Taking a strategic approach to field reimbursement team design

Pharmaceutical drugs have evolved rapidly over the last decade, both in complexity and efficacy. These innovative therapies have provided patients and healthcare providers (HCPs) with hope and treatments for previously untreatable diseases—and they present complicated requirements and processes to dispense and administer. In response, during the last five years, we’ve seen a rapid increase in investment by pharma companies in patient support service teams, which work to mitigate these barriers. 

A key cog in the pharma patient support system is the field reimbursement manager (FRM). FRMs play a crucial role in mitigating barriers by educating and assisting providers and office staff on reimbursement and logistical issues throughout the patient journey. FRMs can often be found a call away or even in person at HCP offices, helping to solve the most complex administrative tasks related to drug access or reimbursement. The presence of a skilled FRM can often be the difference for patients in gaining access to much-needed therapies in a timely manner. In fact, we’ve heard directly from HCPs that an excellent reimbursement experience can be a differentiator in product choice. FRMs have shifted perceptions of reimbursement support from a cost center to a strategic differentiator.

Design and deployment of an effective FRM team is important. Here we’ll cover the key aspects of FRM team design, starting from the team vision all the way to the compliance considerations needed to set the team up for success. 

Designing an FRM team can be a daunting task for pharma companies, whether they are setting one up for the first time or looking to evolve their existing teams. Where should they start and what should they do along the way?

Our proposed framework (Figure 1) gives pharma companies a step-by-step approach to designing an FRM team, ensuring that they can provide the highest-quality support.

The six aspects of this framework cover every single aspect of FRM team design, providing an end-to-end guide on setting up an FRM team for success:

• Vision and strategy focus on the joint team vision and guiding principles that serve as the beacon for the FRM team.
• Organizational design focuses on the optimal field team design and reporting structure.
• Field execution and operations focus on the operating model and processes required to ensure a right-sized and aligned team.
• Hiring, selection and development focus on the core competencies needed to identify talent, hire the right people and subsequently coach new talent.
• Metrics and motivation systems focus on the key performance indicators (KPIs) and incentive compensation (IC) metrics required to measure the impact of a support-type role like an FRM.
• Compliance considerations focus on the key compliance principles and precautions when designing an FRM team.

Designing program and team objectives for an FRM team starts with a joint team vision. This vision should be rooted in mitigating patient barriers throughout the patient journey and, ultimately, improving overall patient experience and outcomes. FRMs may not be aware of the impact that they make on patients, as they predominately work with HCP staff. However, putting the patient at the center of a vision serves as a source of inspiration for the entire FRM team and communicates to the broader organization about the impact FRMs create.

Leveraging the vision, organizations must clearly define team objectives and activities to ensure alignment with their organizational strategic goals. The core competencies across FRM teams will largely remain consistent. But team objectives and activities may slightly vary depending on portfolio dynamics (medical benefit versus pharmacy benefit) and reimbursement dynamics (benefit investigation, risk evaluation and mitigation strategies, specialty pharmacy). While pharma companies express concerns about downstream implications of these variations, an effective metric design will standardize the assessment of the objectives and activities.

The team objectives and activities will be key in developing core competencies down the road for the FRM team. This provides a clear link between what is expected of them and what they’ll be trained on. 

Once there’s alignment around the overall vision and strategy, it’s important to develop the right team structure to achieve these objectives. Determining the right team structure will depend on numerous factors: The number of products in the FRM bag, the reimbursement dynamics of the product and diversity of therapy areas covered. Other considerations include matrix team coordination responsibilities and synergies across product teams, as well as business strategy and customer dynamics. We have commonly seen pharma companies default to product or therapy-area-specific FRM teams; however, it is important to perform a thorough structure assessment to maximize expertise and time spent with customers.

In our experience working with FRM teams, there are four structures we’ve seen across the industry (Figure 2). We’ll note that companies may make minor adjustments to these options or leverage multiple structures depending on their assessment:

• Option 1: Therapy area-focused (or product focused): FRM teams cover a single product or therapy area.
• Option 2: Multitherapy area: FRM teams cover multiple therapy areas.
• Option 3: Activity-based: FRM teams are assigned specific activities based on product reimbursement dynamics (medical versus pharmacy benefit).
• Option 4: Pooled: A portfolio FRM team covers all products.

There has also been growing interest in a virtual FRM team. With HCP offices more willing to engage FRMs virtually, some assume that the FRM role can be fully remote. While this can be an option in select areas across the nation, where offices are accustomed to virtual engagement, there are many times customers prefer FRMs to support them on complex patient cases or educational discussions in person. In addition, based on our experience, virtual FRMs haven’t been able to foster the proactive relationships with HCP offices that in-person FRMs can.

Once a proper field structure has been established, a reporting structure must be developed to manage the team. An effective reporting structure will foster an environment that promotes transparent leadership and coaching. It should also encourage FRM role growth and development, while enabling the implementation of a culture based on the leadership vision. In addition, managers should ideally have significant experience working in the field, allowing them to provide relevant directions to their assigned FRMs. Along with this, a single voice and clear line of hierarchy is important to keep an FRM team focused. 

The FRM is a central part of a pharma field team. As a result, they’re expected to collaborate with other field teams. Organizations often overlook the coordination time, but it makes up a significant portion of FRM capacity. That’s why organizations must look across the organization and identify the cross-functional teams that will be engaging with the FRM. Success hinges on open communication between FRMs and their internal partners. An operating model will need to be put into place with clear directions on how communication should be between FRMs and their counterparts. In addition, design of other cross-functional teams should keep the FRM collaboration piece as a key consideration.

Once a coordination plan for FRMs is in place, it’s time to properly size an FRM team to optimally work in tandem with the pharma field team. For sales representative roles, companies often leverage common sales force sizing metrics like customer potential and volume. That’s why FRM team sizing requires a holistic top-down and bottom-up approach (Figure 3).

As FRMs work both proactively and reactively, sizing based on potential and volume alone doesn’t provide the full picture. A top-down and bottom-up sizing approach looks at FRM activities and patient enrollments to better understand the proactive and reactive workload that will be required. Companies often look at one side of the equation to calculate the resourcing requirements for their FRM teams. This leaves them with an incomplete picture either from a customer engagement standpoint or expected patient caseload perspective. Sizing both ways enables companies to validate their FRM sizing given their nontraditional activities. These are some common ways to size; however, every FRM team requires fit-for-purpose considerations.

Once FRM sizing is completed, a proper alignment will be needed to ensure optimal field workload and coverage. With FRM teams often having a smaller team size than sales, it can seem tempting at first to combine sales territories into FRM territories. However, FRM workload dynamics differ greatly from sales and will follow a different pattern. When designing FRM territories, we recommend beginning with guiding principles, including an equitable workload (for example, number of new enrollments, number of accounts), manageable travel and minimal sales coordination. Territory design consists of levers that are pulled and with each lever pulled, there are trade-offs that need to be considered. That’s why multiple factors must be weighed in unison and a delicate balance must be reached between these factors. Ultimately, a strong FRM team alignment will drive FRM satisfaction, ultimately improving retention. 

There are predominantly two options pharma organizations use to source FRM teams: insourcing or outsourcing. Each option presents its own set of benefits and drawbacks. The decision will depend largely on factors like cost considerations, future team flexibility, compliance challenges, level of control and area of expertise. We recommend that companies complete a thorough assessment of the pros and cons of some of these factors to aid their decision-making process. For example, companies launching a new complex therapy may start with an outsourced team, given the uncertainties of demand and the need for flexibility to scale teams up or down.

As mentioned above, the defined key activities that FRMs will perform will inform their core competencies. These core competencies will serve as a guide to develop FRM job descriptions and listings. We often find that experienced FRM talent isn’t always available when companies are looking to fill positions, especially in more sparsely populated areas of the country. We see successful companies navigate this by focusing on hiring the right people who are “coachable” and then trusting in their internal training processes.

FRM training and coaching are essential for every member of the FRM team. With evolving reimbursement processes and policies, FRMs should be aware of the latest information. When creating a training plan for FRMs, organizations should prioritize highly impactful topics like best practices from the field and the latest payer or government policies. In addition, companies that are periodically updating their training materials have seen higher growth from their FRMs. Finally, coaching remains a huge contributor to FRM overall job satisfaction. In our extensive discussions with FRMs, we’ve heard they want the opportunity to upskill and a clear path for progression within the reimbursement team and elsewhere within the organization.

Pharma companies often struggle to articulate the impact that their FRM teams generate, since they’re a nonpromotional role and don’t interact with patients directly. The traditional metrics that are used to measure other field roles cannot be the sole measures of FRMs. Pharma companies are largely measuring FRMs through activity-based metrics alone, but these activities are just one aspect of the impact that they generate. That’s why we’ve developed the following three-pronged approach to designing FRM metrics (Figure 4).

Through an extensive review of the patient journey and FRM activities, we can generate customer experience and outcomes-based metrics that can be used to create KPIs and IC metrics for FRMs.

KPIs and IC metrics for FRMs will have to be carefully crafted to ensure compliance and HR approval. When working with these metrics, we often recommend ensuring that the metrics can be clearly measured without error and defined for training. Specifically, in terms of IC plan design, we often see management by objectives (MBO)-based compensation plans as the most prevalent across the industry. The incorporation of these metrics into the MBO plans will require refinement and transparent discussion with management and field teams.

As a patient support role, FRMs are legally prohibited from conveying any significant independent value to HCPs, so FRM-to-HCP engagement can’t be promotional. It’s essential for pharma companies to actively consult their legal and compliance teams when designing their FRM teams. Over the years, we’ve seen varying appetites for risk, with some avoiding any decisions that may be a compliance risk. For example, we’ve seen pharma companies that are comfortable with compliant data sharing between sales and reimbursement teams. On the flip side, some pharma companies highly restrict data sharing and communication between reimbursement and sales teams. While it’s essential to consider compliance throughout the team design process, ideas shouldn’t be immediately dismissed due to compliance risk. Novel ideas should still be brought to HR and compliance, as often compromises can be made to compliantly design the FRM team.

Effective field reimbursement design transforms reimbursement support from being a cost center to a strategic differentiator. It’s important to note, though, the most advanced pharma companies are not only leveraging effective field reimbursement design but are also investing in the elevation of FRM specific tools and enablers as well. ZS has developed a significant point of view on this through extensive industry experience helping companies develop, modernize and deploy FRM specific tools and enablers.