1. Adapting Mainstream Marketing Techniques for Difficult to Recruit Providers Letty Cherry Kreger, MHA VaxTrack Immunization Registry Riverside County Department of Public Health Riverside, CA

2. Overview  Background  What is the Seven Step Approach?  How The Seven Step Approach Works  The Seven Steps – Step by Step  Real Life Applications  Conclusion

3. Background  Riverside County stats 4 th largest county in CA 4 th largest county in CA >7200 square miles >7200 square miles IIS currently pediatric, becoming life-span in 2009 IIS currently pediatric, becoming life-span in 2009  Riverside County Providers 1086 providers identified 1086 providers identified 487 providers enrolled 487 providers enrolled 435 are either new or in active recruitment 435 are either new or in active recruitment

4. Background - continued  188 private medical doctors (PMDs) enrolled (>60% of eligible PMDs)  Recruitment activities incorporate basic sales and marketing techniques “Selling” a product / service “Selling” a product / service Overcoming objections, assuming the sale, WIIFM + features & benefits Overcoming objections, assuming the sale, WIIFM + features & benefits  Basic sales techniques haven’t worked for all providers. Of non-enrolled PMDs, 63% are “Not Interested.”

5. Background - continued  Question: How many of the NO’s are not from key decision-makers but from “the gatekeepers”? Staff members who don’t want another task Staff members who don’t want another task Office Managers who are short-staffed Office Managers who are short-staffed  Decided to adapt another marketing technique (Seven Step Approach)

6. What is the Seven Step Approach?  It is a series of 7 steps designed to help achieve a sales/marketing goal.  The first three steps set the tone by getting a “YES” response before you state the purpose of your call.  When followed, it helps increase your success rate by incorporating other basic sales techniques Overcoming objections Overcoming objections Asking for the appointment Asking for the appointment Using scripts to enhance success Using scripts to enhance success

7. Why use the Seven Step Approach?  Office staff have decided to say NO before they know the facts  The Seven Step Approach creates an environment where our message can be heard by: Seeking “yes” responses from the start Seeking “yes” responses from the start  Industry* success rate = 1 yes / 3 “asks” * Direct Sales, Insurance

8. The Fundamentals of the Seven Steps Approach  Follow the steps in order  Use the words provided  Give the person time to respond  Tone and delivery is important Smiles are heard Smiles are heard

9. The Seven Step Approach Overview  Step 1 – Begin the Call  Step 2 – Disarm Your Contact  Step 3 – Get Permission to Talk  Step 4 – Reason for the Call  Step 5 – The Objection  Step 6 – Positioning Question  Step 7 – The Close

10. Step 1 – Begin the Call  Expectation: Get a simple response from your contact (Hi, Hello, Yes, Who?)  Say: “Hello Suzi, this is Letty Cherry Kreger calling.”  Wait for a response before continuing to next step  Wait to identify yourself further.

11. Step 2 – Disarm Your Contact  Expectation: Get a YES response from your contact  Say: Begin your sentence with either If you recall… If you recall… I understand… I understand…  Pause long enough to get the response.  Decide in advance what statement would work best for your call.

12. Step 2 – Disarm (continued)  I understand that you are the office manager for Dr. Smith.  If you recall, I spoke to you last year about whether your office had internet access.

13. Step 3 – Get Permission to Talk  Expectation: You must have permission to talk before the call continues to Step 4 Sales techniques doesn’t mean “sales type” Sales techniques doesn’t mean “sales type”  Say: “Is this a convenient time for you to talk?” or “Do you have a moment to talk?” Yes response – go to step 4 Yes response – go to step 4 “It depends” – more information needed. Go to step 4, but you may have to stop “It depends” – more information needed. Go to step 4, but you may have to stop

14. Step 3 – Get Permission to Talk (continued)  “No” response – find out a good time to call back, but maintain control of the conversation “Would an hour from now (tomorrow morning, next Tuesday, etc.) be a better time?” “Would an hour from now (tomorrow morning, next Tuesday, etc.) be a better time?”  When you call back, you must repeat the first 3 steps: “Hi Suzi, this is Letty Cherry Kreger calling. (Pause) If you recall, you thought that this afternoon would be a better time to talk. Do you have a moment to talk now?” “Hi Suzi, this is Letty Cherry Kreger calling. (Pause) If you recall, you thought that this afternoon would be a better time to talk. Do you have a moment to talk now?”

15. Step 4 – The Reason for the Call  At this point explain who you are and the purpose of the call  Say: Use words like hoping, need, visit, wondering, trying.  Expectation: You will either make an appointment or get an objection.  Ask for the appointment!

16. Step 4 – The Reason (continued)  “I am calling from the VaxTrack Immunization Registry, and I have been trying to follow-up with pediatric offices who are not yet enrolled in VaxTrack. I was hoping to spend about 15 or 20 minutes showing you the software and discussing how it would benefit your office. Would a morning appointment or an afternoon appointment be better for you?”

17. Note!  Seeking “Yes” responses in the beginning makes the contact more receptive  Give two choices for the appointment (early in the week or late in the week, Monday or Thursday, morning or afternoon, etc.). People tend to select one.  If you make the appointment at this point, you have achieved success in 4 steps!

18. Step 5 – Expect an Objection  People are programmed to say NO, so expect an objection  Expectation: Continue the conversation in favorable terms in spite of the objection.  Say: Use “OK” or “I understand” “OK, before I go, may I ask you one quick question?” “OK, before I go, may I ask you one quick question?” “I understand. Before I go, may I ask you one quick question?” “I understand. Before I go, may I ask you one quick question?”

19. Step 5 – Expect an Objection (continued)  Pause long enough for the contact to respond.  Expect to hear YES, OK, or SURE  If the contact says no, end the call by thanking the person for his/her time.

20. Step 6 – Positioning Question  Expectation: Ask questions that reveals a potential need or motivation.  The question must be open-ended  Again, pause long enough for the person to respond  LISTEN to identify their need

21. Step 6 – Positioning Question (continued)  Say: “If you could improve anything about your ____, what would it be?” “If you could improve anything about your ____, what would it be?” “If you could change one thing about your ____, what would it be?” “If you could change one thing about your ____, what would it be?”  Example: If you could improve one thing about your vaccine inventory management, what would it be? If you could improve one thing about your vaccine inventory management, what would it be?

22. Step 7 – The Close  Expectation: Ask for the appointment again by restating your reason for calling and repeating their identified need.  Say: Use “especially” in your response. Also use words like hoping, need, visit, wondering, trying.  Ask for the appointment  If you get another objection, thank the person for his/her time and end the call.

23. Step 7 – The Close (continued)  Example: “This is one of the reasons I was especially hoping to visit with you, so I could share how similar offices found that they were able to become more efficient after they joined the registry, even though they did not increase the size of their staff. Again, I would only need about 15 or 20 minutes of your time. I was wondering what works better for you, morning or afternoon?” “This is one of the reasons I was especially hoping to visit with you, so I could share how similar offices found that they were able to become more efficient after they joined the registry, even though they did not increase the size of their staff. Again, I would only need about 15 or 20 minutes of your time. I was wondering what works better for you, morning or afternoon?”

24. “Seven Steps” in Real Life  Tried out on 7 PMDs (72 recruitment attempts) before staffing changes put tests on hold  Results: Industry Average: 33% (1 in 3) Industry Average: 33% (1 in 3) Our Results: 57% (> 1 in 2) Our Results: 57% (> 1 in 2)

25. “Seven Steps” in Real Life New Provider Enrollments Before Seven Steps With Seven Steps Date of First Contact # Recruiting Attempts Success in 4 Steps Success in 7 Steps Provider A 4/20038NoNo Provider B 2/200311NoYes Provider C 8/200314Yes- Provider D 10/200216NoNo Provider E 8/200310Yes- Provider F 10/200228NoNo Provider G 7/20035Yes-

26. Conclusions  Adapting sales techniques for immunization information systems can facilitate provider recruitment  When properly applied, the Seven Step approach helps counteract the pre- programming that everyone has to say “NO.” Seeking “yes” responses to increase receptiveness Seeking “yes” responses to increase receptiveness Can help move past “gate keepers” to present the IIS to decision makers Can help move past “gate keepers” to present the IIS to decision makers 

27. Conclusions  Using sales techniques does not make you the “sales type” Asking permission to talk demonstrates respect for the person’s time Asking permission to talk demonstrates respect for the person’s time Makes them more likely to do business with you Makes them more likely to do business with you  These techniques allowed VaxTrack to experience a 57% increase in the number of difficult-to-recruit providers who enrolled in VaxTrack 

28. Questions? Letty Cherry Kreger, MHA lcherry@co.riverside.ca.us 951.354.1400