How to Fail and How to Succeed with Business Development

Ask your business development reps the following questions. I bet you won’t be very impressed with their answers.

Why are we better than X Competitor across town? (Hint: Our people should not be the answer.)
Your brochure here states that you provide evidence-based treatment. What does that mean for your program? How is that implemented?
If you want to talk to the discharge nurse at a hospital, what's the best way to do that? What's most important to them?
What kind of results does your program get?
When was the last time you were in the facility?

Whenever I talk to business development reps from facilities, those are the questions I ask. Suffice it to say, if I even get a straight answer, I wouldn't be overly enthused to send my loved one to the program after they answer. If I was a community referral partner, I’d be equally hard-pressed to determine why to refer to your program over the one across town.

The Need for Support, and Training

This is not the business development rep's fault.

They generally had no onboarding to speak of outside of how to use the CRM, how comp and benefits work, and how to connect referrals to the admissions team.
They have no guidance from the organization in terms of how best to approach or work with various types of referral providers such as hospitals vs. jails vs. EAPs.
They don't have any clinical background nor had any training on it, so when someone asks them even a basic clinical question, they can't answer.
Many have never even been to the facility they're sending referrals to.
A big gap for many programs is the lack of systems, training, and processes for their BD team. Providers that have them, not surprisingly, generally have teams that perform 2-3 times better.
Ask yourself or your team the questions above. If they can't answer, it's time to look at building out some robust systems and trainings.

Break The Cycle

Something I often talk to clients about is the fact that many experienced BD reps in the field have bad habits, they’ve just been doing it longer so they can be even harder to train. Hiring someone with 10 years of experience in the field can result in very lackluster results because they’ve never received proper training or guidance.

The lack of training and perpetual hiring of reps with perhaps many years in, but no robust experience, creates a negative situation where nobody is happy with results. Here’s how it usually goes:

The BD rep is hired, often because of contacts they supposedly already have in the field or area.
They’re told what their KPIs are, how it affects compensation, and how to use the CRM. Then they’re told to get to work.
Many BD reps are only used to the horse-trading common between facilities of varying levels of care or that accept different insurance policies. Sometimes they’re given established accounts that the program has had a relationship with for some time. 3 months go by and the rep isn’t bringing in many referrals and most that do come in are from the accounts with previously established relationships, so no new business.
The CEO or Director of Business Development starts pressuring them to improve their performance and increase referrals. They emphasize touchpoint KPIs and start checking in regularly to make sure the rep is doing enough calls and face-to-face meetings every day. They may even make suggestions to diversify their outreach and connect with more hospitals, jails, therapists, or whatever.
The rep is getting concerned. They know their job is on the line. They run from place to place to meet their touchpoint KPI. But they’re only used to the horse-trading with other BD reps. When they go to the hospital, they don’t know who to talk to. When they meet with a therapist, they get asked a bunch of specifics about the clinical programming they don’t know how to answer. They’re scrambling to find new referrals, so don’t stop and take the time or do enough repeat visits to truly build new relationships.
By this point, another month or two has passed. The CEO or Director of Business Development is demanding results as the program is losing money paying the rep every month. The rep, not having been able to get any traction with the diversified outreach, falls back to the tried and true horse-trading. Even if it’s not working well, at least they know it can work and has worked for them before, so they hope maybe working really hard at it will yield better results this time around.
Results are unsatisfactory. The provider decides it either doesn’t have the right reps in place or it simply needs to accept lackluster results and will need many more reps to meet census goals. Old reps are let go or quit; new reps are hired. The additional reps end up competing for the same territory or get put farther afield where referral partners are less willing to refer because the facility is out of state or too far away. Existing referral partners lose trust as they see reps constantly coming and going, which raises questions about stability and makes them much more cautious about referring to the provider than ever before, making the new rep’s job even harder.
Go back to 1 and start the cycle over.

To break this cycle, a provider needs to install a strong onboarding process and ensure new reps are following it from the get-go. If the rep is three months in before their outreach is checked on because a positive trend result doesn’t seem to be forthcoming, it’s too late. Strong referral relationships take time to build, often months. By the three-month mark, the financial need to get the rep performing is too much, so the rep won’t have enough time to turn things around before the decision is made to cut ties.

Because a regular cycle of revolving reps erodes trust and makes each subsequent hire’s job harder, nipping this cycle in the bud and committing to the investment of doing it right is very important. Of course, some providers are many repetitions into this cycle already. They then need to accept the fact that it may be even harder and will have to extend performance timelines for new reps.

What Does a Good Onboarding Training Look Like?

When we install onboarding trainings for providers, it’s a week long with ride-alongs. When doing it in-house after we’ve installed it, I always recommend spreading the training out over 2 weeks and mixing in ride-alongs and fieldwork. This way the trainee reps can start to apply and receive feedback on the implementation of the training points, which I’ve found really helps reps benefit from the training. The only reason we only do a week when we do on-site training since the provider only needs to pay us for a week of training rather than two.

Here’s the basic structure we recommend including:

Day 1: Organization Overview, Therapy Observations, and Giving Tours
Day 2: Admission’s Processes, KPIs, and Prospecting
Day 3: Sales & Outreach Tactics, Collateral, and Presentations
Day 4: CRM, Ride-alongs, Networking
Day 5: Feedback, Practice Sticking Points, Review

By the end of the training, the reps should have a strong familiarity with the program, particularly its differentiators compared to competitors in the area, be able to confidently discuss basic clinical details, and have observed an experienced rep in action while also receiving feedback related to their own performance in talking with community partners.

Structuring the BD Team

There are many ways to structure a BD team, but here are some of the basics to keep in mind.

Reps should account for at least 50% of program admissions and a decent rep will bring in at least 8 admissions a month once they’re up to speed and have established some strong relationships. So if you’re a 100-bed facility, the BD team should fill at least 50 of those beds per month, meaning you’d need at least 6 reps.
Reps should almost never have a territory radius greater than 1-hour’s drive from their house. Otherwise they’ll spend too much time driving and they’ll spread themselves too thin, not doing enough repeat visits to build up relationships with more local partners. If they’re stationed in a large metropolitan city, then that should be their only area of focus.
Always hire reps close to the facility first, then slowly add additional reps in an ever expanding radius as needed. The farther a rep is away from the facility, the harder it is for them to bring in admissions, often half to a third less than a rep closer to the program. Healthcare is local, except for special cases like a unique relationship with a union or tribe, reps shouldn’t be stationed more than 150 miles away from a residential facility or 30 miles from outpatient.
Reps should focus on their strengths. It’s OK to have 2 reps in the same geographic area if, for example, one is mostly focused on hospitals and healthcare while the other is focused on jails, probation/parole, and public safety.
As an exception to the radius rule, it is smart to have reps with very specific backgrounds focus nationally. For example, a previous head of the firefighter’s union would not have a local territory, but would be tasked with building relationships with fire departments across the country.
BD reps should always have company cell phones so that calls from referral partners go to a company line, not a rep’s personal cell phone. Referrals partners need to have relationships with the facility more than the rep.
Reps should have at least 1 week of onboarding, which includes ride alongs and feedback from another experienced rep.
The provider should have playbooks for different buckets - healthcare, justice system, employers, unions, etc. This way, if a rep isn’t sure how to connect with a particular group, they have both guidance and specific collateral to draw on and help them out.
There should be bi-weekly discussions on qualified referral KPIs as well as the activity that led to them. Teams need to regularly stop and analyze what is working and what isn't. Notice that "admissions" is NOT a business development KPI. Admissions is the job of the admissions center. It is only the BD reps' job to send over qualified referrals. It's the admissions team's job to move them to intake.
The BD team should not operate purely as independent outreach, but as part of a comprehensive strategy that integrates other marketing channels. Paid media spends in the territories in which reps operate is essential to help reps get their foot in the door and stay top of mind.

Community outreach isn’t complicated. Consistency and focus tend to be the two primary qualities that drive success for reps. But if proper training and supports aren’t in place, it can be very hard for reps to know where to focus, who the right person is to talk to and how often, as well as what messaging is important to different people.

Looking for help developing your program’s outreach/business development team? Get in touch at engage@circlesocialinc.com or call 800-396-9927.