Since COVID-19 entered our lives, we have all been faced with uncertainty. COVID-19 has challenged us to be better community stakeholders and more creative about how we do business. Medical Science Liaison (MSL) teams have been forced to consider new and creative ways to connect with their customers.
In 2018 Dr. Leona Hamrick, MSL-BC and Dr. Cerise James, MPH presented a workshop at the MSL Society annual meeting on the Regional Medical Director (RMD) On-Call program established at CardioDx. CardioDx is a cardiovascular genomic diagnostic company that allows compliant interactions between the commercial and medical affairs teams. The workshop was prescient for its time because it introduced a non-traditional KOL engagement style that did not involve an in-person face to face meeting. This program pioneered a new way to engage with KOLs by providing a concierge-like virtual service through support of the commercial field team.
The program consisted of the sales team contacting the RMD prior to their office visit alerting the RMD to be on standby. This protocol established that an HCP/KOL encounter might occur within the next hour. These encounters could utilize any technology based on the preference of the HCP/KOL. The interaction could involve a voice call or a video call using platforms like FaceTime, GoToMeeting or Zoom. In addition to last minute encounters, virtual visits could be scheduled ahead of time between the KOL and RMD. These visits were reactive based on requests made by the KOL/HCP and may consist of a discussion on various topics including score report interpretation, investigator-initiated trial requests, and clinical utility. This program was first piloted within a territory for a period of 90 days.
To monitor effectiveness, post call surveys were administered both to the commercial sales colleague and the HCP office. Information captured included effectiveness of the call, RMD accessibility, and quality of scientific exchange. Survey results were ranked on a scale of 1 to 5 with one being least satisfied and five being most satisfied. At the end of the 3 month pilot, an average rating of 4.0 was recorded from external HCP surveys (survey completion rate of 80%) and a rating of 4.4 was recorded from internal commercial colleagues (survey completion rate of 92%) (CardioDx, 2018). Following the completion of the successful single-territory pilot, the RMD On-Call program was launched nationally at CardioDx. On average, 10 RMD On-Call encounters were logged per week, in addition to traditional face-to-face encounters. The metrics recorded for the engagement were captured similar to a traditional in-person KOL metric (type of encounter, scientific exchange, number of providers, etc.) and followed the Medical Inquiry process if additional medical information was required.
This program was created as a response to having limited resources in a small medical affairs team and large geographic territories. In a traditional MSL engagement there is a pre-plan meeting, followed by the in-person meeting, and finally, the post meeting follow-up. This process usually occurs over a span of weeks. The RMD On-Call program accelerated that whole process into days – sometimes hours. This program was well received at CardioDx as it facilitated compliant medical-commercial interactions. Dr. Hamrick and Dr. James have gone on to successfully utilize similar programs in other roles.
Businesses are adapting to out of the box thinking for impactful KOL engagements and have utilized similar models to guide their COVID-19 re-entry strategies. In a recent MSL Society survey regarding the impact of COVID-19 on KOL engagements, 54.7% of Global MSL respondents described an uptick in KOL receptivity to virtual engagements (see Figure 1) (MSL Activities During The COVID-19 Pandemic: Global and USA, 2020).
Additionally, 38.8% of Global MSL respondents stated these virtual KOL encounters lasted 16-30 minutes (see Figure 2) (MSL Activities During The COVID-19 Pandemic: Global and USA, 2020). The FDA also recognizes COVID-19 will change the landscape of clinical trials. They are suggesting sponsors consider alternative methods for assessment including phone calls and virtual visits (Caccomo, 2020).
Given our current situation, a digital transformation within medical affairs teams is inevitable and imminent. When physicians were asked about their concerns surrounding the reduction of interaction with PHARMA related to COVID-19, they were most concerned over prescription sample access but this was closely followed by concerns about the reduction of professional education and clinical trial updates at 50%, 38%, and 31%, respectively (The Aftermath: COVID-19 Insights & Recommendations, 2020). Roberta Ascione, CEO, Healthware Group stated, “We’re starting to see signals that MSLs are in more demand. This was happening already, but we expect to see that demand continue to increase as MSLs are viewed as a more neutral and informative voice than traditional reps” (The Aftermath: COVID-19 Insights & Recommendations, 2020). One potential benefit to virtual engagements is the ability to track and measure what works and what does not in real time. A digital platform can be equipped with analytics dashboards that track activities with actionable metrics (Hansen, 2020). These data-driven insights could produce KOL/HCP behavior virtual benchmarks that would lead to immediate benefits and help shape future virtual encounters. The need for virtual engagement was further illustrated in a survey where physicians were asked what they would like to see from Pharma. Of those surveyed, 46% wanted an increased use of digital tools to interact with MSLs (see Figure 3) (The Aftermath: COVID-19 Insights & Recommendations, 2020).
COVID-19 has catapulted medical affairs teams into change. KOL interactions must evolve and companies are considering what this will mean in the future. As travel restrictions and hospital system access concerns continue, how do we reach KOLs and provide impactful information? Will social media interactions between MSLs and KOLs evolve to become a compliant, mainstream interaction technique? Will we ask KOLs during an initial encounter if they prefer text or email communication (in lieu of face-to-face)? What Customer Relationship Management (CRM) software will be used to effectively capture virtual interactions? Will MSLs routinely record short video messages for KOLs? These and many other questions exist around virtual MSL/KOL engagements.
MSL teams will continue to deliver impactful, concise, compelling, fair, and medically balanced clinical messages that inform KOL decisions. However, many of these interactions will need to move to a virtual environment. The RMD On-Call program was a successful example of an approach that personalized KOL virtual engagement and provided a cost saving benefit by reducing travel. Programs like RMD On-Call are likely to become standard procedure due to reductions in face-to-face access and tighter budgets as a result of COVID-19. As such, there will be benefit in sharing best practices around virtual encounters between MSLs and KOLs.
Caccomo, S. (2020, March 18). Coronavirus (COVID-19) Update: FDA Issues Guidance for Conducting Clinical Trials. Retrieved from U.S. Food & Drug Adminstration: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-guidance-conducting-clinical-trials
(2018). CardioDx. unpublished data on-file.
Hansen, R. B. (2020, May 4). What Pharma Can Do To Win Virtual. Retrieved from PharmaPhorum: https://pharmaphorum.com/views-analysis-sales-marketing/what-pharma-can-do-to-win-in-virtual
MSL Activities During The COVID-19 Pandemic: Global and USA. (2020, May 1). Retrieved from The Medical Science Liaison Society: https://members.themsls.org/page/MSL-Activities-Survey-Discussion
The Aftermath: COVID-19 Insights & Recommendations. (2020). Retrieved from Intouch Group & DHC Group: https://www.covid19aftermathwhitepaper.com/IntouchDHC
Cerise James, MD, MPH, is an expert in Medical Affairs, currently works for mid-size pharma as a Manager, Medical Value Liaison, and holds several board appointments within pharma and academia.
Leona Hamrick, DHSc, PA-C, MSL-BC, is a Medical Affairs leader with 20 years clinical experience. She has served both as an MSL and director of medical affairs – focusing on molecular genomic diagnostics.