Headcount vs. Revenue


anonymous

Guest
Used to work at ALKS as a TBM and then RAD\KAM. Talked with somebody this morning who is still there. Heard about all the changes…sad. All are self-inflicted. Leadership grew headcount way too far in front of revenue and counted on plans with limited chance for success…and they should have known better. Take a look at hospitals & Vivitrol….


As a TBM I tried to get it in hospitals with very little success. Only 1 of the 8 I presented it to signed up…and they never bought a single vial - we gave it to them as a free on-demand starter dose. Ya, there was some pull-through later on, but very little…2-3 vials at the most. Across the country it was the same situation…maybe one or two hospitals would take free doses, but I never heard of a hospital billing for it and getting reimbursed. Maybe it happened but it was a rarity…certainly not something you’d build teams around, but that’s what we did. When I was a RAD under KO we added IDNs to our target list. Same outcome…a very limited number of “successes” even though we were all experienced and successful at selling VIV as TBMs. It wasn’t a people problem, it was a plan problem. We never figured how to motivate a hospital to support Vivitrol. There’s no economic reason for them to do it…in fact…just the opposite. It cost them money in terms of time and resources. They have to order it, store it, account for it, distribute it and dose it. Additionally, they have to spend time educating the patient and family on why it’s a good idea. Then they have to refer the patient to another doctor who knows and uses Vivitrol. Why would any leader of an IDN or hospital want to increase cost without increasing revenue? Their margins are already razor thin and we’re asking them to cut them even more….”cuz it’s the right thing to do”? You’re right, it is the right thing to do from a treatment standpoint, but that doesn’t erase the economic reality they have to deal with. So, the RADs had very little success with IDNs or hospitals. But, even with very limited success, IDNs and Hospitals were used in part as justification for expansion of the RAD\KAM team.

I don’t know what kind of transition happened when GA took over from KO, but GA didn’t seem to accept the reality of how limited our opportunity was in that space. So, we were sent down the IDN\Hospital rabbit hole again, only now it was more formal and more directive. We still didn’t have an answer for the negative economic model we were trying to force on customers but that didn’t stop…or even slow down…the push. And we got the same results….very little success. But, amazingly, that potential business was again part of the justification for increasing the size of the KAM team…and creating new positions between GA and the KAMs.


Vivitrol in hospitals didn’t work with…

TBMs

RADs

KAMs

Hospital Team


We promoted people, hired people and created positions based off a poor understanding of the economic reality of our customers. And now we’re firing people, changing alignments and redoing slides\reports\strategy based off that same stupidity. And the head-count ahead of revenue mistake isn’t limited to just KO and GA. We did the same thing with nurse educators & FRMs…we accepted questionable assumptions about impact on revenue to drive bad growth decisions. Yes, I understand you don’t want to be caught with inadequate capacity to handle growth, but that’s a better problem to have than getting too fat and having to upend lives\careers because you got it wrong. I’m lucky, I’m retired so I don’t have any skin in the game. This isn’t about some bitter old guy venting and looking for social media cheerleaders. This is about bad decisions that are destroying lives…the lives of people you sold a story to. They made life-changing decisions based off what you told them. You owe them more than your handwringing, sympathy and pep talk. Grow as a leader. Publicly admit you made a mistake…you grew the company too fast. Figure out what the right size is, bite the bullet and get there. Don’t fire anybody at this time…give them the option to stay on the books for their base salary & benefits. Find another role within the company for them. Give them 6 months to find another job while still employed. Yes, it costs you money…but that’s your fault not theirs. YOU made the decision to expand, YOU sold them on the role. Accept responsibility for YOUR bad decision, fix it and take care of the people you misled.
 



Extremely insightful and accurate post!! Unfortunately, some of the assumptions and suggestions you make moving forward are either flawed or will never happen. I was in a similar role as RAD as well and I think I know who you are OP and, if you are who I think you are, I know your motivation behind the above post is positive.

Your entire history of the hospital/Integrated Health system teams here at ALKS is extremely accurate. The big problem here now is GA will not take your advice or anyone elses advice. He's doubling down on the KAM role probably because the KAM's were his idea. Get this, there is a big push to have the KAM's contract with IDN's. How absurd!! Viv and ARI are definitely not IDN contract drugs except for the few places where the system takes on full capitation and I'd say that makes up at most 10 to 15 % of the total USA market. The problem is that KAM's do nothing for sales. They spend over 50% to 80% of their time in criminal justice because there is nothing they can do to increase sales in the short term in IDN's. BUT, GA has to find a way to make KAM's show some type of worth to the company even though there is little to none in what they do. They are all pretty good people just not needed with the products we have. Although, that's not stopping GA from figuring out a way to jam in some type of utility spin that they produce sales in any way. It's sad to watch it happening. My fear is that they will start contracting with IDN's and we will realize it is a recipe for double dipping of rebates and another huge waste of time an resources. If the IDN is not fully capitated then they will have to follow the patients health plan formulary anyway. This is true in over 90% of the country. The only place where they don't have to follow the health plan formulary would be in the hospitals and you eloquently made the point of how pointless it is to try to change or work through that. We've tried for years and anyone who has been on those teams knows it is not going to happen.

So, here we are with another sales force that are KAM's again who are asked to do something the market will not allow so they hide in criminal justice and make their TBM's jump through activity hoops so they can claim they are helping the field produce sales all so the KAM's can get paid "activity" bonus and GA is trying to find a way to make it look like they are doing something that truly impacts sales. Thing is they don't! One might say that all the "activity" fire drills they put TBM's through take away from sales. It is a sad game to watch. Do you know how the KAM's are bonused??? Would it surprise you if they had no aspect of their variable compensation tied to sales? How ridiculous is that? That tells you all you need to know.

I agree that GA has to admit that not only the FRM's and Hospital team was a foolish move, but that also the KAM team was. Stop trying to show that they bring value because they don't. It's not the KAM's fault, it's the companies for creating them (AGAIN!!). We'll probably keep changing what they do and spend more time and resources on them only to cut them in a couple years. Foolish is as foolish does.

Maybe we need to purge the entire Astellas stain from this organization before we can begin to think straight again and move forward. I think that would be a good start! Jim R really moved this company in the wrong direction and we are trying to move away from what he did. I think there are some of his team that still remain that are making it harder for us to make that directional change. If they are shown the door, we could pivot a lot quicker and start moving in the right direction faster.

Just the thoughts of someone who has been here for a long time and loves this company and the important products we have that help patients.
 



Follow the chain of events. RP was frustrated that commercial wasn't delivering what he wanted. He thought bold-talking JR was the answer. That pushed MS out. JR got rid of AK, then brought in KS, then GA, and then TN. He started or expanded KAMs, hospital, FRMs and boosted spending. And now we are where we are.
 



Follow the chain of events. RP was frustrated that commercial wasn't delivering what he wanted. He thought bold-talking JR was the answer. That pushed MS out. JR got rid of AK, then brought in KS, then GA, and then TN. He started or expanded KAMs, hospital, FRMs and boosted spending. And now we are where we are.
Getting rid of Mark and Andrew K were great decisions. They were idiots!
 



Getting rid of Mark and Andrew K were great decisions. They were idiots!


Biggest mistake made was getting rid of MS. He was the glue that kept things together. He believed in culture. Now we have TN who is northing but a big pharma schmuck. AK was fool, but the fied wasn’t given what they need for a successful launch..like PK data. GA and TN need to go. Both JR hold overs.
 



Agree that AK was horrible and needed to go. Totally disagree about MS. He was the real deal and we would never be in the place we are now if we had kept MS. JR was so bad for us. He almost single handedly killed this company. Why did it take so long to see we didn't need the FRM's and Hospital team. Just a big money suck for no impact on sales. Why is it taking so long to see that KAM's need to be gone???? They should have been the first to be cut! Anyone in the field from the TBM's to Policy to the managed care peeps know KAM's are worse than useless. They are a complete time drain that take us away from selling!!! Is GA so dense or so proud he can't see or won't admit what a mistake the KAM's are?????? If he is the one making the case to keep them he has to go. IMMEDIATELY!

And if we really are trying to contract with health systems HA HA HA HA HA HA HA! Let's see what that got us a year from now. It really is unbelievable. Maybe if we had like COPD medications or ... I'm really not going to waste my time discussing something so completely stupid. Let's revisit in 12 months and see how that idea worked if we really try to do it. GA grasping at straws. Just admit it was a mistake to hire a KAM team and let's move on!
 



I don't think the KAM team is a mistake, I think it's being asked to do the impossible with hospitals & IDNs....erase economic reality. Until you figure out how to make it at least margianly profitable for them, you're wasting time and money. 8 years ago Jim Frates did a field ride with me and asked the rhetorical question "How do we make it profitable for doctors to use Vivitrol but not break the law?" It can obviously be done, it happens every day in th OP setting. Completely different for IP. You're best bet is a closed network like an IDN, where they might be able to keep the patient in their system long-term, so if they lose some money on IP they can make it up, and hopefully then some, on OP. But if that's the scenario, then they're already making money on the OP side...so why lose any at all on the IP side? One thing they can do is increase patient count by advertising their "exclusive" Vivtrol program...but marketing takes dollars. And, unless something has changed, KAMs aren't allowed to coach them on advertising.

Go back to 5-7 KAMs and have them focus on CJ, VAs & the top 15-20 national treatment programs. The KAMs can drive business in VAs and national accounts, but they can only follow policy wins for CJ. Hold them accountable for growth & sales numbers in VAs and NAs, and use performance metrics for CJ. You promoted some really good TBMs into the KAM roles. They didn't forget how to sell. They didn't get lazy. They're not confused. They're just being asked to do the impossible.
 



Hey Y'all. Jumping in late on this thread. All great points and so true. We really do have some committed and very smart people working here. The one thing I pull out of every post on this thread is GA has to go. Everyone seems to know that except for the only person who counts. Until he gets closer to the truth of the situation GA will continue to be able to use the JR playbook and keep this company from the success it has the potential to achieve.
 






You hit the nail on the head! In any business there are only 2 ways to increase profit. Cut expenses or increase sales.
Expenses would be easiest and we have room to cut: internally to you see all the VP titles. There is a VP for everything and it’s not necessary. Also how many MSLs do we have? I think managed markets has a team and sales has a team. They make a ton and do very little. We need them but not so many. And don’t front load for the launch. We have made so many issues with the FDA and we don’t seem to know what we are doing so it makes more sense to wait.
 






You hit the nail on the head! In any business there are only 2 ways to increase profit. Cut expenses or increase sales.
Expenses would be easiest and we have room to cut: internally to you see all the VP titles. There is a VP for everything and it’s not necessary. Also how many MSLs do we have? I think managed markets has a team and sales has a team. They make a ton and do very little. We need them but not so many. And don’t front load for the launch. We have made so many issues with the FDA and we don’t seem to know what we are doing so it makes more sense to wait.
Or u can do a double stupid move like hiring an expensive team that does nothing to increase sales. You know like the... KAMs. LOL.
 



OMG. The MSL's may be worse than the KAM's you are all talking about. I came here from a company that had over 4.1 billion a year in sales being generated by 4 products and we had half the number of MSL's that are here. We could easily do just fine with only half of them. Maybe not as bad as the money wasted on the KAM's but pretty close.
 






Used to work at ALKS as a TBM and then RAD\KAM. Talked with somebody this morning who is still there. Heard about all the changes…sad. All are self-inflicted. Leadership grew headcount way too far in front of revenue and counted on plans with limited chance for success…and they should have known better. Take a look at hospitals & Vivitrol….


As a TBM I tried to get it in hospitals with very little success. Only 1 of the 8 I presented it to signed up…and they never bought a single vial - we gave it to them as a free on-demand starter dose. Ya, there was some pull-through later on, but very little…2-3 vials at the most. Across the country it was the same situation…maybe one or two hospitals would take free doses, but I never heard of a hospital billing for it and getting reimbursed. Maybe it happened but it was a rarity…certainly not something you’d build teams around, but that’s what we did. When I was a RAD under KO we added IDNs to our target list. Same outcome…a very limited number of “successes” even though we were all experienced and successful at selling VIV as TBMs. It wasn’t a people problem, it was a plan problem. We never figured how to motivate a hospital to support Vivitrol. There’s no economic reason for them to do it…in fact…just the opposite. It cost them money in terms of time and resources. They have to order it, store it, account for it, distribute it and dose it. Additionally, they have to spend time educating the patient and family on why it’s a good idea. Then they have to refer the patient to another doctor who knows and uses Vivitrol. Why would any leader of an IDN or hospital want to increase cost without increasing revenue? Their margins are already razor thin and we’re asking them to cut them even more….”cuz it’s the right thing to do”? You’re right, it is the right thing to do from a treatment standpoint, but that doesn’t erase the economic reality they have to deal with. So, the RADs had very little success with IDNs or hospitals. But, even with very limited success, IDNs and Hospitals were used in part as justification for expansion of the RAD\KAM team.

I don’t know what kind of transition happened when GA took over from KO, but GA didn’t seem to accept the reality of how limited our opportunity was in that space. So, we were sent down the IDN\Hospital rabbit hole again, only now it was more formal and more directive. We still didn’t have an answer for the negative economic model we were trying to force on customers but that didn’t stop…or even slow down…the push. And we got the same results….very little success. But, amazingly, that potential business was again part of the justification for increasing the size of the KAM team…and creating new positions between GA and the KAMs.


Vivitrol in hospitals didn’t work with…

TBMs

RADs

KAMs

Hospital Team


We promoted people, hired people and created positions based off a poor understanding of the economic reality of our customers. And now we’re firing people, changing alignments and redoing slides\reports\strategy based off that same stupidity. And the head-count ahead of revenue mistake isn’t limited to just KO and GA. We did the same thing with nurse educators & FRMs…we accepted questionable assumptions about impact on revenue to drive bad growth decisions. Yes, I understand you don’t want to be caught with inadequate capacity to handle growth, but that’s a better problem to have than getting too fat and having to upend lives\careers because you got it wrong. I’m lucky, I’m retired so I don’t have any skin in the game. This isn’t about some bitter old guy venting and looking for social media cheerleaders. This is about bad decisions that are destroying lives…the lives of people you sold a story to. They made life-changing decisions based off what you told them. You owe them more than your handwringing, sympathy and pep talk. Grow as a leader. Publicly admit you made a mistake…you grew the company too fast. Figure out what the right size is, bite the bullet and get there. Don’t fire anybody at this time…give them the option to stay on the books for their base salary & benefits. Find another role within the company for them. Give them 6 months to find another job while still employed. Yes, it costs you money…but that’s your fault not theirs. YOU made the decision to expand, YOU sold them on the role. Accept responsibility for YOUR bad decision, fix it and take care of the people you misled.
Hard to argue any of the points you make. So then, why is GA so enamored with the KAM position? EVERYONE can see the truth you speak except him. Why do you think that is?
 






Reduce KAM headcount to 6 or 7 and have them do what they did before the silly KAM expansion. Someone said MSLs need to be reduced and that's true too. Never have I seen so many MSL's at a company. Not in over 20 years in pharma. Who approved that expansion?
 






If someone just took the time to dig into what the KAM's actually do and drill down into their senior directors presentations to the management team the lie would be exposed. Sometimes sales teams that have leaders that can SELL what they are doing can pull the wool over inept senior management. I think that may be why the KAM team has survived here.
 



Hard to argue any of the points you make. So then, why is GA so enamored with the KAM position? EVERYONE can see the truth you speak except him. Why do you think that is?

GA is “enamored” with the KAM position because he was brought in by JR to lead them. He has to be enamored bc he won’t have a job otherwise. They already got rid of the FRM’s.