Early Stage Territory Planning for Medical Device Companies

Do your field teams still rely on map, spreadsheet, and note apps? How medical device companies have historically generated sales is no longer adequate for selling medical devices in today's market...and there's a new revenue intelligence tool to help you bridge the gap.

In this episode of the Global Medical Device Podcast, Etienne Nichols talks to Skylar Talley and Mark Mescher from MedScout, a territory prioritization and sales enablement platform.

Skylar and Mark discuss early stage territory planning to get more medical device sales, different aspects of go-to-market strategies, and building and demonstrating meaningful value by understanding pain points.

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Some highlights of this episode include:

• Tools have evolved and MedScout’s platform is a huge step forward. Basically, it brings an Excel spreadsheet to life, maximizes territory data, and is very intuitive and useful for sales reps to understand.

• Skylar has observed an evolution from frameworks/methodologies on the market based on geographic coverage to put numbers, early sales, and clinical proof-points out as fast as possible and leverage an early budgeted staff.

• Companies should start thinking about territory planning early on during the fundraising phase to benefit the commercialization and purchase processes.

• Skylar describes the 3-stage early commercialization roadmap strategy as getting the product into market, developing case studies and understanding where to take them, and knowing the distribution or rep model to execute.

• Relationships are vital early on with the development and commercialization of a medical device company. Physicians educate and innovate, just like engineers.

• Skylar and Mark agree that it’s worth being thoughtful when evaluating available solutions to make sure they are not adding time to your managers and reps.

• Marketers find and generate leads through interesting means, so there’s much better coexistence and co-creation between sales and marketing teams today.

Links:

MedScout

MedScout on LinkedIn

The Rise of the Next Generation of Medtech “Milkmen”

Omnichannel engagement in medtech: The time is now

The rise of digital marketing in medtech

European Union Medical Device Regulation (EU MDR)

Salesforce

Reptrax

Greenlight Guru YouTube Channel

MedTech True Quality Stories Podcast

Greenlight Guru Academy

Greenlight Guru

Memorable quotes from this episode:

“Sales reps aren’t always the best at Excel spreadsheets. Most of them don’t have any idea what a pivot table is.” Mark Mescher

“I don’t hear from a lot of reps out there in the field that they’re just over the moon with how they have to use Salesforce on a day-to-day basis and if they use it on a day-to-day basis.” Mark Mescher

“No two health systems are created equal when it comes to product approval.” Mark Mescher

“Marketing teams are really at the forefront of being very creative in finding and generating leads through really interesting means that weren’t necessarily accessible previously.” Mark Mescher

“Anytime you’re in an early stage environment, or doing something entrepreneurial, go talk to 20 to 30 people that you’re going to be trying to create an impact for.” Skylar Talley

Transcript

Announcer: Welcome to the Global Medical Device Podcast, where today's brightest minds in the medical device industry go to get their most useful and actionable insider knowledge, direct from some of the world's leading medical device experts and companies.

Etienne Nichols: Hey everyone. Today we're going to be talking with Skylar Talley and Mark from MedScout. We're going to be talking about early stage territory planning. So this is more driven towards how do you go about those medical device sales? So Skylar actually founded the company, MedScout. MedScout is his place. It's a tool that he's built for sales planning and tooling at a small to grow stage medical device company. So we go through all the different aspects in how people used to sell, and now using this tool, how can you sell in the future? So hope this is beneficial to those of you who are planning out your early stage territory planning and working towards the medical device sales. Hey everyone. Welcome back to the Global Medical Device Podcast. This is Etienne Nichols, your hosts for today. And with me today is Skylar Talley and Mark Mescher from MedScout. We're going to be talking about some different aspects of go to market strategies. Can't talk today. But let's start with Skylar. Skylar, do you want to talk a little bit about what MedScout is and does before we get into the topic?

Skylar Talley: Sure. We won't spend too long here, but you can effectively think about us as a territory optimization and sales enablement platform. So we work specifically with early to grow stage medical device companies, to understand what their current territory model looks like and how we can help them evolve that to best fit their commercial activities and then build sales enablement plans within the territory. So we can get into a lot of detail. Maybe it makes sense later on in the episode to think about us as a revenue acceleration platform built specifically for medical devices.

Etienne Nichols: That makes sense. Okay. So using that as kind of a springboard, and I know Mark you have a lot of, a few more years maybe than I do in this space as far as, especially in regards to the planning and the go to market strategies and so forth. Have you seen an evolution in how companies do this, or maybe what's some of the ways people used to do it, but maybe they're getting outdated. Any thoughts on that?

Mark Mescher: Yeah, absolutely. I mean, certainly there are still individual reps who are very much on their own as it relates to how they develop their territories and don't necessarily have a tremendous amount of support coming from their companies. Not because their companies don't want to support them, but they don't necessarily realize what tools are now available out there that historically haven't been. You know, there's been a lot of work by sales reps and by regional managers, just diving deep into Google and finding different ways to look at data in various geographies or as it relates to what physicians are out there, but being able to really pull all that information together in a useful way and allow it to drive how you prospect, how you organize your territory, and making sure from a time perspective that you're able to really focus on the right targets has historically been a big challenge. And frankly sales reps aren't always the best at Excel spreadsheets. Most of them don't have any idea what a pivot table is, let alone when they do have the useful tool of Salesforce, really understanding how to maximize and make that work. I don't hear from a lot of reps out there in the field that are just over the moon with how they have to use Salesforce on a day to day basis. And if they use it on a day to day basis, that is. So certainly there's a lot of tools out there, but the evolution to where we are now to really get to where MedScout is basically bringing an Excel spreadsheet to life and putting it in front of you in a way that makes it very intuitive and useful in the day to day activities of a rep is just a huge step forward, not only from the data, but just how easy and straightforward it is for a rep to understand how to really maximize it in their territory.

Skylar Talley: Yeah. I was just going to say, just in my year and a half in market, a couple of the frameworks that I've heard that were kind of previously used for understanding where to place your next sets of reps. The one that stood out to me is kind of interesting was the NFL cities model. So we know that whenever we get to 25 to 30 reps, we're going to target having a rep in every NFL city or something along those lines. And so the early commercial teams that we talk to today are much more so thinking around, okay, we have headcount budget for three W2 reps. Maybe we use some distributors on top of that. For those three full- time reps, where are our early clinical sites, where are key opinion leaders, and how can we use those early relationships to really make the most of those full- time employees and then maybe augment with distributors on top of that? And that's going to be specific by specialty area and stuff like that, but just kind of to build on Mark's point a little bit, I think you're seeing an evolution from these sort of frameworks or sort of methodologies based on just mass geographic coverage into how do we put numbers on the board or early sales and clinical proof points out there as fast as possible, and leveraging our early budgeted staff to do that. So, yeah, just kind of wanted to add some observations from what I've seen in market so far.

Etienne Nichols: Yeah, no, that makes sense. So a lot of our listeners, they may be early stage and maybe they're not to market yet. They may be thinking, well, you know, I mean, this isn't really on my radar yet. Now I'm going to wait until, you know, we're in manufacturing or we're ready to go. What would you say to that? Is there a good time to start thinking about territory planning?

Skylar Talley: I'll just jump in, and then Mark, would love your perspective from the early stage companies you've been at and kind of how that's stepped out from an order of operations standpoint. I think you're going to have to talk about it at fundraising, right? As you are raising that round to get into manufacturing or to start that early commercialization process, if that's on the docket for your company, you should at least know, okay, where do we have, going back to my previous point, those early clinical relationships, where else can we get into with this use of funds for this round? And what does that look like at least from a high level perspective? So I think there will be, depending on how you're financing the company, that's probably where I've seen the conversation really start, is getting ready for that diligence process to say," Hey, okay, we're ready to step up and move to the next stage. What does early stage commercialization look like for us specifically?" So Mark, I'll let you take it from here.

Mark Mescher: Yeah. I would say the earlier you can be thinking about these things, the better off you're going to be for a few reasons. Because it'll creep up quickly on you when it does come time that you do need, you get to commercialization, you do need those managers and reps in place, or you need to develop a pipeline of distributors. And the earlier you can understand where specifically it would be ideal to put those people, the better off you're going to be. Because then you can start down the road of really driving a deep pipeline network of a potential bench of people which could potentially save you on recruiting costs, and certainly get you ahead of the game when it comes to putting the right people in place as an early sales team within the company. And further to Skylar's point with regard to just the fundraising, we've been talking to companies who are thinking about this for their exit strategy as well. So it works well for fundraising, but if you've got everything lined up to really explain why you've defined the territories you've defined and really thought that through when it comes to diligence from somebody who's looking to acquire, that puts you even further ahead of the game.

Etienne Nichols: That makes sense. Did you have something, Skylar? Go ahead.

Skylar Talley: Yeah, I was just kind of, again, just a thought as Mark was working through that, to his point the earlier that you can understand where you think you're going to create commercial traction, but then actually go through, what does it take to get through purchasing at that site or where that physician is located? Whoever your champion is, the earlier that you can start that conversation, we've just seen a lot of sort of misaligned expectations with how easy it was going to be to get those early clinical proof points. So the earlier you can get started understanding purchasing pathways, what it's going to take to actually get the device in somebody's hand at the facility, that's the better off you're going to be, right?

Mark Mescher: It's a great point because in dealing with all the startups I've dealt with, with this previous platform, it's funny to have them talk through their commercialization strategy and somehow thinking that they're going to get hospital approval in a two to three month window when they commercialize. And really not having a good understanding of what value analysis committees are and just the slog it is to just get a product approved, let alone have the physician champions necessary to drive it through and the political capital that they're willing to drive it through. So again, yeah, the earlier you start, the more time you can put into that, Skylar's absolutely right. It's going to benefit you tremendously when it does come to commercialization.

Etienne Nichols: And Skylar mentioned something there, and I kind of want to highlight, he mentioned a phrase I'm not very familiar with, clinical proof points. Can you explain a little bit more about what that is? And we may have to come back to some of the things Mark said, because that political capital thing, that's going to be very interesting, I think. But go ahead, Skylar. The clinical proof points.

Skylar Talley: Yeah. We should definitely talk about value analysis committees and what kind of goes into that. It comes up I would say probably in 50 to 70% of our commercial conversations with device companies. So we'll sidebar there. A lot of the early stage companies that we work with, so we'll help them design their early territory model, and then their first sets of reps are getting product out into market and working with those early key opinion leaders for the company to get case studies, for lack of a better term, in place to say," Hey, here's how we affected this sets of patients. This is what it compares to what we did previously. And this is why it's so much better." And then they can take those case studies into net new relationships for them and use it as a foot in the door. Right? So to speak, say," Hey, here's what we're doing," purposes of example, Dr. X at Cedar Sinai, here's the impact that it had on these patients with this disease state. This is what we can do for your system, for your clinic, for your practice, in so many words. So what I feel like is that a lot of sort of maybe call it the first year, maybe even sometimes longer, depending on the device or the therapy, is focused on putting those case studies, early case studies together, and then figuring out how to take that to market. And quite frankly, where best to take those, who's going to be most receptive to those early case studies and where it's going to move the needle, and back to the previous sidebar where you can get through the purchasing process the easiest. So that's kind of how, if you think about it from a three stage early commercialization roadmap, get the product into market, start to develop those case studies, then understand where you can take those. And then what is the distribution or rep model that you need to actually execute on the last leg of that strategy. So I'll pause there, Mark.

Mark Mescher: Yeah, I mean, I think it's all of that. And then going back to getting into particular markets sooner versus later and understanding which markets you should be in, that's going to help you because no two health systems are created equal when it comes to product approvals. But then there's also the resources of an early stage company that they have to consider allocation for. So if you're allocating four regional managers to start things out and cover a region, but within each region you're pinpointing very specific areas, well you have to look at do I need to get on rep tracks or are there other vendor credentialing softwares that are required based on the systems. And again, going back to the earlier, you can understand that and what the value analysis process is, the better off you're going to be in the long run. And making sure that you're not misallocating resources in that process because obviously every dollar counts early on.

Etienne Nichols: Okay. So if I'm a small company and I have an idea for my product and I'm working on getting funding, we talked about the early stage planning, just even at that early stage in order to get those funds, how detailed do I need to be thinking? You mentioned the clinical proof points, the case studies from the physicians. Yeah, that's later, but I need to be thinking physical, geographical territory, would you even suggest going down to the specific hospital and targeting that region or how does that work?

Mark Mescher: Yeah, I think it benefits you tremendously in a number of ways to be able to pinpoint as best you can both specific systems and specific hospitals. And that's obviously going to start with the physician's champions that you can corral early on. But I know from an investor perspective, the more detailed you can be in going how thoroughly and thoughtfully you've thought through your early stage commercialization, you're going to get a lot more traction with potential investors who realize that you're not just kind of throwing things at a wall and hoping to see what sticks, but are much more thoughtful and strategic about how you're going about things.

Etienne Nichols: Okay. That makes sense. So how do you build those relationships? I know MedScout, I'm sure you're working on your own network, but suppose the companies, just curious, how do those relationships get built?

Skylar Talley: I'll defer to you, Mark, from the days at AngelMD and what you felt like were the most effective strategies for those early stage teams. And I've got some experience over the past year that I'll just add on if I feel like it's incremental, but go ahead.

Mark Mescher: Yeah. I just want to clarify, you're referring to the med device to physician relationship?

Etienne Nichols: Yeah, I think that would be a good place to start.

Mark Mescher: Yeah. So oftentimes there's some legacy associated with that. So it's harder certainly if you're developing a medical device company and don't have historic relationships within the space, and if that is the case, you usually want to go to who's the specialist in your particular area of expertise and the device that you're coming up with and just ask them for advice. They love to teach, and if there's an opportunity for them to both help you tweak the product, help you advance the product and then introduce you to other peers who they think would be beneficial as well, that's always helpful. And then as you're building out that sales team and thinking things through, you have to think through what relationships they have as well. And that's where we get into I guess the discussion of building a direct sales team versus distribution and things like that. Relationships are vital early on with the development of a company and commercialization, because starting from scratch and starting cold with no relationship, you're going to have a very difficult time getting even the best innovations off the ground. Because relationships mean so much these days. And if we go back to the political capital associated with what a physician's willing to go to back for in the hospital, you know, relationships certainly play a part along with certainly making sure it's a product that's going to drive patient outcomes and clinical benefits.

Etienne Nichols: I can see that. Anytime you buy anything, you look at those reviews. That's one of the things, at least my generation definitely, that's what you're focusing on. Skylar, what do you think?

Skylar Talley: The only other thing that I would add on top of that, especially as an inexperienced early stage team, so we participated in the Texas Medical Center accelerator program last fall. And I feel like the venture ecosystem and systems overall are starting to stand up these incubators and accelerators that give you at least sort of shots on goal to talk to clinical decision makers within the system. And so, especially to Mark's point, if you're coming in sort of cold, right, and you may be on that founding team, don't have somebody where you can go understand clinical preference and what they're trying to solve for within the system, some of those accelerators are a great benefit to just sort of shortening the innovation cycle down there and giving you a lot of conversations early on. So I would recommend anybody, yeah, the TMC program was great, really enjoyed meeting the entire team down there. And there's a few others like it out there that I've put up for consideration for folks in the earliest stages.

Etienne Nichols: Okay. That makes sense. And I'm going to circle back to something that Mark said a little bit early on, reaching out to those clinicians because they do kind of typically seem to have the heart of the teacher. You know, I was at MDM West last week and I got to speak with a thoracic surgeon. He basically said," Guys, engineers and doctors have a similar, we score the exact same on psychological tests, including our social ineptitude." Now that's his words, not mine, but his main point was build those relationships with doctors. They want to be innovative in the industry as well.

Mark Mescher: And they want to educate, to your point.

Etienne Nichols: Yeah, exactly. I love it. One other question I had. So this might kind of peel the layers off a little bit as it relates to medical devices. So we could talk about sales, and I do want to get a little bit more into the current strategies. We've talked a little bit about the legacy strategies. But what are some things that you typically, or that may be unique to medical device territory planning versus just any other product that there may be out there?

Skylar Talley: Yeah. I'm going to take this because I think about it a lot from a product standpoint, and then Mark, obviously feel free to follow up right after this, but territories are meaningful, right? Some part of your sales cycle will involve a rep or executive at the company, somebody going and either monitoring a case or going through product training, something along those lines. So you have to be thoughtful with things like, what am I asking from a geography standpoint this rep to do in the early stages? Am I asking her to get on a plane every week? Or is it much more hyper local and she can cover a lot of ground in Houston, for example, because that's a high density area. So that's the first thing that we've seen. And then to Mark's earlier points, relationships still matter. So that can cover a couple of different sort of let's call them vectors. There's the relationship between the founding team and the early team at the company and the rest of industry to say," Hey, we could co- sell well with this product," or," We should talk to this rep that sells this other product because we're not competitive with them," and they'll help us understand the dynamics. And then there's also relationships with early clinical decision makers, back to Mark's earlier point. So who can we get in front of to understand how they're thinking about this particular area. And then there's relationships within systems themselves. Right? And so I think that understanding those relationships and how it affects sales planning is where we've seen the most thoughtful approaches. And it has to be pretty individual within the company itself because that's going to look different from company to company. So those are the two main things that I see as sort of different for medical device sales enablement than say some of the software companies that I've been at previously. I'll pause there. Go ahead, Mark.

Mark Mescher: Yeah, I recently had a conversation with the son of a good friend of mine who was looking to get into the medical device space. And there was a time I would've advised him pretty enthusiastically if the opportunity arose to dive in, but understanding how much things have changed, going back to the value analysis committee and the lack of political capital that physicians have as employees now and not necessarily getting everything they want, the front of the contracting that's associated with it, where they may have a two company contract with a little sliver left for innovation. Those things make it really hard on a rep even when building relationships. And in addition to that, physicians having less and less time available for reps and with COVID hitting hospitals, working to push reps out of the OR, there's a lot going on specific to medical device reps, surgical reps that make it a much more challenging environment than most other industries I can imagine. I have never been in other industries, so I can't really say it, but I do know that this particular industry has gotten far more difficult than it once was to really just do the day to day job. So that's what made me so excited to come on board with MedScout, is just the idea and the platform of being able to utilize your time so much better with so much better data than has ever been available at our fingertips before, to really hone in and do our job, target the right people, build relationships based off that information. And then it just helps you point in the right direction and maximizes your time in the field to do as best you can to meet your goals. days it was 20% over previous year, every year. And that's a hard thing to do these days when it takes that much time to just get in front of accounts and through process. So the more forward thinking, the more information you have that's well organized and at your fingertips, I think the better off the rep's going to be. So there's hope, I don't mean to dissuade people certainly, but I do applaud those out in the industry currently who are being highly successful.

Etienne Nichols: Yeah. There's a lot of noise, whatever industry you're in I'm sure. Especially with all the different communication channels that we have. So we kind of talked about the old way of doing things a little bit. What are some of the tools that people can use, and to take that more targeted approach, including what you guys are working on as well. But what's the real differentiation, I guess, is what I'm asking.

Skylar Talley: Yeah. I'll just kind of go ahead and speak to some of the more macro problems and how we see folks addressing those. So to build on Mark's previous points, actually understanding in the earliest stage possible, what that clear path for commercialization looks like. And there's inputs that go into that. So where you can get within purchasing fastest and into actually affecting patient lives the fastest at a tactical level is what we help companies understand. And so it's going from sort of a old framework approach or a, this is the specialty area that we're going to go after, and here's the two doctors that we're going to start with, to now here's our much more detailed territory strategy across our owned team. So the W2 reps and the distribution team, and here's the top 20 to 40 champions that they're going to go after to start with. So having a platform to do that, which is the opportunity that we're trying to execute on at MedScout, we feel like gives companies a major head start in the market. I think the other things that we've seen in as far as tools are within those groups that you're focusing on, so the targets that you're going after, understanding what their industry presence looks like. So which conferences they're attending, what they're doing on social media, kind of the broader person that you're going after here, and using that to get more sort of creative on early digital efforts and more sort of targeted account based marketing techniques to say," Hey, Dr. so and so really enjoys going to this conference. Let's see if we can get a coffee with them there." Those are the sort of more creative things that we've seen earlier stage companies do to really move the needle as they're starting to get products down to market like we've talked about this entire episode. So I think the only other thing that I would point out that we see common more so today than maybe previously is investing in sales tooling outside of something like MedScout, putting a CRM in place early, but making sure that you're thoughtful about how you're populating that. So going back to the relationships point, understanding who's connected to who, where you have that foot in the door and what the actual strategy is there without having to do a whole lot of calls or manual coordination can save a lot of overhead on the team. So I think those are sort of the three things that you can be thoughtful about in the earliest days from a platform and tooling standpoint that we've seen. And Mark, I'll go ahead and let you pile on there if it makes sense.

Mark Mescher: Yeah. I think the biggest thing, I'm not going to get into real detail about any particular solution, other than just to say that there are a number out there and it's just worth being very thoughtful in evaluating them to make sure it's not adding time to your managers and your reps. It may be a great tool and provide a lot of value, but at what expense? So really thinking that through. I think the other thing that's changed a great deal more recently, it used to be in device sales that the sales and marketing teams did not coexist well together. And the sales teams in most companies tended to look at the marketing department as their brochure creators and tool creators and things like that. And now it's shifted a tremendous amount because of LinkedIn and Facebook and others to where the marketing teams are really at the forefront of being very creative in finding and generating leads through really interesting means that weren't necessarily accessible previously, and certainly are accessible because they understand how to go find them, versus most device sales reps don't have a good understanding of how to utilize those tools in those similar ways. So I think there's much better coexistence than co- creation between marketing and sales than there ever was.

Etienne Nichols: Yeah, that makes sense. I can definitely see the marketing upstream versus downstream and the maybe misunderstanding about how those work in conjunction with sales being an impacter. So building those relationships with physicians early on, getting into the hospitals, understanding those different value analysis committees, that was one thing that I was curious if you could give a little bit more explanation around maybe the process and how those things are looked at. Anything to add in that, or am I just kind of, just need to go do some research?

Mark Mescher: No, there's a lot more to add to that. So, I mean, you have to start with the user. And I guess that's one of the other big differences in medical device compared to a lot of other areas, is the person actually utilizing your product isn't the same person that buys your product, right? So that creates a whole nother dynamic in how you go about things. And though the physician typically is going to be the user of the product. So they need to be your champion and take this to the value analysis committees. You rarely have access to, or even know who's on that committee, unless you're really good and can do a lot of research in that regard. So you need that physician to really spearhead bringing that product into the system and hospital. And there's a bit of coaching that sometimes has to take place, and you need to make sure that you've created a crew champion because, as I mentioned earlier, political capital within a health system isn't as vast for a physician as it once was. So making sure that you're providing them something of great value to them and their patients that's going to improve care and outcomes is what it's all about. And if you can demonstrate that in a really meaningful way, makes it so much easier for the physician to put that in front of a value analysis committee.

Etienne Nichols: That makes sense. Yeah, go ahead, Skylar.

Skylar Talley: Yeah. Sorry to cut you off, Etienne. I think what's been surprising to me working with commercial teams over the past year or so is the degree to which a lot of times the individual rep is asked to make that case for the physician that's taking them in to the value analysis committee, to Mark's point. And there's two sides to that case. Hospitals are businesses, so you have to present sort of a cost savings or incremental revenue aspect for bringing in the device often. But then to Mark's point, you also have to," Hey, here's how many patient lives are going to be affected and in what manner they're going to be affected." And putting that on the reps, it's a lot. Right? And so that's one thing that was kind of surprising to me, and to your earlier question what maybe is unique about medical device, because then you're kind of handing that off and they're going in on your behalf and what's going to come out on the other side, we'll see. So anyways, just kind of wanted to add those two points to the value analysis committee discussion.

Mark Mescher: Yeah. The other thing you have to remember going into those value analysis committees is sometimes you might, let's say you've got an amazing cardiology device, right? And you're chatting with cardiovascular surgeons and they're going to go present or you're going to go present on their behalf. Sometimes your value analysis committee doesn't contain anybody from cardiology or cardiovascular surgery, and you may be presenting to a family practice doc and having to convince them of a product that they don't necessarily deal with or care about. So you got to really be thoughtful about how you go about building that value and demonstrating that value.

Etienne Nichols: To me, this almost says you almost need to treat that physician who's going to be your champion. They literally are part of your marketing team almost to an extension. And the other side of that, correct me if I'm hearing this wrong, but you need to understand not just your product and the solution it provides, you need to truly understand the problem that you're solving. You've got to be able to present that pain point, it sounds like. Interesting.

Mark Mescher: Yeah, no question. I tend to think that many of the things and the problems that we're talking about that device reps deal with on a regular basis speaks to much of what's broken in healthcare and the way the system is set up and the way it functions or doesn't function for that matter. And really putting out there the solutions that are going to create efficiencies and opportunities not only for the physician and the patient, but for the hospital to be more efficient or for the hospital to do a better job of building opportunities that are of benefit in the long run of their hospitals. They tend to be fairly shortsighted in that regard, at least I've seen historically.

Etienne Nichols: Yeah. Okay. Interesting. Do you have any recommendations on how companies should be structuring that team early on or as they go out throughout the life cycle into commercialization?

Mark Mescher: Yeah, it's an interesting quandary because certainly if you go the distribution route, it costs you nothing upfront, but you relinquish a great deal of control, historically. Distributors by definition don't want to be managed, which is why they became distributors. So figuring out ways to, you certainly have to build a management structure that works with those distributors if you decide to go that route. And the more you can be a resource to them and partner with them in meaningful ways, the more ingratiated they will be to you. Your distributors tend to be your customers in certain ways, and being able to really understand their territory, but not be intrusive. But it's one of the things that I was excited about coming over. In my time both as a distributor and then also in my role as managing distributors, the ability to have the details associated with the territory and work with the reps and the distributor principal in that territory to really help them guide them on how to expand their business. Those things didn't didn't really exist previously. And most distributors use a CRM and maybe work out spreadsheets. And oftentimes they're dealing with reps who aren't as experienced in the space and don't have as good a training versus those that come out of some of the larger companies. So you have to weigh the options associated with that. But when Skylar first showed me MedScout, I was just floored at what could happen in the relationships you have with distributors and how you go about working with your distributors and being a resource and a champion on their behalf, as opposed to how it historically has been, which distributors don't want to hear from the regional managers. They just want to be left alone and go about selling product. So that's one way to go. The other side is it depends on what you have for resources, but building out a sales team can be an expensive proposition. Once you've built out that sales team, there's a that takes place, which is even more expensive. So there can be a lot of turnover, but it allows you to figure out the sweet spot of what level of experience you need from those sales people, find that particular type of person, and then training them really well is the biggest advantage associated with that. So you're going to get some training with the distributors, but you can drive really deep into training people the way you want them and getting them to understand and drive new product innovation in a much more meaningful way if they're your employees. So it's a tough situation. A lot of it is just based on resources.

Etienne Nichols: Yeah. One of the things that comes to mind, because I think about the different territories throughout the world, EUMDR, for example, just throwing a wrench in a lot of different people's plans. Not that I want to get too much into the detail on that. I know that's not our topic today. But maybe we can talk about some of the different difficulties you have in different regions. I don't know if that's something you're interested in covering or any unique geographical difficulties in the medical device industry, or any thoughts there.

Mark Mescher: Yeah. I mean, first one that comes to mind is, at least historically adoption of things and the way things have moved through health systems as it relates to pricing and contracting or product adoption, I have historically seen it move primarily from east to west as far as in the country. And part of that has to do with the population in the eastern part of the country. But there tend to be, I guess, health systems on that end of the country that are a little more forward thinking with the way they've gone about things. And adoption tends to take place a little bit quicker with new innovations in the eastern US, certainly with exceptions, but yeah, that's historically what I've seen and what comes to mind initially when you pose that.

Etienne Nichols: Wow, just that tidbit to me just really speaks to the volumes of benefit of working with an expert in the field. I never would've known east to west adoption thing.

Mark Mescher: It's anecdotal certainly, I would need to do a paper to prove that out. But it's just what I've tended to find to be the case. I say that because typically I've worked in the western US other than being in Chicago.

Etienne Nichols: So yeah, sometimes the grass is greener.

Mark Mescher: Right.

Etienne Nichols: Skylar, what did you have?

Skylar Talley: Yeah, I was just going to follow up on that. I think like anything else, the devil's in the details, right? So for instance, in cardiology, what I've heard from early commercial teams is that, for instance, Texas has adopted the AFC model where a physician has an ownership stake in that surgery center, and therefore is able to move products through the purchasing cycle faster. Than somewhere like Columbus, Ohio, where you maybe have, or other areas of Ohio, where you have a large hospital presence that has much more defined processes and gates. So I think it goes back to the earlier part of the conversation, to understand the sooner that you can have those conversations with your clinical champions about what's it actually going to take to get this into your hands and practicing, the better off you're going to be. And having more of those conversations sooner is going to help you triangulate on potentially a regional focus for your early sales team.

Mark Mescher: Yeah. Government policy is a good point, Skylar.

Skylar Talley: Yeah. And the only other thing that you asked about sort of considerations for early sales planning in the previous question, I think going back to what's common in your specialty area. So learn from what's been done in the past, right? And approach it from a first principle standpoint, but it's good to know why maybe over indexes on distributors compared to another specialty or something along those lines. And I think the other thing is understanding. We've seen some companies that invest in a clinical model where you have a rep who's solely there for clinical support in training versus handling commercial activities as well. Or can you get by and provide great service with just an all in one rep or a distributor earlier on. That's going to be dependent upon how complicated your early product is and where you want to move to eventually. So those are the two other sort of considerations that I'd put out there. The last one would be potential alignment with a strategic. So if you have a strategic that you're going after, and, you know, maybe a potential acquisition scenario down the road, it doesn't hurt to think through how you can get in front of their commercial team earlier on in the commercialization process versus later. It is that through a distributor or through working to bring in somebody on to the early sales team that has previous relationships at that strategic. So just wanted to kind of pile on to those two points a little bit based on what I've seen over the past years.

Etienne Nichols: Yeah, great points. I think this is something, it sounds like something that, I started out as product development engineer, manufacturing and so forth. And it's something that I'm sure that those who are building small companies are thinking about, but the level of detail required, it's almost as if you're building a product, you're designing a product, but you're also designing your strategy as well. Just like we talk about designing quality management systems on this podcast quite a bit, all of these are design problems that you've got to work through the details. That's great. Any other recommendations to companies working through this process or thoughts that come to mind as we kind of wrap this up a little bit?

Mark Mescher: We covered a lot. Again, I just go back to the challenges associated with the day to day jobs of medical device rep or the managers or the VPs of sales. And thinking through in this ever- changing time, not only your product strategy, but what is the digital strategy that can go along with that? There are some really great companies out there who have really thought that through and developed entire departments around that. Now certainly at the early stage, that's a difficult thing to do. And it certainly depends on the specialty you're engaged in, a company in the building something for aesthetics or plastic surgery should be diving very deeply into things like Instagram and marketing themselves in different ways. Not just as a company, but as an individual rep, utilizing things like LinkedIn to really develop a network and build as an individual rep, figuring out ways to get the advantage of getting in front of physicians is a challenging thing, but there are new ways to go about doing it. So that's probably the biggest thing, is just the ever- changing times that are out there and how you adapt to them and make the most.

Etienne Nichols: That makes sense.

Skylar Talley: For me, and this is kind of maybe abstracting out outside of device, but anytime you're in an early stage environment or doing something entrepreneurial, go talk to 20 to 30 people that you're going to be trying to create an impact for. Go do the legwork to have the conversations and not just ask about the problem set that you're focused on, but make it a conversation around what's affecting their day to day lives. What's affecting their commercial progress. The systemic trends, what's changed over the past five years, so that you can start talking in their language sooner, and understanding their problem sets and how to frame your solution as something that's going to address one of the top three to five problems that they're dealing with on a regular basis. And so that's true in software companies, that's true in device companies, but doing sort of the early leg work to have those 20 to 30 persona conversations, I think is kind of bar none you have to do that as early as possible, and you should continue to try to talk to that persona often and update your understanding of what's affecting them. I think the other thing is I really enjoyed BCG and McKenzie both have different series of articles about how med tech sales is changing, and how that's trended over the past decade or so. Etienne, I'll send you the links to those. I think that those would be awesome to include in the show notes as potential resources. BCG, that series is kind of cool because they started in 2013, did another installment in 2017, and then another in 2021. So you can see how things have changed and things have not changed really in the industry since then. So I'd point people to those resources as well. And they do a good job I think of speaking to sort of Mark's points around how should you be thinking about digital in the earliest days and what that's going to maybe look like moving forward. So just a couple of other points.

Etienne Nichols: Yeah, that's great.

Mark Mescher: Yeah. I would say lastly, that sales is still sales, that hasn't changed at all. When you get in front of the doctor, you better know your product really well. You better know how it relates and provides value to the doctor. But the third pillar would be knowing that doctor and being able to speak on their level as much as humanly possible will benefit you not only in that particular sales call, but will help you develop a relationship with them. You got to think they're much more apt to want to develop a relationship with reps who really know their stuff, not only their product, but their particular specialty and area, as well as more info you can gather on that particular physician or target and be able to relay that in meaningful ways to show value is tremendous. And so it's still selling. It goes well beyond feature and benefit to value creation, but it still hasn't changed in however long it's been in existence, right?

Etienne Nichols: That's a great point. Wherever you go, people are people, wherever you go. And sometimes when you're in a different country, the most beautiful sound you can hear is your own language. So I'm sure it's the same in the operating room.

Mark Mescher: There you go.

Etienne Nichols: That's cool. Well, I appreciate you all taking the time to have this conversation. It's been eyeopening for me, certainly. Will include in the show notes, Skylar, if you get those notes to me, that'd be awesome. We'll send that link to that BCG article, as well as a link to MedScout if you're interested in learning more about what Skylar and Mark are up to and how they can maybe benefit your team in the early stage territory planning, we'll have that link in the show notes as well. So be sure and check that out. Thank you all for listening to the global medical device podcast. As you know, we're powered by Greenlight Guru, the only medical device success platform that is designed specifically for medical device professionals by medical device professionals. So if you're interested, go on over to www.greenlight.guru to see more. We will see you all next time.

About the Global Medical Device Podcast:

The Global Medical Device Podcast powered by Greenlight Guru is where today's brightest minds in the medical device industry go to get their most useful and actionable insider knowledge, direct from some of the world's leading medical device experts and companies.

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