HLS PodcastJohn Rounseville, cofounder of Saxa Solutions, discusses some of the challenges facing healthcare providers, physician recruiters, medical device sales reps and specialty providers who are looking for more referrals.


How CRM can help with Physician Relationship Management, patient engagement and tracking data about and from medical devices — whether the devices are located in provider facilities or with patients.


Below is a transcript of the episode, edited for easier reading.

Steve: Welcome to CRM Talk, the show that brings you the latest in CRM and CRM related news and information. This is Steve Chipman. Today I’m joined by John Rounseville, co-founder of Saxa Solutions, a Salesforce consulting partner that specializes in the healthcare and life science industries. John’s company is also the developer of Sapience MD, a physician database application that runs natively on the Salesforce platform. Welcome John!

John: Greetings, Steve! How are you?

Steve: Doing well, thanks. Thanks for joining us today. I want to start by asking you to tell us a little bit more about Saxa Solutions. Where you guys are located. What you do. The types of clients you work with.

John: Yes – as you mentioned, we are a Salesforce partner. So, we are familiar with the entire suite of Salesforce products; we work with Sales Cloud, Service Cloud, Community Cloud, App Cloud and then perform a lot of integrations from Salesforce into backend systems EMR’s, ERP’s, etc.

We’re based in Boston. We have an office up in Exeter, New Hampshire as well, where our service delivery team is. So, the Greater Boston area actually is a nice sweet spot for us because as you mentioned, we are focused entirely on the healthcare and life sciences industries.

We work with a lot of healthcare providers. We work with a lot of specialty providers, medical device, pharmaceutical companies — the life sciences spectrum. Boston is of course ripe with that with a great concentration of hospitals and technology and the like. So it’s a good spot for us.

Steve: Sure. But you do service nationwide?

John: We do – yes! We have a delivery team that can perform services nationwide. We have clients from Sunnyvale, California down to Miami, Florida to Baltimore, Maryland. So yes, absolutely!

Steve: You mentioned healthcare providers. Let’s focus on that for a second. What are some of the challenges you’re seeing today among healthcare providers, from more of a business and technology perspective. We’ll talk about the CRM part afterwards.

John: Yes – of course. I will avoid the current issues that are going on with the ACA and insurance systems that are just too nebulous to tell what’s going on there. But providers — the challenges that they’re facing. First of all they have very expensive systems that are all very closed off. Their medical devices don’t talk to EMR’s or each other. We just had Partners Healthcare here in Boston with a variety of hospitals. They just implemented an Epic implementation. It cost them upwards of 1.2 billion dollars and it took two years. So you see a lot of that. Basically what providers do is they’re struggling with person power across the board.

As we all age and start living longer, the patient population is really growing rapidly, but the practitioner population — and when I say practitioner population I mean not just doctors but medical professionals across the board — just isn’t growing quickly enough to meet the needs of that patient population. So there are big gaps there in terms of care and there are longer waits to see them now. The physician population is actually stagnant or even shrinking versus the patient population. It’s expensive to become a doctor, the hours are tough, it’s a lot of paperwork. Current immigration policies aren’t really helping the situation either. We get a lot of our doctors from foreign countries, so it’s becoming a bit of an issue in terms of care.

So recruiting them is really getting more and more important. Practitioners are your assets and a hospital or practice really can’t bill or create revenue streams without them. At the same time physician recruitment is tough. Doctors are just not found in the normal channels. They’re not on LinkedIn. They have odd hours and they’re extremely busy. So reaching them is hard. Recruiting them is a very high touch process and it takes a lot of time and effort to get them into your network.

Steve: So even if you have a lot of good data on the physician population then you still have the same struggle of how do you get in touch with them and how do you stay in touch with them once you’ve gotten in touch with them right?

John: Exactly! And that’s not just a recruitment question. That’s an outreach question. So if I am a specialty provider that wants to do outreach to physicians… let’s say I’m a physical therapy center and I want to get physical therapy referrals from orthopedic surgeons or sports medicine doctors — it’s getting harder and harder to get in front of those doctors to be able to get those referrals into their networks.

Same with medical device salespeople. They sell specific devices really that are geared toward specialties and specialty procedures. So they sell a specific stent for gallbladder removal into the G.I. population and it’s a real hands on sale. They want to get in front of the doctors and show them how it works. And doctors are really fussy about the instruments they use in a procedure. So, really being able to get in front of those doctors across the board and being able to recruit those doctors across the board is becoming harder and harder to do.

Steve: and speaking of medical devices, what changes are you seeing in that industry and in CRM?

John: So, an obvious use of CRM… for pipeline, straight sales forecasting and sales management. Very straightforward. We’re also seeing a need for field service and asset management. We’ve worked with a few customers with some fairly expensive devices. They want to take care of those devices when they’re out there at the customer’s location. So there are a lot of times there’s an ERP integration from their backend system that pushes that serialized asset into Salesforce. And then it associates that asset to the account and location. So that makes it easy for the service representatives to locate where that asset is and be able to provide service to it, do RMAs, warranty management and contract management — that kind of thing.

We’re also seeing — with the need for more patient engagement in addition to connected devices — we’re seeing a shift toward more patient engagement directly with the device. So the old model of the device goes to the distributor and the order then goes to the patient… the seller really never engaged with the patient. Now we’re seeing medical device companies with actual clinical teams who are coaching and training the end users of the device on how to best use the devices. Getting direct feedback on the effectiveness of the device. If it’s a prescribed device, managing that prescription, confirming benefits, etc.

We’re actually building some patient communities so that the patients can interact directly with our clients’ Salesforce orgs and engage with those clinical teams that are in there. Also building communities so that the end user patients, with approval and go ahead, can engage with each other and start talking to each other about how they’re using the device and what works for them. So we’re really seeing you know that old model of “here is the device see you later” move to, “Here’s the device. Here’s how you use it. How is it working for you?” Or, in an IOT play that device will speak directly to our customer’s Salesforce org and tell them how often the device is being used, if it’s being used properly and how well it’s working.

Steve: And so for that all work, the provider at some point has to provide visibility to the medical device manufacturer as to who the end user patient is.

John: That’s correct. We’re actually building out of physician community as well so that once the physician prescribes this specific device they can see how their patients are using it and then monitoring their usage; and then checking back in with them to see how well it’s working for them. We’re actually building out the capability of a patient entering a journal so the journal tells the physician how well the device is working, it’s for pain management.

Steve: Back to physician recruitment and physician relationship management, what have you built out specifically in Salesforce to address some of those challenges?

John: In terms of physician recruitment or physician relationship management, we’ve built out a few applications. Objects for requisition. Objects for candidates Objects for interviews. And then onboarding workflows, workflows around compensation.

Physicians actually move from a fixed income model after a certain amount of time to a variable compensation model. And knowing when that happens is going to be important to physician recruiters and HR specialists because doctors are going to start looking around after a certain amount of years with their income so fixed. Once it becomes variable or they have the ability to become variable, they’re going to want to go find another job or find another to practice work in.
So we built out an application around that that really manages that high touch process. Our product which I’ll get towards the end, Sapience, also brings in data from a bunch of different databases out there. That really helps to find those physicians and practitioners in general. So it’s not just physicians that are in here, it’s all sorts of providers.

Steve: What systems are you typically replacing could be just pen and paper and spreadsheets in some cases?

John: Often. You’re exactly correct! That the last two hospital networks that we worked with… the first was on an Excel spreadsheet with files all over the place. And we all know the pitfalls of that. And then the second one was exactly… pen and paper. Manila folder with information on it and gets lost all over the place. And really no ability to accession those candidates through their pipeline and get them hired. As you can imagine that really causes a lot of blockades for care.

If you don’t have the physicians to manage your patient population, you’re really going to start to run into billing issues. You’re going to start to run into patient engagement issues. You’re going to start to lose patients out of your network.

Steve: I imagine you’re getting pretty good buy-in — so unlike the traditional CRM which you roll out to a bunch of salespeople and it’s hit or miss. You’re solving some problems in a very elegant way and therefore I have to imagine the adoption that you get is probably higher than if you were rolling out to group of salespeople for example.

John: Yes. You’re exactly right and as I mentioned before referrals are very important too. So a lot of these hospital networks have outreach teams and physician liaison teams; where they go reach out those practices and really drive referrals into their network. You mentioned sales too. It’s important there too. Medical device salespeople really want to target physicians that their products are really pertinent to.

What Sapience actually does is it brings in claims data and you can see specific HCPCS codes in there. So you can see what procedures those doctors are doing. A medical device salesperson would be real interested to see, “oh wow! This is the set of doctors that I should be reaching out to, these should be my targets.’’ And really, that does drive adoption. Instead of just having a set of data — “here, call this group of people” — you are getting really specific actionable info into your system.

Steve: So you’re providing a lot more value to a team of medical device reps than say a more generic sales team where they’re just expected to go into CRM and key in data, log their activities. You’re providing them with key information when they come into CRM, and so they’re compelled more than your average salesperson maybe to really spend time in CRM.

John: Yes. Not only that, but it allows them to search specific geographic areas and specialties. So if they want to find gastroenterologists in the state of Maine they can go ahead and do that. That will pull in their NPI number. It will pull in the first name, last name specialty and group practice (if they belong to one) and also search by group practice too.

So if they want to search for a specific group practice they can go ahead and do that. Once they pull in all those providers from that practice they can see who exactly is doing what by the claims data.

Steve: So the database is fueled by these big data sources and you really have your starting point physician record. Then as a salesperson — medical device or pharma — you can add to that record. You can start to log phone calls conversations. Your sent and received e-mails. You might even, for a specific organization, have some custom fields where you can store information specific to how you do business as a medical device company. So over time you’re really getting the benefit of data both from these big data sources and from the CRM users who are continually enriching the records, right?

John: That’s correct! And native on the Salesforce platform. So it’s not integration. It sits natively on the Salesforce platform. It also pulls in hospital affiliations too. So let’s say you have a neurosurgeon and they have a private practice somewhere. Well, it also pulls in the specific hospitals that they’re doing their surgeries in. And that goes across the board. So that’s an important piece, because if you’re a medical device person, it’s not really likely that you’re going to get time with that neurosurgeon at the private practice. You’re going to find them at the hospital and be able to engage with them there and show them your products there.

So that is true. Also as you mentioned it’s augmented by the salesperson. And we also keep the data clean. We have data enrichment and refreshment going on in the background. So as our databases get updated periodically, you can either schedule an automatic refresh for the data in your system — or you can do it manually. Push a button and refresh the data that’s in there.

Steve: So if there are new claims since I last refreshed, those will magically appear in the claims list?

John: Yes – that’s correct!

Steve: And I guess with affiliations too, you might have physicians that the drop an affiliation and gain a new one. So, over time that will be updated too?

John: Yes. Or they move to a new practice as well. What we find is that physicians often work in multiple practices, not often, occasionally. So they work in one group practice over here and then they work in another group practice over here. We’ve actually built out a special conversion within Salesforce. And we harnessed that one to many feature that Salesforce rolled out maybe a year or so ago now. And what it does is it will associate that one contact to multiple group practices.

Use case there is that if you have a good relationship with one doctor and one group practice and you see he’s working in another group practice as well, you can actually leverage that relationship with that doctor to start making contacts in the new practice. I said group practice a lot there!

Steve: That does make sense. The other thing I wanted to ask you about was the whole idea of patient engagement and the importance for hospitals and providers to really rethink the way they’re engaging with patients. Maybe you could talk a little bit about that.

John: Hospitals are really changing how they do business and it’s been going on for a little bit now. If you go to any hospital network website, you’ll start to see the terms engagement or patient care — front and center. It used to just be, “we’re going to build a hospital here and because we’re here the patients nearby will come to it.” That’s no longer working, particularly in rural settings. There are some examples of that. But the message has really moved to, “you better specialize in a set of services and go to market with those well and then treat patients like a customer.” Or, they are going to be gone and they will tell everybody that they know about the care that they got at that hospital.

They’re figuring out that while they’re trying to help people, it is a business and they have a bottom line they have to hit and bean counters are involved.

Steve: And I never thought of it — are patients yelping hospitals and providers the way they are restaurants at this point?

John: I would imagine that they are. I haven’t seen any examples of that but I’m sure that’s possible!

Steve: Yes — or that or they just go away as you say. Let’s talk a little bit about patients managing their care at home, this whole concept of connected or not connected medical devices and where that all sits right now.

John: It really comes back to the fact, and it’s no secret, that the biggest cost driver at hospitals is length of stay. So they really need to turn over their beds as quickly as they can. That goes not just for hospitals but across the board any kind of specialty provider. That said an even bigger cost driver is readmittance. That’s where all bets are off in terms of cost. If they’re going to discharge a patient to turn that be over, they want to make darn sure that patient is well enough, so that they don’t get readmitted and become a bigger cost down the road. They need to make sure that patient is ready to go home and has an adequate care plan once they get there. Or they’re coming back at considerable cost. What Salesforce has done and we’ve done with a few of these is work within Health Cloud.

Health Cloud really manages patient engagement, really manages that care plan: pulls in caregivers at home as well which is an important component. You have people who need help when they’re at home. Elderly and post-surgical patients. Involving that caregiver when they’re at home is important.

We’re also seeing more and more connected medical devices here. I was just speaking with a friend of mine who’s participating in a heart study. So he literally is wearing a device — he volunteered at the study — that monitoring his heart when he’s awake and doing physical activity, connecting it to a bunch of other data and then giving feedback on where he is at rest, when he’s hard at work, etc.

We’re seeing more and more of these connected devices. That’s really helping with care plans and helping people manage their care at home. Because the hospital can then monitor what’s going on with that patient at any given time. The problem is we’re living in a world where data is coming in from these devices probably faster than hospitals can consume the data. Who is there on the other end of the line, when the heart starts to go into afib or something like that — to really make sure that everything’s okay!

There’s a struggle there but I think with the emergence of big data, you’re going to start to see that even out over time.

Steve: So can some of that data actually find its way into Salesforce and if so how was that sensitive data protected?

John: Salesforce has really good native capabilities around protection of PHI’s. As you know you can encrypt down to the field level — what people are able to see. They’ve also added the dimension of a product called Shield, which really tightens up security. It gives you event monitoring, so if people start moving data out of the system, you can see it. Auditing over time. Field audit level. So you can really see if people are making changes to patient data or accessing patient data. In general, encrypt the patient data — that’s really what the bread and butter of Shield is.

When we work with patient data — we’re careful not to touch patient data at all if we can avoid it and that’s one of our main policies — but if we do have to we have really specific policies around handling that patient data. We have a 90 page protocol around protecting that patient data. Making sure that our laptops are encrypted. Making sure that our phones are protected. Making sure that when we move data around we make it encrypted. So we take a lot of safeguards around how we protect data at the utmost level that we can.

Steve: I remember when Salesforce first came on the market and one of their pitches was that your data is safer in our data centers than it is behind most corporate firewalls That’s probably the case with hospitals as well. We’ve certainly heard some recent news about hospitals getting attacked by the WannaCry ransomware. So, in general Salesforce even without these added protections tends to be more secure than in most private networks.

John: Yes. Knock on wood. We haven’t seen a significant breach at Salesforce. Of course, I say that today and tomorrow watch what happens. I think one of the biggest breaches that they had was someone you know lost their password.

Steve: Socially engineered.

John: Yes, so it was an end user that made a mistake and it was only their company’s data that was breached. So trust.salesforce.com — they throw that out there.

Steve: So let’s tie everything we’ve talked about together and maybe just tell us overall about Sapience MD and how that as an app that runs on top of Salesforce or inside of Salesforce depending on how you categorize it. Tell us just a little bit about the capabilities of Sapience and some of the uses in the HLS industries.

John: Sure! So we mentioned providers. It’s a bunch of different use cases for providers. And as I mentioned, what Sapience allows you to do is pull in provider data plus provider practitioners. Anyone who’s basically filing claims — they’re pretty much in this. So that goes for speech language pathologists. That goes for physical therapists — all the way up to neurosurgeons.

The provider use case is obviously, “hey, I want to start recruiting some physicians. I need physicians for my network. I can find them here. Find out what they do what their specialties are and make sure they align with the position that I want to hire them for — or contract them for.” Likewise specialty providers. I mentioned the physical therapy shop. They want to perform outreach. Or a home healthcare organization wants to do outreach to doctors to gain referrals.

They’ll have a liaison team. They’ll need doctors to call into or practices to call into. Sapience allows you to import all the records that you want to be able to do that — build out your database for your outreach and liaison activities.

Medical device. Same thing. You want to see physicians that are performing really specific surgeries or specific procedures that your medical device can help with them with. That will help you build out your pipeline.

Those are basically the three main use cases: physician recruitment & provider recruitment; physician outreach & referral management; and medical device sales outreach for pipeline building.

Steve: It sounds like one of the big benefits is, as opposed to a situation where you’re just downloading a list of physicians into a spreadsheet — it’s really hard to manage a relationship out of a spreadsheet row. But if you bring physician data into Salesforce, you’ve got a lot wider and richer information. You’ve got data that can be updated by both CRM users and from the big data sources. It’s a much more dynamic living, breathing record that really helps with relationship building.

John: Exactly correct. We pull it in from the databases. We normalize it and we make it consumable to the end user in a format that has a nice user interface and is really recognizable.

I hate to reference something Data.com because Data.com data isn’t the best. But in terms of the look and feel, the way that it’s used is really similar in terms of checking the box and then adding these leads or contacts to your database.

Steve: The old stare and compare type metaphor.

John: Exactly!

Steve: Great! So someone is interested in either a demo of Sapience MD, the app, or they’re interested in your professional services on the Salesforce platform within the HLS industries, how can people reach you?

John: They can get it at our website at saxasolutions.com. There is obviously a “contact us” that goes right into our Salesforce database, where you turn into a lead and we reach right out to you and can offer you a demo or even a trial if you’re ready for it. It plugs right into sandboxes if you have Salesforce and want to give it a test drive. It’s not a problem to install. You can also send us an email at [email protected]

Steve: One last question. If you’re not a current Salesforce user, could you actually demo this on a trial Salesforce org — or would you need to be a full paying customer?

John: You could demo it on trial, not a problem. It works on any license, so not an issue.

Steve: So even if you’re not paying the big bucks for Enterprise or Unlimited, you’ve got Professional you can still use it.

John: That’s correct!

Steve: Great! Okay, John well thanks very much for your time. I’ll have some additional information in the show notes as to how people can reach you and reach Saxa Solutions.

John: It’s been a pleasure Steve. Thank you!