Field-based medical (FBM) teams act as a scientific bridge between the pharmaceutical/biotech company and healthcare providers (HCPs). Their work is non-promotional and aims to improve patient care by acting as a trusted partner and liaison. Traditionally, the performance of FBM teams has been assessed using quantitative metrics like reach and frequency. That is, how many HCPs were engaged, and how often. In recent years, this model has created a polarizing debate among strategists that seek to measure performance in a way that is not based on commercial measures (ie profit from sales). As we have evolved and the capabilities of FBM have grown, a more sophisticated approach may consider multidimensional outcomes that include quantitative and qualitative measures.
While easy to collect, reach and frequency metrics have significant limitations. The most obvious challenge relates to the quality of engagement. A focus purely on a number of interactions can distract from the overall goal of the team and overarching medical strategy (Figure 1.1). Although impact can be peripherally described by numbers, influence on HCP behavior and patient outcomes is qualitative in nature. Furthermore, meetings without purpose reduce credibility and the long-term likelihood of becoming a trusted partner.
A shift towards outcome-based metrics that drive strategic value and impact
As the healthcare system grows in complexity, there are increasingly greater ways for FBM to interact with HCPs and health systems. A multifactorial scorecard inclusive of quantitative and qualitative measures (Figure 2.1) could be an effective strategy to describe meaningful impact. Key outcomes may consider:
- Clinical insights that drive publication, authorship, or study development
Like an advisory board, field medical engagements collect clinical insights that help direct data generation. In collaboration with the HQ medical team, key questions collected in the field can be used to produce post hoc analyses. This could include patient demographic subcuts, additional analyses on secondary outcomes, or may include new study ideas altogether. This provides the opportunity to engage HCPs in formalized co-authorship while advancing unmet needs in the field.
- Direct feedback from HCPs following an engagement or activity
For HCPs and KOLs whom the FBM team interacts with, solicited feedback can help inform the organization on the impact being made by the team, individual, or strategy. While some teams choose to obtain blinded team results, others may choose to seek direct feedback regarding an interaction or presentation. This data can be used to demonstrate the impact of HQ strategy and potential needs for refinement.
- Patient outcomes reflected by individual accounts or real-world evidence
The core goal of all medical affairs teams is to improve patient care. The impact of FBM activities could be reflected in patient outcomes within an institution or region. For common conditions, this may be reflected in patient RWE data – health resource utilization, multidisciplinary outcomes, or localized publications. Within rare conditions, impact may be described through reductions in a patient diagnostic odyssey and appropriate identification.
Example field activities that drive impact outside of the traditional 1:1 engagement model
| Field led advisory boards | Separate from HQ advisory boards, field-led advisory boards can be used as a tactic to collect novel insights specific to a region or institution. |
| Multidisciplinary roundtables | Different specialties can come together to discuss perspectives and collaborative approaches to patient management. |
| Poster presentations | FBM employees can present posters on behalf of the organization to demonstrate peer-level credibility and connection to clinical development. |
| Clinical Study Collaboration | Field teams act as “boots on the ground” of the company to identify new trial sites as well as address challenges with patient recruitment & liaise with clinical operations. |
| Disease state awareness programs | Education can be delivered by FBM to broad audiences who may not typically have contact with field personnel. |
Does a value and impact-driven framework mean that metrics are dead?
Hardly. Baseline numbers of interactions and frequency of engagement will always help describe the outcomes of a field-based tactical strategy. Just as a scientist tracks outcomes in an experiment, and a PI looks for improvements in primary and secondary objectives in a clinical trial, field metrics can be used to describe the success of a strategy. They should not, however, serve as the north star. Metrics can be incredibly useful to advocate for FBM value, internally, when communicating strategic outcomes. In organizations driven by data, metrics such as frequency, recurrence, duration, and reactive/proactive encounters can help describe the unique value of field activities.
Challenges in Measuring FBM performance in a multi-dimensional model
Despite clear advantages to using a value and impact-driven model, monitoring low performance can be a challenge without rigid metrics. Traditional key performance indicators (KPIs) provide a black-white framework for attainment. As we transition to qualitative and outcome-driven approaches, there is inherent subjectivity. As new measures are created, it is important that a clear benchmark standardizes the evaluation of the FBM individual or team. An impact model also may present challenges due to time- unlike the immediate data from reach and frequency, it could take months or years for outcomes to materialize. From here, it remains critical that leadership distinguishes effort from impact. Although an individual may be highly active, it is possible that they lack the ability to make a measurable scientific impact. A meaningful interpretation of outcomes irrespective of time spent on preparation is critical.
Moving beyond the metric in a fast-paced healthcare landscape
The medical affairs function is evolving at an exponential rate. As we describe the outcomes of FBM teams, it is critical that leaders use a balanced approach to assess fieldwork. This will require a multi-dimensional model that combines quantitative and qualitative metrics from field activities. A holistic view of performance may capture actionable insights, study involvement, authorship engagement, non-promotional speaking collaborations, or involvement in advisory boards. The north star of every FBM team should be focused on improving patient care. By adopting a multi-dimensional assessment model, organizations can ensure that FBM teams drive scientific and clinical impact. From here, the success of a team can focus on quality of outcomes, rather than quantity, to drive value and impact within the healthcare ecosystem.
Figure 1.1 The Evolution of field medical activities supports the creation of value and impact-driven metrics. Traditional metrics rely on a numbers-driven approach to describe success. A “reach and frequency” model relies on repetitive one-size-fits-all engagement that does not account for the needs of the HCP or substantiative exchange. As the industry has evolved, impact-driven metrics allow for more robust outcomes through field activities by shaping strategy, improving patient outcomes, and collaborative initiatives involving research and content dissemination.
Figure 2.1 Example of a multidimensional framework to assess qualitative and quantitative measures of value and impact. Incorporating quantitative and qualitative measures allows for a robust view of the impact of field activities. Strategically, this could result from an actionable insight that drives the course of a new publication or post that originated from an HCP engagement. An identified case regarding patient improvement or identification could describe a direct impact on patient care. Collaboration could be identified by the facilitation of a new study site or navigating through a challenge with recruitment. Taking an outside-in approach requires the FBM individual to assess the needs of an HCP or institution and synergistically support their needs while advancing patient care and company objectives.
Disclaimer: The ideas discussed in this manuscript belong to the author and do not represent the views or endorsements of his employer.
About the author:
Christopher N. Hansen, PhD, MBA
Chris is a translational scientist by training with extensive experience in the pharmaceutical industry and medical affairs. Chris completed his PhD and postdoctoral training at the Ohio State University and later completed his MBA with a specialization in healthcare leadership. He has spent over a decade in the industry working as a MSL, Medical Director, and MSL Director. He has supported 13 product/indication launches while leading HQ and field strategy development for field teams. Throughout this time, Chris has consistently looked for opportunities to mentor new and aspiring MSLs. He seeks to transform healthcare by inspiring field medical teams to deliver high quality patient-focused engagement. When not at work, Chris is an avid runner and loves spending time with his wife and four children.
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