Relationships can be tricky things – no more so than the pharma-contract sales organisation relationship. So, what are the secrets for making it a perfect match?

Think contract sales organisation (CSO), and you might think “suppliers”, “transactional” or “reducing overheads”. This has often, in many ways, been the traditional view of a CSO in its role in the pharma-CSO relationship, reflecting the sales environment at the time.

“I think it would be true to say that historically CSOs have often been viewed as suppliers, meeting metrics and identifying issues but not necessarily being proactive in helping the organisation to solve its long-term challenges or challenges within the healthcare system,” says Robert Taylor, VP head of EMEA, commercial solutions, integrated engagement services at QuintilesIMS.

This is a view echoed by Ryan Wooller, business development director at Star. But while this traditional transactional view has been built around reducing overheads, and increasing flexibility and capacity based on the share-of-voice approach, Wooller says the relationship and the CSO’s role in it is changing. “The traditional view may still be the case in some instances, and understandably so,” he says. “However, I think this view and these reasons are becoming less relevant as the commercial models are changing in the UK.”

Notably, this is down to the current “dynamic” sales and healthcare environment where an ageing population, cost pressures and restructuring in the NHS has forced the pharmaceutical industry to rethink how it markets and sells its products. Market access is decided by payers, doctors are busy, and interactions are becoming more tailored, with an increased emphasis on multichannel engagement as part of the sales and marketing strategy. Says Taylor: “The landscape is transitioning to a multi-channel approach, with face-to-face sales being one channel amongst a number of others that are used to have contact with end customers. I do think we are moving towards a comprehensive, digitally-enabled approach to customer engagement for the entire customer team.”

But what does that mean for the role of the CSO? In a nutshell, it means that role has evolved. Where pharma is looking to align itself and remain relevant to the NHS – particularly in supporting the service across a wider pathway of care instead of just focusing on a treatment – so too are CSOs changing to reflect the interactions and service needs of their customers’ customers, Wooller says. “CSOs have had to up their game in terms of how they provide the ‘core’ sales and market access services to reflect engagement preference of HCPs and payer stakeholders while focusing on developing strong capability in new areas such as service redesign, project and change management, and service wrapped around the patient.” He adds: “CSOs still have a significant role to play in this dynamic healthcare environment, not just in providing flexibility and driving down overheads but also in allowing pharma to innovate and evaluate new commercial models and services while mitigating risk.”

Taylor believes  that, if anything, the CSO is becoming increasingly important as the healthcare environment changes – providing skills from data analytics capability to targeting and deploying effective multichannel approaches, to service delivery and providing creative solutions. “CSOs bring experience and help to ensure dependable delivery,” he says. “They give access to a range of services, which can help companies to achieve commercial excellence by enabling them to implement their commercial strategy in the most effective way. This might involve defining a strategic rationale for a long-term commercialisation plan, deploying realistic sales strategies for entering a crowded market, deploying and managing people, or offering expertise around the deployment of different channels.”

Alongside this evolution, Taylor says CSOs are also increasingly required to take on an advisory role. “Today, the more advanced and sophisticated CSOs are not only seen as true partners in delivery but also as advisors, proactively working with customers to shape services and determine how challenges can be overcome in a creative way. CSO outsourcing is now an essential strategy to accomplish all of pharma’s goals.”

Of course, the CSO role very much depends on those goals – whether it’s as simple as vacancy management or treatment wrap-around services – and these relationships with pharma companies will differ depending on the demands. But Wooller points out that there can still be a place for traditional core services, depending on the situation. “That being said, there is an opportunity to engage differently in the new environment we find ourselves in, and CSOs are now viewed by many companies as genuine partners.”

So, in light of this and the new environment, what should an effective relationship look like? For Taylor, it’s about setting clear expectations and having a full understanding of the company’s objectives, and to look strategically at how a CSO can provide added value, specifically over the long-term. When there are high levels of engagement and visibility, there is an opportunity to shape solutions to meet the pharma company’s needs, he says.

Furthermore, senior investment in, and oversight of, the relationship are key, and can be an indication as to whether it is viewed as strategic rather than transactional, he adds. “In my experience, our most successful collaborations are those where we have established strong and trusting relationships with senior management, as well as the account management team, and where we are fully aligned with objectives and strategy. In these types of relationship, we are able to achieve the goals set in the frame of the relationship and bring true value to the collaboration.”

Wooller adds that early engagement and open dialogue is critical and, as the relationship develops, this individual interaction is central, especially as it moves away from the senior leaders involved with initiating the relationship to the junior staff involved with project delivery. Wooller says it is the CSO’s responsibility to create a great customer experience and lead the way in managing the relationship. “Like any relationship, outsourcing is much easier to consummate than it is to terminate, and recover from, if done poorly. It takes time to implement an outsourcing initiative, and longer to do it right.”

That means that unrealistic expectations and poor communication – on both sides – makes for an uneasy relationship, Wooller explains. “CSOs have been guilty of accepting to implement poorly thought-out strategies, and pharma can be guilty of unrealistic expectations of what the CSO can deliver,” he says. “Relationships turn sour when there is no real desire for partnership working by the pharma client and there has been a lack of accountability and poor customer experience on the CSO side.”

While Wooller explains there is an onus on the CSO to make the relationship function smoothly and effectively for both sides to benefit, he equally says pharma has an opportunity to think differently too. “Outsourced organisations wish to be treated as an equal partner in any pharma-CSO relationship. Generally, we want to feel like we are part of the extended team and not just a transactional outsource partner.” He says “significant value” can be created by approaching the relationship in this way.

Moving forward, Taylor agrees the pharma-CSO relationship needs to be looked at as a co-investment, working as a partnership. “The pharma industry is behind many others that use outsourcing more effectively and to a greater extent. I think there is an opportunity for both pharma and CSOs to develop in tandem when evolving new services and the way in which we promote to our customers.”

Wooller adds it is more important than ever that CSOs now provide services and interactions that are relevant and aligned with delivering healthcare outcomes. For this reason, he notes the trends that should be on the industry’s radar: notably the shift to differential resourcing of sales in different geographies that reflect the local access picture, the shift to real-world outcomes, and further consolidation of clinical and payer decision making. Taylor also adds the development of new technology and how that will shape sales and marketing in the future, as one to watch.

The big challenge and opportunity, though, is to become relevant to support the wider pathway of care, Wooller says. The introduction of Sustainability and Transformation Plans in the NHS is one example of where pharma and CSOs can work together to provide more holistic support across the patient pathway. “Testing new commercial models as part of a relationship with a CSO could be a good way to mitigate risk and make some early learning,” he notes.

In addition, STPs may be the catalyst to moving away from the rhetoric around joint working between the NHS and pharma to real, meaningful peer-to-peer engagement, Wooller says. Indeed, this highlights the fact that pharma’s relationship with a CSO will need to mirror pharma’s relationship with the NHS, based on innovation, flexibility and real-world outcomes, he says. It’s this, he adds, that will determine whether the pharma-CSO relationship will succeed.

Katrina Megget is a freelance journalist specialising in the pharmaceutical industry