdings Co., Ltd and UDG. Under Greg’s leadership, Ashfield became an industry leading partner with more than 650 staff across 44 clients in five years.

Pharmaceutical Commerce sat down with Mr. Flynn to find out where Ashfield is going in the US. Here’s what he had to say.

1) Ashfield is a large multinational organization, and part of yet a larger multinational organization, UDG Healthcare. Can you put Ashfield in context for us? What role does it play within UDG Healthcare?

UDG Healthcare operates across three divisions; Sharp, Aquilant and Ashfield.

Sharp Packaging Solutions is a global leader in contract commercial packaging and clinical trial packaging services for the pharmaceutical and biotechnology industries, operating from state of the art facilities across the US and Europe. Sharp is also a world leader in ‘track and trace’ serialization services, which will require all prescription drugs to have a unique serial code for authentication and traceability.

Aquilant is a leading provider of outsourced sales, marketing, distribution and engineering services to the medical and scientific sectors in the UK, Ireland and the Netherlands.

Ashfield is a global leader in commercialization services for the pharmaceutical and healthcare industry, operating across two broad areas of activity: commercial and clinical services, and communications services. It focuses on supporting healthcare professionals and patients at all stages of the product life cycle.

Ashfield represents the largest division of operations within UDG Healthcare with 6,000 employees globally, representing 61% of the overall group profit for UDG Healthcare. UDG Healthcare has a huge stake in Ashfield’s success in the near-term, with nearly $500m dedicated to the acquisition of strategic companies—the most recent acquisitions of Vynamic and Cambridge BioMarketing being prime examples—focused on commercial and patient services. We see a tremendous opportunity to help our clients along the entire value chain—not just big pharma either; emerging biotechs and small pharma companies are very much companies where we can provide value in their commercialization and patient support services.

2) Do pharma companies contract with Ashfield for a global service, or country by country? And second, how does the range of services Ashfield offers represent a unified offering? Do clients hire Ashfield for its full range of services, or do they order ‘a la carte’?

Ashfield operates in more than 50 countries with offices in 22, and our corporate structure manages these operations territorially: US/Canada, the EU, and Japan. We’ve been providing an outsourced sales force, nursing and contact center solutions for more than 20 years, and in the last year, significant progress has been made in evolving our service offerings, introducing new innovative commercial models and winning larger contracts, particularly with global clients.

Ashfield offers a suite of services that work together along the entire value chain of a product’s lifecycle: Access to medicine, knowledge about the medicine, support to patients on medicine.

Through our Market Access team, we enable access to treatment by helping manufacturers navigate the challenges of bringing their medicines to market. For example, clients looking to go to market with late phase products are often unsure whether to commercialize the product themselves or to outsource. In order to create the most successful strategy for pharma and biotech companies, it is critical for them to know how payers are going to react to the product in the marketplace. They ultimately need a real-life view to see how the product would be reimbursed by payers.

Once a product is in the market, we are the conduit of knowledge to HCPs, helping them make informed treatment decisions that directly impact patient care. We can accomplish this in a number of ways, most notably by deploying commercial teams to educate HCPs and developing medical information resources to enable meaningful scientific discussion. Our healthcare communications companies help communicate brand and disease messages, while our event management company provides a means of educating physicians or organizing an internal sales meeting prior to product launch.

Most importantly, our mission is to support the patient to help achieve positive outcomes. Our clinical teams, comprised of nurse educators, connect HCPs and patients with impactful solutions such as adherence risk assessments and in-home instruction to help manage their condition.

The level of service we provide really depends on the need of the client and its respective product along with its internal capabilities to drive commercialization. Oftentimes biotech and smaller pharma companies do not have the bandwidth to solve some of the more complex challenges with bringing a product to market. In this case, we would operate as an extension of their organization, leveraging our market access relationships or rapidly deploying a sales force needed to achieve their financial goals. When it comes to some of the larger pharmaceutical companies, our focus tends to be more commercial or clinical in nature, delivering field and contact center sales or patient support teams. However, in all engagements, we match our tailored services to the opportunity the brand is afforded. In many instances, the brands we service need highly customized solutions and a unique skill set to achieve success.

The intrinsic value Ashfield brings to each engagement is our ability to draw upon the market knowledge and field experience gained globally within our multiple service offerings. For example, our healthcare communications companies can draw upon our field experience to improve their messaging or our event management experience can help sales teams better tailor their message to each specialty.

3) The core part of Ashfield seems to be contract sales, whether in-field or remote. What is the appetite today for hiring contract salespeople by your clients? How does Ashfield differentiate itself from what your competitors are doing?

Interest and appetite by both our current and prospective clients is quite high. The healthcare landscape continues to shift and organizations from small biotech and start-ups to Top 10 Pharma look to Ashfield for flexible, scalable and responsive promotional solutions. Ashfield partners with our clients to bring true innovation, all based on our learning and successes from around the world. There is also significant interest globally in clinical solutions and this has become an expanding area for Ashfield as well. Our client partners come to Ashfield for assistance with patient support and education in order to ensure the appropriate patients are prescribed their medications and continue treatment long term, with the hope to ultimately improve patient outcomes.

Ashfield is the fastest growing contract sales organization (CSO) in the US and certainly only one of two truly global CSO providers. We attribute our growth to several items: First, as an organization, we are focused on improving patient’s lives and supporting patient outcomes. This focus runs through everyone who works for Ashfield and into every solution we build. Second, Ashfield is extremely service focused. We can offer scale but with a boutique service level that our clients want. Finally, our values of quality, partnership, ingenuity, expertise and energy form the bedrock of our organization. They are not simply words on the wall. These elements are being responded to by the US market as clients look for true, meaningful partnership vs. transactional relationships.

4) What makes the ideal candidate for an Ashfield contract sales position? With its hires and its organizational structure, how does Ashfield address the differing needs of reps knocking on doctors’ doors, and market access that meet with payer formulary committees or contract negotiation groups?

The needs of our clients range widely for contract sales positions for a variety of reasons. The therapeutic area—now including orphan and rare diseases, specialty versus large primary care products, and the position of the brand in its life cycle, all impact how the product is best represented. For us, we do not simply build sales rep teams. Our clients and their customers have wide needs and we offer innovative solutions to address these needs. For us, it’s about truly customizing job requirements to suit the project, drawing upon our patient focus, high business acumen and track record of success to deliver the required solution. This is what our clients are looking for and what we provide.

In addition, the actual roles of sales representatives continue to evolve in the industry and Ashfield is driving this evolution. Ashfield currently has a wide range of teams and designs to suit the project. These include: stand-alone and embedded hospital and primary care teams, patient-focused patient service teams, integrated field and phone teams, rapid deployment representatives, as well as remote Medical Science Liaisons (MSLs).

Certainly if the brand is not positioned on a formulary, or a plan in place to subsidize patient costs, deploying sales teams can be an exercise in futility. As a result, market access has become a hot topic for virtually all of our clients and particularly those who are in launch or pre-launch phase. To address this, Ashfield has a dedicated Market Access company through the acquisition of the top market access company, Synopia Rx, several years ago. As a result, our sales teams have the capability to partner directly with our market access teams to address payer requirements whether they are large payer groups and/or GPOs or IDNs and pharmacy & therapeutic (P&T) committees. In addition, we have developed a market-access training program which is integrated into our initial training for virtually all teams to ensure every representative has a solid understanding of the payer landscape.

5) Is there a need to address specialty pharmaceutical markets (including rare diseases) differently from mass-market drugs? How does Ashfield structure its approach in this case?

The US medication landscape is moving rapidly to specialty-based products. In fact, by 2021 45% of the products on the market will be focused on the treatment of a specialty or rare disease. We can attribute this to an aging population requiring more acute treatment for diseases where there are few alternatives.

What this means to pharmaceutical and biotech companies is they will be faced with targeting smaller populations with much more complex treatment regimens; not to mention that in the next five years, we will see more than 100 specialty medications enter the market. In terms of supporting and commercializing specialty markets, the approach is similar to primary care products, with one big exception: The products will need to be launched and in market much quicker and with far more frequent product introductions. This creates some increased risk for our pharma and biotech partners—not just managing the sheer number of product launches, the logistics of getting on formulary, and planning materials and launch programs—but more importantly, helping the patient population understand their condition so that they start and stay on therapy.

What Ashfield and other CSOs bring to the table is a unique, rich experience background to address various therapy areas in different markets. This allows CEOs and commercial leaders to hedge their risk by passing the burden along to industry outsourcing partners. The reality is, with a daunting amount of new products in the next five years, the industry will need to build a launch machine. The advantage we have in the US is our sophistication when it comes to understanding the market and healthcare needs. Sourcing the right candidate for rare disease and specialty positions is driven by altruistic achievement—taking personal satisfaction in finding that “needle in a haystack” patient whose life may depend upon the client’s product.

Our recent acquisition of Cambridge BioMarketing is a strong indication of our commitment to this market need. As a leader in orphan drug launches, providing direction on HCP programs and patient outreach, this acquisition of Cambridge BioMarketing not only provides a platform for growth in the support of orphan and rare disease drugs, but also offers additional support in patient-support communication and digital outreach.

6) Ashfield is making a big push for what it calls “patient services teams,” but these teams appear to be focused mostly on assisting physicians in their patient interactions.In an era of decreasing physician access, how does this patient services approach make a difference? How much of what Ashfield does interfaces directly with patients, and how does that work?

Traditionally, pharma and other industries have used a sales model that relies on finding and training reps who can call on customers to promote and sell their brand. It has become increasingly apparent that this model should continue to evolve in response to the changing priorities of healthcare. The Patient Service Team—separate from, but complementary to, traditional sales teams—enriches the way brands interact with prescribers and helps them care for their patients. The Patient Service Team truly puts a company’s desire to be customer-centered into action. Their job is to call on nurses and physicians every day, but their conversations are only about improving the lives of patients—delivering disease literature and/or copay assistance information. The structure of the service team call is to spend only a few minutes talking with the office staff about the patient and as a result, has proven to be very successful.

To drive this success, the very profile of the service rep is quite different than that of the detail rep. Service reps tend to come from a customer service background versus the science background of their field sales rep counterparts. They are not overtrained on the product to avoid slipping into any kind of features/benefits discussion. They have a clear mission to serve patients, and as a result, tend to have improved job satisfaction and retention.

In place now for more than seven years, the Patient Service Team has achieved nearly 100% access to targeted accounts because of their proven value to patients, physicians and office staff over traditional representatives. Although many companies find this model sometimes difficult to embrace in that it does not represent an opportunity to sell, the patient support delivered, and the overall acceptance by the physician and the office staff, are proving to be a boon for the brand. Worked in tandem with appropriate details, the model offers a win-win for everyone.

In addition, client profitability with this new model has gone up. This is a direct result of either increasing or maintaining sales coupled with a decreasing cost base. With greater accessibility, these service reps can do significantly more calls in a day than the traditional sales rep, thereby reducing call cost by 75–80%.

It is important to remember that the traditional model remains in place when a service model is utilized depending on where the brand sits in the life cycle. For instance, a service rep model can be applied to complement a new product launch in providing the needed patient support required when switching therapies, while the detail rep can handle the presentation of the science involved with the brand.

7) A lot has been written about the patient journey, patient centricity and patient support. How does Ashfield address this with your service offerings?

The patient has rightfully become the focus of the pharmaceutical industry. Being able to deliver improved patient outcomes is an imperative, not just in delivering improved quality of life, but in reducing healthcare costs due to non-adherence and helping the pharmaceutical industry recognize their intended revenue streams to fuel future research.

Ashfield is proud of our track record in delivering patient support programs. We have developed a model used successfully by several of our clients where we use our call center to identify patients and set up appointments, and then have a clinical nurse educator either do an in-home visit or conduct a virtual appointment via computer to train the patients on the use of the medication and follow up with them on a regular basis to make sure they are adhering to their treatment regimen. We have established a 24/7 hotline for some clients where patients or prescribers can call in to learn more about new treatment options or ask questions once treatment has begun. We also have reports that can be shared with physicians so they can monitor their patients progress.

To do patient support programs properly, we have worked within our clinical and communications companies to identify the concerns and emotions of the patients and their caregivers as they learn about their diagnosis and proceed through their experience with the disease. By the way, we have learned in patient focus groups that they eschew the word “journey,” likening it to a vacation when going through a disease process is anything but. Instead, they prefer the word “experience.” This is just one example of how we must learn to listen to the patient, their advocates and caregivers in order to map out meaningful support programs.

We have found that creating patient advisory boards early on in product development, and continuing to elicit feedback from patients once undergoing treatment, provide us with a clearer understanding of what patients truly need. When companies make assumptions of what may be needed for a successful initiation or adherence, they often miss the mark in setting up patients for success. Patients need realistic expectations of what to expect with treatment—including side effects and what may happen if they stop taking a treatment or miss doses.

8) Ashfield as an organization, and you as one of its managers, bring a very diverse, global perspective to life sciences commercialization issues. What can you tell the pharma industry about the varying communications and marketing needs around the world?

I’ve had the opportunity to work in different markets internationally, and I have found, that although culturally different, the trends in healthcare are similar. Spiraling healthcare costs, the shift towards specialty meds—the movements are the same. As an international company, we recognize the importance to invest in our capabilities to help pharma on a global perspective. For example, a client’s vision could be to have a global contact center, with matched quality regardless of market. We would deliver a solution respecting the cultural differences while recognizing the macro trends to better support our client’s needs.

The most important element that drives our success is the talent within the organization. Ashfield’s most valuable asset is its people, regardless of country. What differentiates it is that we retain or acquire the best talent to deliver value to pharma.

As a service provider to pharma, we’ve all got a stake in improving lives. It’s incumbent on us to live our values; to play an active role—supporting our clients’ mission. Because of this, we have transitioned away from the transactional vendor-client relationship, to one of a more strategic partnership. With that said, we can’t just ask to be partners—we need to demonstrate through proving our capability. We can all achieve much more together, business-to-business and peer-to-peer. Navigating the system and an aging population, this challenges us to break the barriers down, improve standards and support a global business.

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