simmonsdewitt

Pharma's Realization Blind Spot

Wed, 14 Oct 2026 08:00:00 GMT

Pharma's investment in a patient is largely complete before the first dose, and the return depends on everything that happens after it. The blind spot begins when clinical intent must become sustained therapy. The gap is not a failure of commitment and it is not set by the market. It is a yield, and a yield is the product of how a commercial system is designed and run.

The realization blind spot is structural rather than intentional

Over several decades pharma has built a powerful intent engine around the clinical decision to prescribe. Evidence generation, medical engagement, segmentation, promotion, field execution and performance management have all been developed to help clinicians reach informed treatment decisions and to reach more of the clinicians for whom the evidence is relevant. Medical and scientific work has its own purposes and its own governance, and it should not be reduced to promotion. Taken together, these capabilities create a sophisticated environment around the Path to Prescribe , and the architecture is mature because the objective has been culturally central to commercial organizations for a long time.

This note began as an attempt to publish a cross-category benchmark for Realization Rate, defined here as the share of prescriptions written that ultimately become sustained therapy. The benchmark could not be built from published evidence. The literature consistently reveals the fill stage, and it does not provide the full progression from prescription through therapy start, ninety-day continuation and twelve-month persistence on one common denominator. The inability to construct that progression is not a failed research exercise. It is evidence of the measurement blind spot itself.

Two commercial truths now collide. The first is that promotional excellence remains indispensable, because pharma still has to create awareness, build clinical confidence, communicate evidence and earn the prescription. The second is that once the prescription exists, many of the barriers that determine whether intent becomes therapy are experiential rather than promotional. They arise in fragmented handoffs, unclear affordability, poorly timed outreach, difficult navigation, disconnected support and uncertainty about what happens next. Those failure modes require a different commercial response, because promotional remedies are designed to create or reinforce intent rather than to resolve the friction that prevents existing intent from becoming treatment.

One boundary governs how everything that follows should be read. An unfilled prescription is not automatically recoverable revenue, and a public cross-category benchmark does not yet exist. The studies in this report span different years, populations, payer mixes and definitions, which means the evidence is directionally important and cannot support false precision. The design choices, caveats and implementation detail that make the measure defensible are set out in the appendices, so that the argument can be read without them and built with them.

Pharma built an intent engine before it built a realization engine

The asymmetry is visible in the operating model, because commercial culture has historically organized around the Path to Prescribe. Before the prescription, functions share mature systems for evidence, targeting, promotion, access strategy, field execution and performance management. These disciplines are deeply resourced, professionally specialized and connected to performance expectations that leadership understands. That is the intent engine at work, and it creates the conditions under which a clinician decides that a medicine is right for a patient.

Experience developed under a different logic. Patient services, benefits investigations, affordability support, nurse education, specialty pharmacy coordination and adherence programs can be substantial and well-funded. They have often been treated as support around the commercial model rather than as disciplines inside the value proposition itself. The cultural instinct is understandable, because the prescription has traditionally been interpreted as the commercial event. The consequence is that the Path to Fulfill and the Path to Adhere can absorb significant investment while remaining fragmented across functions, vendors, measures and owners whose numbers describe local completion more clearly than the patient's overall progression.

This is an operating diagnosis rather than a claim that every manufacturer or brand carries the same weaknesses. The practical test is whether leadership can follow an appropriate treatment decision across functional boundaries and see why it progressed, stalled or ended. The issue is not the absence of post-script activity. It is the absence of one end-to-end performance architecture. Pharma has become highly capable at creating clinical and commercial intent, while the post-script environment increasingly determines whether that intent survives. The former is built on the disciplines of evidence, education and promotion. The latter is shaped by access, affordability, communication, coordination and confidence. Both are commercial, they are not the same kind of commercial problem, and they do not respond to the same remedies.

The failure modes change character after the prescription. Each of the following is a progression failure rather than a persuasion failure, and the pattern is consistent enough to be recognizable inside most organizations.

A benefits investigation can stall for days or weeks while the patient has no clear view of what has begun, what is missing or what will happen next.
A prior authorization can succeed while the outcome still fails to reach the patient, caregiver or office staff member who needs to act on it.
Affordability support can exist and still fail to help when eligibility, enrollment or next steps are difficult to establish at the moment of need.
Specialty pharmacy outreach can be operationally complete and still ineffective when it occurs at times the patient cannot answer or provides no practical path back into the process.
Therapy can reach the home while the patient remains uncertain about how to start, what to expect or where to turn when confidence breaks down.

That pattern matters because promotional and experiential problems are not interchangeable. Once the physician has prescribed, another message or another impression does not resolve a stalled benefits investigation, make an affordability path easier to understand, reconnect a broken handoff or give a patient confidence to start. Those are experience failures that interrupt progression after persuasion has already succeeded. In the post-script path, experience is therefore not a service layer added to the value. It is one of the mechanisms through which therapeutic and commercial value is realized at all.

Realization Rate is the return on an investment made before the first dose

Almost everything a company invests in a brand is committed before any individual patient is treated. Evidence generation, medical education, field engagement, access work and promotion are all incurred ahead of a decision the company does not make and does not control. The prescription is the clinician's independent judgment that the medicine is right for a particular patient. What the investment creates is not that decision. It creates the opportunity to serve a patient the clinician has judged appropriate, and that opportunity is earned value. It is not revenue and it is not yet a patient on therapy. It is the point at which an upstream investment becomes a specific, countable chance to deliver the benefit the medicine was developed to deliver.

Realized value is the return on that investment. It is a patient who started the therapy and stayed on it long enough to receive the benefit the trial demonstrated, which is the only point at which the clinical claim and the commercial claim are both satisfied. Between the opportunity and that patient sits a sequence of handoffs, and at each one some of the earned value fails to progress.

The Realization Rate is the yield between the two. It is realized value divided by earned value, and because the same value per patient sits on both sides of that division, it is equally the number of sustained patients divided by the number of prescriptions written. A brand with a Realization Rate of 30 percent is converting thirty of every hundred opportunities its investment created into the outcome the investment was made to produce. The other seventy are not lost to a competitor. They are lost to the system between the decision and the dose, which nobody designed and nobody owns.

Stated as a yield, the measure does three things that a satisfaction score or an adherence rate cannot. It puts demand creation and progression on the same arithmetic, because investment that grows prescriptions and investment that grows the share realized can be compared against one base. It gives finance a number denominated in money it already recognizes, since earned value multiplied by one minus the yield is the Customer Value at Risk the brand is carrying. It makes the loss a property of the operating model rather than of the market, because a yield is what a process delivers from its inputs, and processes can be redesigned. The frame also keeps the commercial interest and the clinical interest pointing the same way. The company earns its return only when the patient receives the benefit, so nothing in the measure rewards a prescription that should not have been written or a patient who should not have stayed.

Value leaks at five rungs, and a fixed base is what makes the leak visible

The yield is lost in stages, and the stages form a ladder. A prescription is written, which is where value is earned. It is filled, which is where access is cleared. Therapy is started, which claims cannot see and the support system sometimes can. The patient continues to ninety days. The patient persists to twelve months, or to whatever horizon the trial established as the point of benefit. Each rung is a seam between parties with different incentives and different definitions of done, and each seam leaks.

The ladder only works if every rung is measured against the same base. Each stage has to be expressed as a share of the prescriptions originally written, never as a share of the survivors from the rung below. Suppose one hundred patients receive a prescription, fifty fill it and forty reach the continuation milestone. Continuation among those who filled is 80 percent, which is forty over fifty, and it is a perfectly valid number for the purpose it was built for. Progression from the original cohort is 40 percent, which is forty over one hundred. A commercial organization that only ever sees the first figure believes it has a strong brand with a minor access issue. The second figure shows that sixty of every hundred opportunities never became the outcome the investment was made for, and that most of the loss happened before the service teams ever met the patient.

That is why the denominator is the design choice that matters more than any other. A fixed base prevents a high persistence rate measured on a small surviving cohort from being read as strong end-to-end performance. It prevents an access problem from being managed in isolation from the patient behaviour that follows it. It prevents activity metrics from standing in for the outcome they were meant to influence. It prevents functions, vendors and dashboards from silently changing the denominator as the patient moves through the system. Realization Rate does not replace adherence, persistence, access or experience measures. It is the fixed frame that connects them, so leadership can see how much value is surviving each rung and where the ladder is breaking.

The patient has to clear two horizons, and the clinical one governs

The last rung of the ladder is set by the trial rather than by the finance calendar, and that choice carries the economics of the whole frame. A medicine demonstrates its benefit over a defined duration of exposure. A patient who stops before that duration has borne the cost, the effort and the side effects of treatment without the result the evidence promised. The company, for its part, has incurred the full cost of serving that patient without delivering what the medicine was developed to deliver. The clinical benefit horizon is therefore the governing horizon, and it is where realization is measured.

The second horizon is commercial. Every patient started carries a cost to acquire, meaning the share of the upstream investment that produced the opportunity. She also carries a cost to serve, meaning the access, support and pharmacy work that moves her onto therapy and keeps her there. Those costs are incurred early, and the contribution that recovers them arrives month by month. There is therefore a point on the persistence curve at which a patient has paid back what it cost to reach her, and every month beyond it is return on the investment. That is the payback horizon. A patient who discontinues before it is a loss on the investment, and a patient who continues past it is where the brand's return actually originates.

The two horizons are the argument for treating the total patient experience as an economic discipline rather than a service. For most ongoing therapies the payback horizon arrives before the clinical one, which means the company's financial interest and the patient's clinical interest sit on the same side of every discontinuation. Neither is served by a patient who stops at week six. Both are served by an experience good enough that the patient stays through the point where the evidence says the benefit arrives, and the company is rewarded for delivering that benefit rather than for anything short of it. Anchoring the measure on the clinical horizon rather than the payback horizon is what keeps the frame honest, because a company that counted a patient as realized at payback would be measuring its own recovery instead of the patient's result.

Where payback sits relative to the clinical horizon is brand-specific. Finance should establish it from actual acquisition and service cost rather than from the illustration above, and Appendix A sets out how the two are kept separate from recognized revenue. What does not vary by brand is the standard the horizons impose. The experience between the decision and the dose has to be designed to carry a patient to the clinical horizon. That is the only point at which the medicine, the patient and the investment have all received what they were owed.

Two brands with the same revenue carry very different yields

The two brands below are illustrations rather than client work, and the figures are deliberately round so the arithmetic stays visible. Assume both treat the same condition and each prescription represents one patient. Both are worth twelve thousand dollars in net value for a patient sustained through a twelve-month horizon, and both are measured at twelve months because that is where their trials demonstrated benefit.

Brand A had forty thousand prescriptions written in the period, and twenty-four thousand of those patients were still on therapy at twelve months. Brand B had eighty thousand prescriptions written and the same twenty-four thousand sustained patients. Both produce 288 million dollars of realized value, which means a revenue line on its own cannot tell the two apart.

The two brands stop being comparable the moment the yield is applied. Brand A realized 60 percent of the opportunities its investment created against 30 percent for Brand B, and the complement turns that gap into money. Brand A is carrying 192 million dollars of Customer Value at Risk while Brand B is carrying 672 million, which is three and a half times the exposure on identical revenue. The example also shows the two forms of the rate agreeing, since Brand B's twenty-four thousand sustained patients over eighty thousand prescriptions is 30 percent, and its 288 million realized over 960 million earned is likewise 30 percent.

What the comparison exposes is a ranking the existing scoreboard reverses. Brand B writes twice the prescriptions, which on most commercial dashboards reads as the stronger performer and is probably being managed as a demand success. The yield says instead that Brand B is creating clinical intent it cannot convert, so further investment in demand largely produces prescriptions that will not become therapy. Its binding constraint sits after the script, in the rungs this report shows to be unmeasured across the published literature. The example identifies a question for investigation rather than proving that Brand B's barriers are avoidable, and the question is the point.

The same arithmetic shows how differently the two growth levers pay. At Brand B's 30 percent yield, ten percent more prescriptions means eight thousand additional scripts, two thousand four hundred additional sustained patients and 28.8 million dollars of additional realized value. At the existing eighty thousand prescriptions, lifting the yield from 30 percent to 40 percent means eight thousand additional sustained patients and 96 million dollars of additional realized value. That is a ten-point improvement rather than a ten percent one. These are arithmetic scenarios rather than forecasts or equal-cost options, and the return on either depends on what an intervention actually achieves and what it costs. What the comparison establishes is that yield is a growth lever of the same order as demand creation, and that a brand plan which cannot see it cannot weigh it.

The benchmark does not exist, and the empty table is the finding

The audit covered five therapeutic groupings, with four researchers working independently against the same five-stage ladder across peer-reviewed literature, claims analyses, payer disclosures and academic repositories. The objective was to populate each rung while holding prescriptions written as the base at every stage. The resulting evidence matrix contained one populated access column and three empty downstream columns, a pattern that was consistent enough to become the central research finding rather than an incidental limitation.

Empty stages indicate no published measure on prescriptions written as the base in the evidence reviewed. They do not imply that no conditional persistence studies exist, and they refer to the reviewed evidence rather than to the entire literature. Category measures are reported as found, and the definitions behind each row are set out in Appendix B. These observations are neither a current industry median nor a league table.

I expected this work to end with a benchmark. Instead it produced an empty table at three of the four post-script rungs, and that empty table is the more useful artifact, because it shows precisely where public evidence stops and where internal measurement has to begin. The absence of a benchmark should not be read as evidence that manufacturers cannot measure their own brands. It means that public evidence does not currently support a defensible cross-category Realization Rate benchmark on one common base. A company with access to its own claims, hub, specialty pharmacy, patient support and field signals can know considerably more about its own yield than the public literature can reveal.

The fill stage alone reveals a material realization gap

In four of the eight observations in the audit, fewer than half of prescriptions written were filled. The most severe observation was in PCSK9 inhibitors, where 30.9 percent of prescriptions in a 45,029-patient study ultimately reached a fill. GLP-1 orders written where obesity was the only recorded indication were filled 37.2 percent of the time, against 47.5 percent where diabetes was the only recorded indication and 64.6 percent where both were recorded. Commercially insured patients newly prescribed specialty oral anticancer medications had a 45.5 percent approved-and-filled rate within ninety days.

These observations are not a league table, because they come from different periods, datasets, payer mixes and clinical contexts. They should not be used to declare one category better than another or to infer a precise recoverable revenue pool. Their value is more fundamental. They show that the loss at the first rung alone is large enough, across several commercially important populations, to belong on the commercial leadership agenda rather than remain confined to local access or patient services reviews.

What can be concluded safely is that the prescription is not the end of the commercial value chain. In several major categories a substantial share of clinical decisions does not survive the first post-script gate. The same event is simultaneously a patient progression problem and a commercial yield problem, even though the exact share that is recoverable will vary by brand and circumstance.

A rejected prescription often disappears rather than redirects

A 2026 study in JAMA examined more than two million first-fill attempts for single-source branded drugs across approximately 1.17 million people. Formulary-related rejections rose from 24.3 percent of initial attempts in 2018 to 40.7 percent in 2024, a relative increase of about sixty-seven percent in six years. More consequentially, 48.4 percent of rejected attempts were followed by no fill of the rejected drug and no fill of another drug in the same therapeutic class within ninety days. That is an observed dispensing gap rather than proof that every affected patient remained untreated or could have been recovered.

The finding still challenges a common managerial assumption, which is that rejection simply redirects the patient to a formulary alternative. Some rejected prescriptions do redirect, and a substantial share do not. When no therapy in the class appears within ninety days, the system has not converted the original clinical decision into an alternative treatment path. The decision has effectively disappeared from the observable commercial progression.

The same pattern appears in specialty oncology. Among more than twelve thousand patients newly prescribed specialty oral anticancer medications for blood cancers in 2022, initial insurer rejection reached 64.9 percent in Medicare and 84.0 percent in commercial coverage. By ninety days, only 54.5 percent of Medicare patients and 45.5 percent of commercially insured patients had both received approval and filled the prescription. Higher out-of-pocket cost was associated with lower fill rates even after approval, which means approval cannot stand in for completed access.

Persistence is measured only among patients who survive the access gate

The claims architecture creates a second measurement boundary, because it can observe a dispense and it cannot directly observe whether a patient actually starts therapy. A pharmacy claim records a financial event, which is the dispensing of the medication, and it does not record whether the patient swallowed a tablet, injected a biologic or abandoned the product after collection. The population that fills a prescription and never starts therapy is therefore difficult to observe at scale, even though it sits directly on the ladder.

The ninety-day and twelve-month rungs create a different problem. Persistence is widely studied, and it is usually reported among patients who initiated therapy, which means the base has already changed. The resulting rate can be clinically valid and useful for the purpose for which it was designed while still being incomplete as a measure of end-to-end yield. Of one hundred prescriptions written in the PCSK9 evidence, roughly thirty-one are filled, and persistence is then measured on that selected cohort rather than on the hundred.

The GLP-1 evidence shows why the two bodies of work cannot simply be chained together. The Rodriguez study of discontinuation and reinitiation illustrates the value of the conditional perspective, but it cannot supply a prescription-to-persistence rate for the Sarpatwari order cohort, because the populations and study designs differ. Multiplying rates across those studies would manufacture an end-to-end estimate that neither of them established, which is the arithmetic shortcut this audit declined to take. The implication is not that persistence measures should be discarded. They should be placed on the fixed-base ladder, so leadership can see conditional performance among patients who started therapy alongside cumulative loss across the full population that was originally prescribed.

Yield is a leadership choice, not a market condition

The instinct inside most commercial organizations is to read a low fill rate as something the market did to the brand. Payers rejected it, pharmacies abandoned it, patients could not afford it, and the competition had better coverage. Each of those things is sometimes true, and none of them explains why two brands in the same category, facing the same payers and the same patients, can run at 30 percent and 60 percent yield. The market sets a ceiling on what any brand can realize. The operating model determines how close a brand gets to it, and the distance between the two is the part of the loss that leadership actually controls.

Three things determine where a brand sits under that ceiling, and none of them is decided by a competitor. The first is whether the ladder is measured on a fixed base at all, because a loss that is not visible cannot be managed and most organizations have never computed it. The second is whether anyone owns the seams, since every rung of the ladder is a handoff between parties with different incentives, and a handoff with no owner is where value goes to disappear quietly. The third is whether the signals that a patient has stalled are acted on inside the window when action still matters, rather than discovered in a monthly report after the patient has already moved on. A company can hold all three of those levers and never have pulled them, because the scorecard never showed the loss.

That is what makes the blind spot a design issue rather than a market condition. Demand creation has a named owner, a budget line, a forecast and a review cadence, which is why its performance improves every year. The post-script path has owners for each service and nobody for the sequence, which is why its yield has stayed invisible. Deciding to measure the yield, to assign the sequence and to act on the signal is not an operational detail delegated to patient services. It is a commercial operating model decision, and it belongs with whoever can convene market access, patient support and the field in the same room and hold them to one number.

Nobody decided this, and the history explains it without excusing it. The commercial model was built around the prescription because for most of the industry's history the prescription was reliably the sale. As access friction, affordability friction and persistence loss have grown, that assumption has quietly stopped being true, and the measurement system has not caught up with the economics. Leadership teams are still being rewarded on demand created while a growing share of that demand never becomes therapy. The yield is the number that closes the gap between what the scorecard rewards and the return the business actually earns.

A realization layer turns the blind spot into a management system

The post-script environment is already staffed and funded across access, patient services, specialty pharmacy, field and digital support. What is missing is the enterprise layer that connects those capabilities around progression. That layer makes stalled events visible, assigns accountability across functional boundaries and allows leadership to manage yield with the same seriousness applied to demand creation. That layer carries four things and the set is closed.

It carries the measure, using one fixed-base ladder from the written prescription through sustained therapy so cumulative loss remains visible, with rung rates, cumulative yield and confidence shown together.
It carries the signal, treating a stalled benefits investigation, an affordability barrier or an unresolved handoff as an event the commercial system can see and manage, with a shared barrier taxonomy and a distinction between observed facts and inferences.
It carries the standard, governing post-script interactions against explicit experience and progression conditions, meaning clear next steps, response windows, completed handoffs and confirmation that a barrier was resolved, rather than against activity completion alone.
It carries the ownership, assigning accountability above the individual function for the end-to-end yield and for the value that fails to progress, through a named executive sponsor and operational owners able to act across functions and vendors.

A realization layer is not a software product, a new channel or a relabeling of patient support. It is an operating choice about which progression the company will measure and which events it will treat as signals. It is equally a choice about which experience and progression standards will be enforced, and who will own the value that fails to move forward. Technology can enable that choice and it cannot substitute for it. Maturity develops from reporting activity, to governing handoffs, to responding to events, to learning which interventions change outcomes, and an organization earns each step through better operating discipline rather than by buying the next one.

Timing is where the layer becomes consequential, because a monthly report may reveal that patients did not progress long after the useful intervention window has closed. An office needs a missing document request while the case is active, and a patient needs an understandable next step at the moment affordability or treatment uncertainty becomes a barrier. Working from events as well as reporting cycles is what makes that possible, and it is where newer tools earn a place. The varied language in authorized notes, messages and service interactions can be summarized, classified and routed to an accountable owner faster than a person reading case files can manage. That is a proposed operating design rather than a claim the cited studies evaluated, and it holds only where authorized data, connected workflows and human review of anything that touches care, eligibility or sensitive communication are in place. A call made, a message sent or a case closed does not establish that a barrier was resolved, and an unresolved barrier should return to an owner rather than disappearing into a completed activity count.

Measure the yield before trying to improve it

Five questions establish whether a commercial organization can see its own yield today. For the brand that matters most this year, what share of a mature prescribed cohort reached sustained therapy. Where is the largest absolute loss on the ladder, whether at rejection, abandonment, never starting, early discontinuation or longer-term persistence. Does every function use the same base, the same stage definitions and the same clock. Who is accountable for each unresolved barrier and for the gap between prescriptions written and sustained therapy, by name rather than by committee. Which interventions have evidence that they changed progression rather than simply generated activity.

The practical discipline is to measure the yield before optimizing it. An enterprise cannot reliably improve what it cannot yet see, and a baseline built on contested definitions will be argued with rather than acted on. Appendix A sets out the design choices that keep the baseline defensible and a twelve-week agenda for establishing it.

The executive question is not your Realization Rate, yet

This work began with an expectation that a benchmark existed and could be assembled from published evidence. It ended with a documented blind spot instead. Publishing that blind spot is more useful than filling it with a fragile estimate, because it establishes the measurement problem clearly enough for commercial leaders to act on it.

For a commercial leadership team, the useful first question is not what the company's Realization Rate is, because almost nobody can answer that cleanly today. The more productive starting point is to ask, for the brand that matters most, how many patients in a mature prescribed cohort reached therapy, how many progressed further, and who owns the gap between those numbers. A borrowed benchmark encourages comparison before the measurement system is ready. A documented blind spot creates the case for building the measurement system itself.

A manufacturer that establishes a defensible fixed-base Realization Rate for one of its brands will know more about its own yield than the public literature can currently tell anyone. More importantly, it will have created a management frame capable of distinguishing where additional promotion is useful from where the real constraint is experiential, operational or structural. The investment that produces a prescription is already made by the time the clinician decides. The next commercial advantage comes from earning a return on more of it, and building the discipline to see the yield is what makes that opportunity investable.

Appendix A. Design and implementation considerations

The measure described in the body is simple to state and has to be built with care. The considerations below are the terms of use. They are what allow a finance team, a medical team and a commercial team to accept the same number, and they should be settled before the first baseline is computed rather than argued about after it.

Counting unit. A patient-based rate counts unique patients with a defined index prescription or treatment episode. It never divides unique patients by all prescription transactions, because refills, duplicates and changed orders would inflate the base and depress the yield for reasons that have nothing to do with progression. Where the available data counts prescriptions rather than patients, the unit should be stated and held constant rather than mixed.

The clock and the horizon. The measure has to specify how long a patient has to fill and to start, whether later milestones run from prescribing or from initiation, and which gaps count as discontinuation. It should use cohorts with sufficient follow-up rather than treating an immature cohort as a failed one. Twelve months is an illustrative horizon for ongoing therapy rather than a universal clinical standard. Finite courses need a completion measure, and other treatments need milestones suited to their clinical use, so the horizon should be set by the trial evidence for the brand rather than by a reporting convention.

What is reported separately. Missing observations, loss of coverage, death and clinically appropriate stops should be reported as their own categories rather than silently removed or labelled as avoidable leakage. A switch, a decision against treatment or a clinically necessary discontinuation may be the right outcome for the patient even when it reduces a particular brand's revenue, and commercial measurement must preserve that distinction. Coverage exclusions, unaffordable cost, supply constraints and clinical considerations cannot all be solved through better communication, so a navigation problem has to be distinguished from a structural access problem and from an appropriate clinical decision. Without that discipline, teams end up optimizing contact volume while the underlying constraint stays exactly where it was.

Modelled value and actual revenue. Earned value in this frame is modelled potential, meaning prescriptions written multiplied by the net value of a patient sustained to the clinical benefit horizon, and it is not revenue earned under accounting rules. Realized value is likewise a modelled measure, meaning sustained patients multiplied by that same value, rather than recognized sales. The patient ratio and the value ratio are equal only under that common-value assumption. Where patients differ materially in price, dose or duration, the two diverge, and a weighted economic measure should be calculated separately rather than assumed. The patient ratio is what a brand team can establish and audit. The value translation is what makes the number legible on a profit-and-loss statement, and it carries whatever uncertainty sits in the value assumption rather than contaminating the underlying count.

Partial Value and Forgone Value. Realized value is binary by construction, so a patient who filled once and discontinued at six weeks contributes nothing to it, on the grounds that she did not receive the product the trial tested. She did contribute revenue, which means realized value sits below what the cohort actually generated. That difference is Partial Value, meaning revenue collected from prescriptions that filled and then stopped short of the duration the label claims. Forgone Value is the revenue never collected because the prescription was rejected, abandoned or never started. Under the simplifying assumption that milestone achievers each generate the modelled full-horizon amount, cohort revenue equals realized value plus Partial Value, and Customer Value at Risk equals Partial Value plus Forgone Value. That identity is the reconciliation a finance team will look for first, and it should be presented with its assumption attached.

In practice, rebates, dose changes, timing and variable treatment duration break the simple version, so finance should build the bridge from actual cohort revenue rather than treating the frame as an identity for reported company net sales. Neither term on its own says whether the shortfall was avoidable. What the split does say is which path is leaking, since two brands can report an identical yield while carrying opposite mixes, and Partial Value is the component whose exposure becomes concrete the moment a payer proposes an outcomes-based agreement.

Data sources by rung. Manufacturers and their partners already hold or buy many of the signals required to build a brand-level view. Access and linkage are not guaranteed, so the first task is to inventory the available signals before promising an end-to-end view, and to show clearly what is observed, what is estimated and what remains unknown.

Cost to acquire and the payback horizon. The payback horizon in the body is a brand-level estimate rather than a reported figure. Cost to acquire should be built as the commercial investment attributable to a period divided by the patients started in that period, and cost to serve as the access, support and pharmacy cost per patient over the same period. The payback horizon is the month in which cumulative net contribution per patient recovers both. It should be stated with the allocation rules attached, because different rules move it by months, and it should never be used in place of the clinical horizon as the point at which a patient counts as realized.

Benchmarking sequence. There is no defensible industry median today, which means benchmarking should begin inside the company. The first useful comparison is a brand against itself over time, with consistent definitions and adjustment for material changes in mix. The second is one brand against another inside the same portfolio, where clinical horizons, populations and access conditions are sufficiently comparable. A common reporting template alone does not make two brands comparable, and external benchmarking becomes meaningful only after those internal disciplines are stable enough to support it.

A twelve-week operating agenda. Twelve weeks can establish a baseline and launch an operating test. It cannot establish twelve-month persistence for newly enrolled patients, so early signals should be reviewed while the organization commits to the longer follow-up that evaluating sustained outcomes requires. An intervention should be funded on its incremental contribution after product, delivery and intervention costs rather than on the whole of Customer Value at Risk.

Appendix B. Methodology, limitations and source notes

The evidence audit used prescriptions written as the fixed base and searched for published measures at four downstream rungs, which were filled, therapy started, held at ninety days and held at twelve months. Figures were not interpolated across populations. Conditional persistence measures were not converted into fixed-base measures. Where a comparable figure did not exist, the cell was left empty. The audit was conducted by four researchers working independently against a common five-stage structure. Its search strings, screening records and researcher outputs are held internally rather than reproduced here, so this note describes the audit without claiming the status of a reproducible systematic review. The two-brand comparison and the hundred-patient illustration are constructed to show the arithmetic and are not drawn from client work.

Definitions behind the evidence table. The three GLP-1 rows are indication subgroups from one study of 9,848 orders in a single Colorado health system between 2018 and 2022, measured as fills within ninety days. They predate the widespread use of newer obesity treatments, so they should not be read as current national GLP-1 performance. Oral oncology values represent approved and filled within ninety days. The RA biologics figure is the complement of 40.6 percent not filled or administered within three months. The PCSK9 figure is a historical access finding from a 45,029-patient study rather than a current category forecast. The lipid-lowering range is the complement of patient-level initial nonadherence of 10 to 18.2 percent across studies in a systematic review. The same review reports a prescription-level range of 1.4 to 43.8 percent, so calling it a single statin fill benchmark would overstate its comparability.

Limitations. Five limitations materially narrow the claims in this report. The category observations come from different years, payer mixes, datasets, geographies, counting units and observation windows, so they should be treated as a collection of category observations rather than as a controlled cross-category benchmark. Some begin with an order while others begin with an attempted pharmacy claim. A prescription that is written and never filled does not automatically represent recoverable commercial loss, because clinical change, screening requirements, patient preference, speculative prescribing and other legitimate reasons can produce the same observed event. Claims capture dispensing rather than ingestion or administration, which makes therapy start the least observable rung in external data, although medical administration claims offer a closer signal for therapies given in a clinical setting. Prescriptions written is itself an imperfect base, since orders never transmitted to a pharmacy and unobserved cash or assistance-program fills remain absent from claims-based datasets. In oncology, death and disease progression can compete with abandonment as explanations for non-fill and discontinuation, which narrows what can be inferred from a missing dispense.

Source verification. Publication metadata and the quantitative claims drawn from each source were checked against publisher records, indexed abstracts and study-institution reporting on 14 October 2026. Two corrections were made in this revision after that check. The GLP-1 figure of 47.5 percent had previously been labelled as diabetes and obesity recorded, and it applies to diabetes only, with 64.6 percent the correct figure where both were recorded. The lipid-lowering range had previously been labelled as statins, and it belongs to the patient-level range of a review that covers lipid-lowering medication more broadly. The oncology publisher full text was not accessible for this review, and its central figures were corroborated through Penn Medicine's own account of the study.

Sarpatwari A, Soto MJ, Ganguli I, et al. "Glucagon-Like Peptide-1 Receptor Agonist Order Fills and Out-of-Pocket Costs by Race, Ethnicity, and Indication." JAMA Health Forum. 2025;6(10):e254258. doi.org/10.1001/jamahealthforum.2025.4258
Doshi JA, Li P, Geng Z, et al. "Insurance and Cost-Related Access Barriers to Specialty Oral Anticancer Medications for Blood Cancers in a Nationwide Sample of Medicare and Commercially Insured Patients." Journal of Clinical Oncology. Published online 30 September 2026. doi.org/10.1200/JCO-26-00247. Corroborated through Penn Medicine, "Insurance barriers limit access to blood cancer drugs," 30 September 2026.
Kan HJ, Dyagilev K, Schulam P, et al. "Factors associated with physicians' prescriptions for rheumatoid arthritis drugs not filled by patients." Arthritis Research and Therapy. 2018;20:79. doi.org/10.1186/s13075-018-1580-5
Navar AM, Taylor B, Mulder H, et al. "Association of Prior Authorization and Out-of-Pocket Costs With Patient Access to PCSK9 Inhibitor Therapy." JAMA Cardiology. 2017;2(11):1217-1225. doi.org/10.1001/jamacardio.2017.3451
Cooke CE, Robertson T. "Initial non-adherence to lipid-lowering medication: a systematic literature review." BMC Primary Care. 2024;25:284. doi.org/10.1186/s12875-024-02524-z
Levy JF, Alexander GC, Vabson B, Ippolito BN. "Formulary-Related Insurance Denials of Single-Source Branded Drugs in the United States." JAMA. Published online 9 July 2026. doi.org/10.1001/jama.2026.8702
Rodriguez PJ, Zhang V, Gratzl S, et al. "Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity." JAMA Network Open. 2025;8(1):e2457349. doi.org/10.1001/jamanetworkopen.2024.57349

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: What is Realization Rate, and how do you calculate it? , Patient support operating models, the router nobody built , What is value leakage in pharma? and The commercial system is a link in the therapeutic value chain

Patient Support Program Consulting for Pharma

Tue, 13 Oct 2026 16:00:00 GMT

Most manufacturers fund patient support generously and cannot say what it returns. The programmes work, the people in them are capable, and nobody can produce a number that connects the spend to the therapy a patient actually started. The Customer Excellence AGENCY rebuilds patient support as an operating model with a measure attached to it.

The problem is rarely the programmes and almost always the seams between them

A typical flagship brand publishes between three and seven separate affordability and support routes, rising to nine once the government programmes it refers patients to are counted. Each one of them is well built and does the job it was designed to do. A copay card absorbs cost at the counter, a hub opens benefits investigations, an assistance programme covers the uninsured, a nurse educator answers the phone, a foundation relationship catches the people the others miss. Every component has an owner who can defend it.

What almost never has an owner is the compound. In October 2026 I audited the published patient support pages of eight flagship brands from eight different manufacturers, across immunology, oncology, cardiometabolic disease and obesity, and counted the routes a patient can take. Every brand in the set published several routes, and not one published a tool that resolves which route is hers. In every case that function exists, it is staffed, and it runs as a telephone number.

That matters commercially rather than only experientially. A call centre is sized to call volume rather than to prescription volume, so its capacity is set by how many people ring rather than by how many people were prescribed. It runs during business hours, which are the hours a working patient is also at work. It produces almost no structured data, because what a case manager resolves in four minutes tends to be recorded as an enrollment in whichever programme the call ended in. The patient who read five sets of eligibility conditions, could not determine which applied to her, and closed the tab appears in no programme's denominator and no call log. She appears later as an abandoned prescription with no attributable cause, where the loss is almost always read as a price problem.

What a patient support operating model review establishes

The engagement begins by moving the denominator. Most patient support reporting counts enrollments, which measures the people who found their way in. A Realization Rate anchored at the prescription counts everybody the commercial system earned, including the patients no programme ever saw, which is exactly the population the current numbers are structurally unable to observe.

From there the work is diagnostic and it runs against data a company already holds. Rejection rates arrive as claims data. Abandonment at the counter is visible through hub and specialty pharmacy partners. Refill behaviour sits in dispensing data most brands already buy. The one stage nobody can see from the outside is the patient who collected a prescription and never started therapy. That population is reachable through the support programme and the field organization, both of which are in contact with people the claims cannot observe. A brand that measured even three of those four stages would know more about its own realized value than the published literature can tell anyone.

The review then tests the experience itself against a published standard rather than against opinion. The Consumer-Grade specification is a closed set of six conditions, and in the audits I have run, four of them commonly fail on assets a company owns outright with no payer, pharmacy or prescriber in the way.

Recognition fails when the system does not know who she is even while she is signed in elsewhere on the same property.
Coherence fails when the routes are presented as a list rather than as a path, and several of them lead to different domains.
Effort fails when the sorting work has been transferred to the person with the least information and the most at stake.
Resolution fails when nothing on the page closes the question and the only thing that does is a call she has to initiate.

None of those four is expensive to fix relative to what they cost. All four are invisible to a programme level scorecard, which is why they persist inside organizations that are investing seriously in patient support.

How the engagement runs, and what you hold at the end of it

Patient support sits inside the three commercial priorities this practice works across, and the engagement draws on all three. The diagnostic belongs to brand performance , because the loss it finds shows up in a brand's realized revenue rather than in a service metric. The intervention work belongs to field performance , because the frontline encounters these barriers long before any dashboard records them. The durability belongs to the customer excellence enterprise , which is where a capability stops being a project and becomes a way the organization works.

The work follows three phases, each of which leaves something behind. Reframe is a data driven diagnostic run against existing commercial data, establishing where value is leaking between the prescription and sustained therapy and sizing the Customer Value at Risk in the brands that matter most. Mobilize is the first direct engagement with the organization, combining a baseline field survey with acute interventions on the barriers that are costing the most now. Operationalize converts that baseline into continuous signal collection and embeds barrier workflows into permanent ways of working, so the capability survives the engagement rather than leaving with it.

What a client holds afterward is a measured Realization Rate for the brands in scope and a stage by stage account of where the loss occurs and who owns each stage. Alongside those sit a routing design for the patient who cannot currently tell which door is hers, and an operating model in which post-script value has a name attached to it above brand level. None of that is a report, since a report stops producing the day it is delivered. It is a set of measures and workflows that sit inside the commercial system and keep producing after the work ends.

Who does the work

The Customer Excellence AGENCY is led by Wayne Simmons, who led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse, and designed the customer experience delivery system for a major manufacturer's direct to patient platform. He is the author of The Customer Excellence Enterprise (Wiley, 2024) and founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. Earlier in his career he inherited a well resourced customer experience programme anchored in survey scores, judged it commercially inert, and dismantled it in order to rebuild the discipline around value realization and progression measurement. That decision is the origin of this practice and the reason its measures look the way they do.

Engagements are run player coach rather than deck and leave. The published research behind this page, including the eight manufacturer audit and the Realization Rate measurement work, is open and can be checked before you ever speak to anyone.

Where to start

The first conversation is diagnostic and costs nothing. Useful preparation is a single question you can answer internally beforehand. For the brand that matters most to your business this year, how many of the prescriptions written for it last quarter reached a patient, and who in the organization is accountable for the gap between those two numbers. If the answer involves three functions and no name, the problem described on this page is already operating inside your company and is currently being recorded as an access problem.

Patient Support Operating Models: The Router Nobody Built

Sat, 10 Oct 2026 22:55:00 GMT

Eight pharmaceutical manufacturers have each built a set of affordability programmes for a flagship medicine. Not one of them has built the thing that tells a patient which programme is hers. That function does exist in every case, and in every case it is a telephone number.

Eight manufacturers have built the routes and none has built the router

I spent part of this week doing something a brand team could do in an afternoon and almost nobody does. I opened the patient support pages for eight flagship branded medicines, each from a different manufacturer, across immunology, oncology, cardiometabolic disease and obesity, and I counted the doors.

A door is a distinct route a patient can take to afford her medicine. A copay card is one. A bridge programme that covers her while a prior authorization is contested is another. A patient assistance programme for the uninsured is a third, an independent foundation a fourth, a cash pay price a fifth. Each has its own name, its own enrollment path and its own eligibility condition, and the conditions are frequently mutually exclusive.

Every brand in the set published several. The range ran from three to seven routes built by the manufacturer, rising to as many as nine once the government programmes the page refers her to are counted. The counting rule matters and I will come back to it, because a stricter definition lowers the numbers considerably. What a stricter definition does not touch is the finding underneath them.

The audit covered eight brands and found the same shape in each

Five of the eight offer an insurance type selector, which asks a patient to declare whether she is commercially insured, on Medicare, on Medicaid or uninsured, and then shows her a filtered list. That sorts the doors. It does not open one. One manufacturer runs a genuine eligibility engine, and it sits two domains from the brand page, tests a single programme, and returns a refusal to a commercially insured patient without routing her anywhere else.

Discoverability is not the problem, which closes off the easy explanation. Every list sat one click from the brand's main patient page, two at most. The patient can find the doors without difficulty. What she cannot find out is which one she is standing in front of.

A list of conditions is not the same as an answer

Consider what the page actually asks of her. One brand's copay card requires commercial insurance, including exchange, federal employee and state employee plans, plus residence in one of the fifty states or four named territories and a prescription for an approved indication. It then excludes anything paid in whole or in part by Medicaid, Medicare, the VA, the Department of Defense, TRICARE or any state pharmaceutical assistance programme. The same manufacturer's assistance programme applies instead if she has no insurance, or has Medicare Part D, or is having difficulty paying, and is assessed case by case against a household income threshold the page does not publish.

Those two paragraphs are both accurate, both necessary and both written by lawyers who were right to write them that way. Read by a person who has just been prescribed something and does not know what an exchange plan is, they are a quiz with no answer key. She is being asked to perform an eligibility determination on herself, using categories drawn from benefit design, in order to receive help she has already been told she may qualify for.

In the commercial organizations I have worked inside, this is not experienced as a design failure, because no single person ever sees it. The copay card team owns a card that works. The assistance programme team owns a programme that works. The foundation relationship is managed by someone else again. Each component is well built and the compound is nobody's.

The routing function exists and it runs on a telephone

Here is the part that turns a website observation into an operating model observation. Every brand in the set closes with a phone number, and in at least two cases the page says in plain words what that number is for. Programme eligibility is assessed by speaking to a case manager. One oncology page lists a single number for checking whether insurance covers the medicine, learning about copay options, finding out about free medicine, and speaking to a representative, all four.

So the routing function is not missing from the operating model. It has been built, it is staffed, and it works. It simply runs as a call centre rather than as a system, which tends to have three consequences a brand team can feel in its numbers without ever tracing them back here.

It is sized to call volume rather than to prescription volume, so its capacity is set by how many people ring rather than by how many people were prescribed. It operates during business hours, which are the hours a working patient is also at work. It also produces almost no structured data, because what a case manager resolves in four minutes of conversation tends to be recorded, at best, as an enrollment in whichever programme the call ended in.

The patient who cannot tell which door is hers appears in no denominator

That last consequence is the commercially expensive one and it deserves to be stated carefully. A manufacturer can see, with precision, how many patients enrolled in each programme. What it cannot see is the patient who opened the page, read five sets of conditions, could not determine which applied to her, and closed the tab.

She enrolled in nothing, so she appears in no programme's denominator. She called nobody, so she appears in no call log. She does appear, eventually, as an abandoned prescription with no attributable cause, which is the category where this loss currently sits and where it is invariably read as a price problem.

Price is sometimes the honest answer. Often it may not be, because the patient in question was eligible for assistance that would have resolved the price entirely. What stopped her may not have been cost at all.

It was an orientation barrier wearing a cost barrier's clothes, and the two have completely different owners and completely different fixes. One of them is a pricing decision taken at executive level. The other is a routing problem on a page the company already controls.

Four of the six Consumer-Grade conditions fail on a page the company controls

The Consumer-Grade standard is a closed set of six conditions, and this page appears to fail four of them. That is unusual for an asset a company owns outright, with no payer, pharmacy or prescriber standing in the way.

Recognition fails, because the system does not know who she is even when she is signed in elsewhere on the same property. Coherence fails, because the routes are presented as a list rather than as a path, and several of them lead to different domains. Effort fails, because the sorting work has been transferred to the person with the least information and the most at stake. Resolution fails, because nothing on the page closes the question, and the only thing that does close it is a telephone call she has to initiate.

Anticipation and Visibility survive. The company has anticipated that she will need help paying, which is why all these programmes exist, and it is visible to her that they do. The failure is specific and it sits between knowing she will need help and knowing which help is hers.

What a brand team can count on its own site tomorrow morning

The useful thing about this finding is that verifying it requires no data, no vendor and no budget. It takes one person, one browser and about forty minutes.

Count the distinct affordability routes a patient can reach from the brand's main patient page. Count how many separate domains she can be sent across while doing it. Then try to determine, as her, which route applies, using only what the pages say. Finally, find the mechanism that answers that question for her, and look at whether it is a system or a staffed line.

If the answer is a staffed line, that is not a failure of the people on it. In my experience those teams are among the most capable in any commercial organization and they resolve what reaches them. The question is what fraction of the people who needed them ever rang, and nothing in the current patient support operating model can answer it.

The measure that would is the one this practice is built on. A Realization Rate anchored at the prescription rather than at the enrollment counts everybody who was prescribed, including the patient who never entered any programme, which is exactly the population the programme level numbers are structurally unable to see. The orientation gap is a Path to Fulfill problem and it is measurable the moment the denominator moves.

Methodology, what I could not establish, and the objection I would make

The audit was conducted on 10 October 2026 by opening each manufacturer's own patient support pages and recording the exact wording of every programme name and eligibility condition. Brand sites are rebuilt frequently and offer terms reset annually, so every figure is a point in time observation. Three of the eight brands were then re-verified independently against the live pages before publication, and the orientation finding held in all three, with two of the three stating on the page that eligibility is determined by telephone.

The counting rule is the weakest part and it has to travel with the numbers. I counted a route as distinct where the manufacturer presents it as a separate thing a patient does, with its own name, enrollment path or eligibility condition. Collapse that to money moving mechanisms only and the counts fall to roughly three to five per brand.

The orientation finding is unaffected by that collapse, which is why it leads here and the counts support rather than the reverse. Government programmes a manufacturer merely refers a patient to are reported separately and are not credited to the manufacturer, since it did not build them, though from the patient's chair they are doors on the same page.

Two sites could not be reached during the audit, which makes one brand's count an undercount rather than an estimate. No company in this set was selected for being worse than its peers, and the set deliberately excludes manufacturers where I have a prior working relationship.

The strongest objection a reader can make is that auditing a public website measures the brochure rather than the system. In oncology particularly, the practice's financial navigator absorbs most of this work, and a patient in that setting may never face the page at all.

The objection is correct as far as it goes. It may also describe the finding rather than refute it. A function discharged by a person the manufacturer does not employ, does not train, does not fund and cannot observe is a reasonable definition of a seam that nobody owns. The navigator is doing the routing, and in my experience doing it well. She is also doing it instead of the operating model, and the manufacturer learns nothing from any of it.

What I cannot tell you is how large the loss is. That would need the denominator this piece argues does not currently exist, which is an uncomfortable place to end and an honest one.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Pharma CX, why it stalls and what replaces it , Pharma's Realization Blind Spot and How to choose a pharma CX partner

How to Choose a Pharma CX Partner

Sat, 10 Oct 2026 18:00:00 GMT

A pharma CX agency is a firm engaged to design and govern how physicians, patients and the people around them move through a company's commercial system. The difficulty in hiring one is that at least three unrelated kinds of business answer to that description. A commercial leader can often see that earned value is disappearing somewhere between a prescribing decision and a patient on therapy. What that leader cannot see is which category of firm is built to work there.

Institutions tend to name a problem only after they have learned to govern it, and this one has no settled name yet. So a search returns strategy houses, research shops and creative agencies side by side, all of them speaking the same vocabulary. This page tries to make the choice legible, including the places where my own firm is the wrong answer. Read it as a buyer's guide written by one of the options, with the bias stated rather than hidden.

The buyer's real problem comes one step earlier

Most hiring conversations start too late. A leader arrives having already decided to buy help, then compares firms that are not comparable. The prior question is which part of the commercial system is failing. That determines the category of help, and the category matters more than the vendor.

The failure itself tends to look the same in every company. Earned value, meaning the value a brand has already won through evidence, access and a clinical decision, does not fully survive the trip to a patient on therapy. Scripts are written and some are never filled. Therapy starts and some of it stops early.

No competitor takes that difference, which is what separates value leakage from lost share. The term means contract slippage in general business, so the pharma sense needs stating. The loss here is largely experiential rather than clinical or promotional. That matters for hiring, because experiential failure sits between functions, and the firms selling into pharma are mostly organised to work inside one.

Three kinds of firm answer to the same words

Describe the three fairly and the choice gets easier. Each is genuinely good at something, each has a real limit, and a buyer who recognises a caricature of their current partner will stop reading. Nothing below is a judgment about anyone's competence.

The large strategy and analytics firms

These firms own the quantitative machinery of a commercial organization, and they own it properly. Data infrastructure, segmentation, targeting, incentive design, forecasting and the analytics sitting under a launch are their native ground. They are built to answer large questions at scale and with method.

Where they tend to stop is the handoff from recommendation to installed capability. The output is usually an answer rather than an operating model, and the work often concludes before the operating model has changed. Nothing about that is a flaw in the craft. The commercial arrangement pays for analysis rather than for the slow business of changing how functions hand work to each other.

The research and benchmarking firms

These firms measure how customers experience an industry and compare one company against its peers. The instruments are serious and the panels are expensive to build. For a leader who needs to know whether a problem is theirs or everybody's, this may be the right purchase.

Where they stop is the distance between a rank and a diagnosis. A benchmark tells you where you sit against a peer set, which is useful, and it is not the same as knowing which of your own journeys breaks, at which stage, or who owns the break. I have sat in rooms where a benchmark result was presented with real rigour and nobody present could name the next action. The measurement was sound and the accountability was entirely missing.

The brand and creative agencies

Narrative, identity, campaign and the design of what a customer actually sees are craft disciplines, and the good agencies are very good at them. They can change how a brand is understood in a market, which is not a small thing to be able to do.

Where they stop is a matter of geography rather than skill. Almost everything determining whether a prescription becomes therapy happens in places a campaign does not reach. Benefit verification, prior authorization, affordability support, pharmacy coordination and the first ninety days of a patient's own life are the territory of the Path to Fulfill and the Path to Adhere. A creative brief has no instrument that operates there.

Why is none of the three built for this?

The honest conclusion is that none of the three is wrong, and most companies need some of all of them. The analytics firms answer questions pharma cannot answer alone. The benchmarking firms supply comparability. The agencies build the brand that earns the clinical decision in the first place.

What none of them is engaged to do is govern whether earned value survives the journey. That problem sits across medical affairs, marketing, field, market access, patient services and the hub, and ownership of it is often distributed to the point of absence. A firm hired by one function will work inside that function's authority, which is exactly as far as the problem's edge.

There is a second reason the category stayed unnamed. Pharma tried importing consumer customer experience a decade ago and largely rejected it, because the first iterations genuinely did not fit the industry, and that rejection was rational. The wrong lesson drawn from it was that consumer CX does not translate to pharma and that experience is therefore a soft agenda, when the real conclusion was that pharma needed its own interpretation.

Internal confidence makes this harder to see than it should be. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs, against 82 percent of life sciences executives who say they are satisfied with those same strategies, in work published by Deloitte . A gap that wide suggests the inside is measuring something other than what customers experience.

The questions to ask any firm you consider

The most useful preparation is to write seven questions and ask every firm the same seven, because the answers separate categories faster than any capability deck. What follows is roughly what a strong answer sounds like, and what a weak one sounds like.

Start with what will be measured. A strong answer names progression, meaning movement along a stage ladder from scripts written to filled, therapy started, ninety days and persistence. A weak answer names sentiment, satisfaction or a relationship score, which reports how customers feel rather than whether they moved forward.

Ask who owns the handoffs between functions once the engagement ends. A strong answer names roles, decision rights and an escalation path that still exists after the invoices stop. A weak answer describes a steering committee, which is a forum rather than an owner.

Ask what happens to the capability when the team leaves. A strong answer describes instrumentation, a cadence and people inside the company now running something they did not run before. A weak answer offers a playbook, and a playbook with no owner is simply a document.

Ask to be shown where value is lost on a specific brand, by stage, with a number attached. A strong answer is uncomfortable, specific and willing to be wrong in front of you. A weak answer retreats to industry averages, which cannot be acted on by anybody.

Ask how the work differs from what a benchmark would tell you. A strong answer is candid that a benchmark may be the cheaper and better purchase for the question you actually have. A weak answer tries to be both a benchmark and a transformation, and rarely manages either.

Ask which of the three paths the work will touch, and why that one. Prescribe, fulfill and adhere have different owners, failure modes and economics, so a firm treating them as one journey has not worked inside them. A strong answer picks one and defends the choice.

Last, ask what the firm would refuse to take on. A strong answer comes quickly, because a practice with a real method knows its own edges. A firm that can do everything has usually codified nothing.

When should you not hire anyone at all?

Three situations make an external engagement a poor use of money, and they are more common than this market tends to admit. Saying so costs me work occasionally, which seems a reasonable price for being useful here.

The first is the absence of a named owner. If no single executive is accountable for what happens between a prescribing decision and a patient on sustained therapy, an external firm will produce a report nobody has the authority to act on. The governance question comes before the vendor question, and who owns customer experience in pharma is rarely as settled as an organization chart suggests. Fix the ownership first, even when that takes a quarter.

The second is a decision already taken. If leadership wants a number to justify a direction it has chosen, that is a research purchase and should be bought as one, from a firm that sells research. Buying transformation to validate a conclusion wastes the budget. More expensively, it burns the organization's appetite for the real work later.

The third is a constraint sitting somewhere else entirely. If a brand's actual problem is clinical differentiation, formulary exclusion, supply or a label, experience work is not the lever and no amount of journey design will become one. Experience governs whether earned value survives, and it cannot earn value a brand has not yet won.

Where The Customer Excellence AGENCY fits

My own firm is a commercial systems architecture practice for pharma and life sciences. The work is the distance between a prescribing decision and a patient on sustained therapy. That stretch of the therapeutic value chain is what the industry files under commercialization, and it has never been held to a standard of its own. Customer Excellence is the capability that governs it, and the fourth of the four domains of commercial excellence beside launch, marketing and sales.

Three service lines carry the work. Accelerate Brand Growth begins with stalled growth as the symptom and traces where value is leaking, by stage, with numbers attached. Strengthen Field Performance treats the frontline as an intelligence system rather than only a channel, because field observation reaches a broken journey long before a dashboard detects it. Scale Customer Excellence makes the capability an enterprise one, with instrumentation and governance that outlast a programme.

What it is not

The firm is a boutique rather than a scaled analytics practice. There is no benchmark panel here and no syndicated data, so a company needing comparability against a peer set should buy that from a firm owning a panel. This is not a creative agency and it does not produce campaigns. A company whose real need is any of those three should buy those three, and I will say so early.

What should any engagement be measured against?

What distinguishes this work is the measure it is willing to accept. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value. A commercial system that cannot tell the difference will keep reporting success at the moment its real work begins.

So any engagement should be judged on the Realization Rate of a pharmaceutical brand , meaning realized value divided by earned value, rather than on a satisfaction score. The measure matters more than the method, and it certainly matters more than the firm.

If the commercial system is a link in the therapeutic value chain, then a commercial failure is a therapeutic failure. A molecule that works and does not reach a patient has the same clinical outcome as a molecule that does not work. The difference lies only in where the failure gets recorded.

Key Takeaways

Three unrelated kinds of firm answer to the same search words, and the category of help matters more than the choice of vendor.
Strategy and analytics firms deliver recommendations at scale, and the engagement often ends before the operating model changes.
Benchmarking firms tell a company where it ranks, which is not the same as knowing which journey breaks or who owns the break.
Creative agencies shape what a customer sees, and almost everything determining whether a prescription becomes therapy happens where a campaign cannot reach.
An external firm is the wrong purchase when nobody owns the problem, when a decision has already been taken, or when the real constraint is clinical or supply.
Any engagement should be measured on the share of earned value that becomes sustained therapy rather than on how customers say they feel.

Diagnostic Questions to Consider

Name the single executive accountable for what happens between a prescribing decision and a patient on sustained therapy.
State whether the firms you are considering will measure sentiment or progression, and what each has proposed as evidence.
Describe what will remain inside the organization once the engagement ends, in terms of instrumentation, cadence and named owners.
Identify which of the three paths carries your largest loss today, and the number you can attach to it.
Decide whether the question you actually have is a benchmark question, a research question or a governance question.

Closing Reflection

Buying advice is mostly an exercise in matching a problem to a category, and the category here has no agreed label. That leaves commercial leaders doing vendor diligence on a question they have not yet framed. The framing is the work, and it is cheaper than the first engagement.

I have come to think the most useful service anyone in this market can offer is a clear account of what they are wrong for. A firm that cannot say that has either not met its own limits or has decided not to mention them. Either way, the buyer ends up discovering those limits on their own budget.

The science in this industry is frequently extraordinary and the experience surrounding it is frequently ordinary. Closing that gap requires no discovery, which is what makes it the most solvable problem in pharma and the most neglected. It asks only that someone be accountable for the whole distance between a decision and a patient who is actually better.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

The Customer Excellence Glossary for Pharma

Sat, 10 Oct 2026 17:30:00 GMT

Every discipline arrives with a vocabulary, and the vocabulary usually arrives before the discipline has settled. This glossary collects the terms I use to describe how pharmaceutical commercial systems create value and where they lose it. These are not industry-standard definitions. They are the working vocabulary of one practice, set out in The Customer Excellence Enterprise and sharpened since in client work.

Several of the terms below deliberately disagree with how the same words are used elsewhere. Realization Rate means something quite specific to an accountant. Value leakage means something quite specific to a procurement lead. I have kept both words anyway. The pharmaceutical meaning is the one that describes what actually happens between a prescribing decision and a patient on sustained therapy, and a borrowed word with a declared quarrel is more useful than a new word nobody recognises.

A glossary that presents itself as neutral reference is usually making an argument while pretending not to. I would rather declare the argument. What follows is a vocabulary with an author, a point of view and a set of positions that can be checked and contested.

The architecture

Consumer-Grade Pharma

Consumer-Grade Pharma is the standard a pharmaceutical commercial system is held to when patients and prescribers judge it against the best interaction they had anywhere, rather than against another pharmaceutical company. It is the category and the movement that sit at the top of this architecture. The Consumer-Grade Specification behind it is a closed set of six conditions: Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Thresholds are set per organization rather than handed down.

Consumer-Grade is hyphenated and capitalised because it names a specification and not a mood. Felt attributes such as easy, simple, fast and transparent are reported outcomes that decompose into those six conditions, which is what makes them designable. Pharmaceutical companies are patient-centric by nature, so the change they face is entering the consumer arena where people have choice. The longer account of Consumer-Grade Pharma as a commercial standard works through the conditions one at a time.

Customer Excellence

Customer Excellence is the enterprise capability that designs, delivers and scales coherent experiences across the three paths a customer travels, and that governs whether clinical intent becomes realized therapy. It is the fourth domain of commercial excellence, alongside launch excellence, marketing excellence and sales excellence. It is a pharma-specific interpretation of customer experience rather than an import from another industry. Imported customer experience was rejected in pharma because the first iterations did not fit, so the rejection was rational and the wrong lesson was drawn from it.

Customer Excellence is most often confused with a programme, a department or a training initiative, and it can survive as none of those. It becomes durable only as an enterprise capability living in leadership, organizational, operational and commercial DNA. The case for Customer Excellence as pharma's fourth pillar sets out what that requires of an operating model.

The therapeutic value chain

The therapeutic value chain starts with the science and ends with patient therapy, and the clinical decision is its pivot point. That decision depends on the commercial model, which makes the commercial system part of the chain rather than a layer bolted on after it. The job of the commercial system is to put the state of the art in front of the decision before it is made, then see the decision through.

The consequence is the load bearing part. A molecule that works and does not reach a patient has the same clinical outcome as a molecule that does not work, so a commercial failure is a therapeutic failure. That is the argument I reach for before the arithmetic, and the commercial system's place in the therapeutic value chain develops it properly.

Commercial excellence

Commercial excellence is the discipline of making a pharmaceutical commercial system perform as well as the science it carries. It has been built as three named domains, launch excellence, marketing excellence and sales excellence. Each of the three optimizes the creation of clinical intent. None of them owns whether that intent survives.

Outside pharma the phrase often shrinks to sales effectiveness and pricing discipline, which is a narrower thing than what is meant here. Used properly it names the whole apparatus that carries a medicine from approval to a patient who stays on it, and read that way the gap becomes structural rather than optional. The account of the four domains of pharma commercial excellence explains why the fourth is the one nobody built.

Experience as the third leg

Experience is the third leg of a pharmaceutical value proposition, alongside product and brand, and it is the lived experience of obtaining a medicine and staying on it. Pharma industrialized product and brand with real rigour. Experience was left to default while the other two were designed, which is the enemy in all of this. The three legs do not add together, they multiply.

In the Enterprise Value Realization model, realized value is brand multiplied by product multiplied by experience, raised to the power of culture, and discounted by one minus Customer Value at Risk. Brand, product and experience describe design capability. Customer Value at Risk describes operating performance in a period, and those two roles stay distinct. The treatment of experience as the third leg of the pharma value proposition works through why multiplication rather than addition is the right form.

The measures

Realization Rate in pharma

The Realization Rate of a pharmaceutical brand is Realized Value divided by Earned Value, meaning the share of the value earned at a prescribing decision that becomes sustained therapy. Earned Value is Earned Scripts multiplied by the value of a sustained patient. Realized Value is Sustained Patients multiplied by that same value. Progression is measured on a stage ladder of Scripts Written, Filled, Therapy Started, 90-Day and Persistence.

The same number can also be stated as a patient ratio, because the value term sits on both sides of the division and cancels. Sustained Patients divided by Earned Scripts returns the identical figure. Multiplying that ratio back by Earned Value returns Realized Value in money, which is the form a finance conversation usually wants. Keeping both forms in view matters because the money form holds a budget line and the patient form is the one an operating team can act on.

Realized Value is deliberately binary, and that choice has a consequence worth stating. A patient who filled once and stopped at six weeks contributes nothing to Realized Value, on the grounds that she did not receive the product the trial tested. She did contribute revenue, which means Realized Value sits below reported net sales rather than equalling it. That difference is Partial Value , and a brand that cannot name it will lose the measure in the first finance review.

Accountants and lawyers use realization rate to mean billed hours against billable hours, and a reader who arrives from that sense has landed in a different field. There the ratio describes how much of recorded time turns into invoiced revenue. Here the numerator is therapy and the denominator is clinical intent, and the thing being measured is whether science reached a human being. The page on the Realization Rate of a pharmaceutical brand keeps that distinction in front of the reader throughout.

Partial Value and Forgone Value

Partial Value is the revenue a brand collects from prescriptions that filled and then stopped short of the duration the label claims. Forgone Value is the revenue it never collected at all, because the prescription was rejected, abandoned at the counter or never started. Together they account for the entire distance between Earned Value and Realized Value, which is what gives Customer Value at Risk an internal structure instead of leaving it as the Realization Rate restated in money.

The two behave very differently and most reporting collapses them. Forgone Value is money that never arrived, so it reads as a shortfall and tends to be pursued through access, affordability and fulfillment work. Partial Value is money that did arrive without the outcome the label describes, which makes it the most exposed revenue in the portfolio rather than a credit against the loss. A company holding a lot of it is carrying a position that becomes awkward the moment a payer proposes an outcomes based agreement.

The practical use of the split is allocation rather than accounting. Two brands can report the same Realization Rate and carry opposite mixes, and the mix names the path. A brand heavy in Forgone Value is losing on the Path to Fulfill . A brand heavy in Partial Value is losing on the Path to Adhere . The rate says a brand is leaking and the mix says where to put the money.

Value leakage in pharma

Value leakage in pharma is the therapeutic and commercial value earned when a clinician decides to prescribe and then lost before the patient starts, continues and benefits from therapy. It is the distance between Earned Value and Realized Value. No competitor takes the difference. The system between a decision and a dose takes it, quietly, without anyone deciding that it should.

In general business, value leakage usually means contract slippage, the margin that drains out of a signed agreement through unbilled work, unclaimed entitlements and unenforced terms. Pharma has its own adjacent term, revenue leakage, which describes money lost in pricing, rebates and gross to net. Neither of those is what is meant here, and the difference matters because both of them can be fixed in a contract while this one can only be fixed in a journey. The full account of value leakage between a prescribing decision and sustained therapy traces where it occurs.

Customer Value at Risk

Customer Value at Risk is Earned Value multiplied by one minus the Realization Rate, which expresses value leakage as a forecastable figure. It is the commercial exposure created by friction, fragmentation and failed handoffs inside a commercial system. It requires no translation in a finance conversation. A loss stated in that form can hold a budget line, which a loss stated as a journey map rarely can.

Read as arithmetic alone it would only restate the rate, and the thing that saves it from that is the decomposition underneath. Customer Value at Risk is Partial Value plus Forgone Value, two components with different owners, different remedies and different kinds of risk attached. The rate reports a period. The exposure states what the next period carries if nothing in the commercial system changes, which is the property that lets it be planned against rather than merely reported.

A reader meeting this measure for the first time often assumes it is a shortfall multiplied by net revenue per patient. It is not, and that version produces a smaller and less useful figure, because it describes one period rather than the exposure the system is carrying. Customer Value at Risk shares its page with the arithmetic of pharmaceutical value leakage , because the two are the same observation expressed in different registers.

The measure did not begin in pharma. It was introduced in 2023 by Tom DeWitt and Wayne Simmons, writing for Michigan State University's Broad College of Business . They proposed it as a risk based complement to the accounting based earned growth rate, which Fred Reichheld had offered as the counterpart to Net Promoter Score. The argument there was that measuring customer experience only by the revenue it captures on the upside leaves out the revenue it protects on the downside. Boards tend to respond to the second more readily than the first, because losses loom larger than equivalent gains.

In that original form the calculation ran from the probability of customer churn, which suits a business whose customers are already its own. The pharmaceutical formulation replaces churn probability with the Realization Rate, for a reason worth stating plainly. Value in pharma is more often earned at a clinical decision and lost before therapy begins than lost from a patient who was already retained. A churn based measure cannot see a patient who never started, and that patient is where most of the exposure sits.

The three paths

Path to Prescribe

The Path to Prescribe is the first of three journeys where pharmaceutical value is won or lost, running from an undiagnosed patient to a clinical decision. Ownership sits with medical affairs, the field force and marketing, with the brand team named as owner across all three paths. It is the one path pharma has genuinely industrialized, and it deserves respect as such.

The instruments a brand team actually holds sit almost entirely here: prescribing data, market research, message testing, share tracking and promotional response. That is why end to end brand ownership can be real on an organization chart and thin in practice, since the measurement stops where the decision is made. The page on the Path to Prescribe examines what that instrument set can and cannot see.

Path to Fulfill

The Path to Fulfill is the second of three journeys where pharmaceutical value is won or lost, running from a clinical decision to the medicine in a patient's hand. It passes through benefit verification, prior authorization, affordability, specialty pharmacy coordination, onboarding and first fill. Each step is administered by a different party with different incentives and a different definition of done. Almost none of the friction a patient meets here is legally required.

Dropout on this path is commonly read as a payer problem, which is comfortable and largely wrong. The friction is experiential rather than clinical or promotional, and that matters because what was designed can be redesigned. The page on the Path to Fulfill walks the handoffs in the order a patient meets them.

Path to Adhere

The Path to Adhere is the third of three journeys where pharmaceutical value is won or lost, running from a first fill to the duration the clinical trial actually demonstrated. An efficacy claim is a claim about a duration. A patient who stops early did not receive the product that was tested. Some attrition reflects sound clinical judgment or informed patient choice, and that deserves respect rather than intervention.

The distinction worth holding is between attrition that someone chose and attrition that the system absorbed. The second kind is unresolved responsibility wearing the costume of a clinical outcome. The page on the Path to Adhere separates the two and explains how to tell them apart in practice.

The disciplines

Customer consciousness

Customer consciousness is the degree to which customer reality is present in decisions before those decisions are made, rather than sentiment about customers collected after the fact. Raising it is the purpose of Customer Excellence, and the pillars of the practice are the instruments that raise it. In the context of category formation the term also carries an upstream sense. There it means reading a customer's world deeply enough that what their life is making them need becomes visible before any market has formed around it.

Customer consciousness is routinely confused with customer satisfaction, which measures how people felt once the decisions had already been taken. The working test is simpler than any score. Did the decision taken on an ordinary Tuesday have the customer's reality in the room with it. The essay on customer consciousness and the GLP-1 phenomenon shows the upstream sense at work in a category that formed around a need nobody had named.

Predisposition

Predisposition is the condition of an enterprise that is predisposed to deliver exceptional experiences structurally and systematically, rather than through frontline heroics. It describes how a company is built, not any lean a customer holds toward the brand. Heroics work as a subsidy, and a subsidy conceals the design gap it is paying for. Predisposition becomes durable only when Customer Excellence is embedded in leadership, organizational, operational and commercial DNA.

The word is borrowed from marketing, where it usually describes a customer's tilt toward a brand before any purchase, and reversing the direction is the whole point. The question stops being whether customers are predisposed toward the company and becomes whether the company is predisposed toward them. The page on structural predisposition in pharma sets out the four dimensions of DNA it depends on.

Customer intelligence

Customer intelligence is the method by which a commercial system raises its customer consciousness, organized as Context, Orchestration and Progression. Context comes from three listening instruments that compound only in this order: synthetic personas generate the hypothesis, direct voice of the customer tests whether people recognise it, and the frontline confirms whether it is happening. Orchestration is where context becomes continuous progress across channels. Progression is where the work is proved, on the stage ladder.

Taken alone, each instrument produces a defensible artifact and no decision, which is how customer intelligence gets confused with market research. AI accelerates whatever operating system already exists, so an organization that speeds up a quarterly cadence without repairing what it listens to will simply be wrong faster. The hub page on customer intelligence in pharma carries the method and its health measure together.

The instruments

Voice of the frontline

Voice of the frontline is the structured capture of what a company's field force, hub agents, medical information team and patient support staff directly observe. It is the most unimpeachable signal in the commercial system for four reasons that stack. It is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke.

Voice of the frontline is often mistaken for sales feedback, which travels as anecdote and dies in a meeting. The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. Treating that encounter as intelligence rather than as commentary is the move. The page on voice of the frontline in pharma describes how to capture it without turning it into another report.

Synthetic personas

A synthetic persona is a model generated stand in for a customer, built from existing research and public data, used to produce simulated answers to questions that would otherwise be put to a real person. In pharmaceutical use it is a hypothesis generator rather than a source of truth. Its value collapses when it is validated against itself rather than against observed reality. Simulation fidelity differs sharply by audience, being checkable for physicians, unverifiable for patients and lowest of all for payers.

I own a method here and no platform, and the distinction is worth stating plainly rather than leaving to inference. The instrument comes first in the order of context and last in the order of authority, which is an uncomfortable position for anyone selling it as an answer. The page on synthetic personas in pharma research sets out where the method holds and where it fails.

FieldOS

FieldOS is an operating blueprint for field intelligence and activation in pharma, built around a closed loop of six stages. The stages are Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, and Learn and Improve. AI sits at the centre of the loop supporting every stage, never as a stage of its own. Components are tailored per organization, because a blueprint describes a direction rather than a product.

FieldOS is about better listening rather than better pre-call planning, which separates it from field AI built to improve what a representative says in the room. Your field force has a lot to say, and the open question in most commercial organizations is whether anyone is listening. The page on the FieldOS operating blueprint describes the loop and what each stage asks of an operating model.

The Transfer Coefficient

The Transfer Coefficient is the proportion of meaningful frontline intelligence that survives the journey from customer observation to consequential organizational action and measured effect. It is the health measure of a customer intelligence capability. A low Transfer Coefficient indicates a research function rather than an intelligence capability. The loss it measures is structural, rarely a failure of attention by anyone in the chain.

Most commercial organizations have never measured it, which is itself the finding worth sitting with. The coefficient shares its page with the Context, Orchestration and Progression method , because it is the only honest way to know whether that method is working or merely running.

Why naming a loss is what makes it fundable

Organizations govern what they can name. A loss without a name has no owner, no budget line and no place on a scorecard, so it gets absorbed rather than managed. Absorption is quiet by nature. It shows up much later as a flat quarter with no obvious cause and a set of explanations that all sound plausible.

The point here is mechanical rather than linguistic. A named loss can be assigned to someone, measured against a baseline and funded with a number, which is how a commercial organization starts governing something it was previously carrying in silence. Vocabulary is the first instrument of governance, and it tends to arrive before the governance does.

Several of these definitions will be argued with, which is the right response to a vocabulary that claims to describe how value behaves. Precise disagreement is more useful to me than vague agreement, and it is how a practice vocabulary earns the right to become a shared one. The definitions above are offered in that spirit.

About the Author

The Customer Excellence AGENCY: Advancing the Pursuit of Excellence in Service of Science.

Customer Intelligence in Pharma: Context, Orchestration, Progression

Sat, 10 Oct 2026 16:40:00 GMT

Customer intelligence in pharma is the capability that puts customer reality into a commercial decision before the decision is made. Most organizations hold pieces of it and very few hold the whole thing. The pieces are usually a survey program, a field reporting process and, increasingly, an AI modelled audience, each run by a different function against a different question.

Institutions tend to listen in the manner that is easiest to administer rather than in the manner that is hardest to ignore. A survey can be commissioned, scheduled and reported, so it becomes the instrument of record. What customer-facing colleagues observe every week arrives without a template, so it rarely reaches a decision intact.

In pharma that pattern carries a specific cost, because the decisions in question govern whether a patient ever starts therapy. The clinical decision is the pivot point of the therapeutic value chain, and it depends on the commercial model around it. Intelligence is therefore part of that value chain rather than a service alongside it.

Context, Orchestration and Progression name AI's role in a commercial system

I describe AI's role in a commercial system as three things, which are Context, Orchestration and Progression. Context is what the system knows about a customer's actual situation. Orchestration is what the system does with that knowledge across channels and functions. Progression is whether the customer moved, which is the only evidence that the first two worked.

Taken in that order the three become a method rather than a technology agenda. Most commercial AI investment so far has gone into the middle one, because orchestration has products attached to it. Context is harder to buy and Progression is harder to admit, which is roughly why programs can improve visibly and change very little.

Context comes from three different listening instruments

Context is produced by listening, and the clearest evidence that pharma's listening is not working sits in the gap between two scores. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs, against 82 percent of life sciences executives who say they are satisfied with those same strategies . A gap of that size is rarely a measurement error.

Two parties are scoring two different things, and one of them is scoring its own activity. That happens when the instruments in use report what the organization did rather than what the customer met. Three instruments are available, they are genuinely complementary, and each one is precise about something the other two are vague about.

Direct voice of the customer

Direct voice of the customer is what a prescriber, a patient or a caregiver reports when asked. Done well it can be reliable about sentiment, preference and stated intent, and it carries the authority of the customer's own language. A sound approach to voice of the customer in pharma treats those words as evidence of how something felt rather than as evidence of what happened.

Its limits are structural rather than methodological, which means better questionnaires do not remove them. Asking happens on a schedule, so the answer describes a past state by the time anyone reads it. Recall compresses, so the moment a case stalled gets remembered as a general impression. A survey may establish that an authorization process is frustrating while telling you nothing about which step broke on which account.

Voice of the frontline

Voice of the frontline is what customer-facing colleagues observe in the ordinary course of doing their work. My argument for treating it as the superior signal rests on four properties. It is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke. Those four together make it the most unimpeachable and actionable intelligence in the commercial system.

The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. A field colleague often knows which practice has stopped starting patients, and why, several weeks before a prescribing report registers the change. The organization usually holds that knowledge somewhere and offers it no route to travel.

None of that reflects anyone's competence. Field teams report what they have been given a form to report, and those forms were designed to capture activity rather than barriers. Treating voice of the frontline as intelligence rather than as administration is a design decision, which means it can be made.

Synthetic personas

A synthetic persona is a modelled customer, assembled from available evidence and used to rehearse a question at a speed and scale fieldwork cannot reach. Run well it compresses weeks of exploratory work into an afternoon and surfaces hypotheses nobody in the room had thought to test. That is a genuine contribution and a narrow one.

The limit deserves saying plainly rather than in a footnote. A synthetic persona is a hypothesis generator, never a source of truth, and its value collapses the moment it is validated against itself rather than against observed reality. The failure mode is subtle enough to have earned a name, and I have set out the calibration trap argument in full elsewhere rather than restating it here.

The honest framing of synthetic personas in pharma is that they are an instrument inside a method rather than a capability in themselves. The instrument is already commoditising, which is ordinary for tooling of any kind. The method that decides what to ask it and what to do with the answer is the part worth owning.

The three instruments compound only when they run in order

None of the three is sufficient alone, and almost every organization runs one of them. Synthetic personas generate the hypothesis. Direct voice tests whether people recognise it. The frontline confirms whether it is happening.

Run in that sequence the three compound, because each answers a question the one before it could not. A hypothesis no customer recognises gets discarded cheaply. A hypothesis customers recognise and the frontline cannot find is a perception problem rather than an operating one. A hypothesis all three confirm is a barrier with a location, an owner and a cost attached.

Run in isolation each produces a defensible artifact and no decision. The persona study becomes a deck, the survey becomes a tracker, and the field observation becomes a call note. Every one of those can be well made by capable people. None of them on its own tells a commercial leader what to change next week.

Orchestration is where context becomes continuous progress

Context that never reaches an action is a research output with a longer name. Orchestration is the half of the method where what the system knows changes what the system does. Channel coordination makes outbound activity consistent, while journey coordination makes a customer's progress continuous. Context is what the second one requires and the first one does without, which is the distinction most omnichannel programs are never forced to confront.

A company can coordinate every channel on almost no context at all, because consistency is a property of the message rather than of the customer's situation. Continuity is a different achievement, since finishing a case that started elsewhere requires knowing what has already happened to whom. Recognition and memory are context problems that get routinely misdiagnosed as orchestration problems.

This is the point where the three instruments earn their keep operationally. A barrier that direct voice registered as frustration and the frontline located on a named account can be routed to someone with the authority to clear it. Without that context, orchestration can only sequence what it was already planning to send.

Progression is where the method is proved or discarded

Progression measures whether a customer moved, using a stage ladder rather than an activity count. The stages run Scripts Written, Filled, Therapy Started, 90-Day and Persistence, organised under the Path to Prescribe, the Path to Fulfill and the Path to Adhere. An intelligence capability is judged by whether a named stage improved after it reported something.

The health measure of the whole method is the Transfer Coefficient. It is the proportion of meaningful frontline intelligence that survives the journey from customer observation to consequential organizational action and measured effect. Few organizations have calculated it, and those that estimate it tend to find the answer uncomfortable.

A method with a low Transfer Coefficient is a research function, not an intelligence capability. The distinction is practical rather than semantic, since the two cost similar money and return quite different things. Written prescriptions are intent rather than realized value, and the same logic applies upstream to insight. An observation that never reached a decision was intent as well.

Customer consciousness is what the method is for

Customer consciousness is the degree to which customer reality is present in decisions before they are made. It describes a property of decisions rather than a sentiment about customers, which separates it from the warmer vocabulary it often gets grouped with. Raising that degree is the purpose of Customer Excellence, and a working intelligence method is how the raising actually happens.

Customer Consciousness sits as the hub of the flywheel, the state the three service lines produce together. Brand work, field work and enterprise culture work each raise it from a different direction. A listening system is the mechanism underneath all three, because none of them can read a customer's world without one.

Can a quarterly cadence serve a continuous ecosystem?

Pharma's commercial intelligence has historically run on a quarterly or annual cadence, against a healthcare ecosystem that now moves continuously. Access policies change, formularies shift, practice patterns reorganise, and patient expectations get reset by services from outside this industry entirely. A market research cycle that reports in twelve weeks is describing a world that has already changed.

The obvious response is to point AI at the cadence and make the cycle faster. That response deserves a plain answer rather than a hedged one. AI will not make a fragmented commercial model customer-centric. It makes whatever operating system exists faster and more scalable.

The consequence of that is uncomfortable and worth stating directly. AI raises the stakes on the operating model rather than substituting for it. An organization that accelerates a quarterly cadence without repairing what it listens to will simply be wrong faster, with more confidence and better charts behind it.

FieldOS is where the loop gets operationalised

A method needs somewhere to live, and in this practice that place is FieldOS. FieldOS is an operating blueprint for field intelligence and activation, defining the direction an organization aspires to take its field operating model. Components are tailored per organization rather than installed as a fixed product.

The loop runs six stages, which are Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, then Learn and Improve. AI sits at the centre of that loop supporting every stage rather than occupying one of its own. Reading the field impact operating system alongside this page gives the mechanics, where this page gives the method.

The ambition behind all of it is better listening rather than better pre-call planning. Most field AI on offer improves the talking, through next best action, message refinement, call preparation and territory optimisation. Improving the listening is the harder build, and it is largely the one that moves a progression number.

Key Takeaways

Customer intelligence in pharma is the capability that puts customer reality into a commercial decision before that decision is made.
AI's role in the commercial system is Context, Orchestration and Progression, and context is the part almost nobody has built properly.
Three listening instruments produce context, and direct voice, frontline observation and synthetic personas are each precise about a different thing.
Synthetic personas generate the hypothesis, direct voice tests recognition, and the frontline confirms whether it is happening, which only compounds in that order.
The Transfer Coefficient measures how much frontline intelligence survives to consequential action, and a low one marks a research function rather than an intelligence capability.
AI makes whatever operating system exists faster and more scalable, so accelerating a broken listening cadence produces faster error.

Diagnostic Questions to Consider

Name which of the three listening instruments your organization actually runs, and which decisions each one has changed in the past year.
State the elapsed time between a field colleague observing a barrier and someone with authority acting on it.
Estimate your Transfer Coefficient by tracing ten recent frontline observations through to a measured effect.
Identify whether your last synthetic audience exercise was validated against observed reality or against its own prior output.
Report which stage of the progression ladder improved as a result of your most recent customer research investment.

Closing Reflection

The instruments in this method are not equally fashionable, and the least fashionable one is the most valuable. Synthetic audiences attract attention because they are new, visible and demonstrable in a meeting. Frontline listening attracts far less, because it asks for process change rather than procurement, and it produces findings that implicate the operating model.

That ordering of attention is worth resisting. The work I have seen change a progression number has almost never started with a better model of the customer. It has started with a route by which what the field already knew could reach someone able to act on it, quickly enough for the action to still matter.

Exceptional science deserves an exceptional commercial system, and a commercial system is only as conscious as what it listens to. The healthcare ecosystem is now continuous, which makes a quarterly understanding of it a liability rather than a discipline. The organizations that take this seriously will own a method rather than a tool, since tools change hands and methods compound.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

The Commercial System Is a Link in the Therapeutic Value Chain

Sat, 10 Oct 2026 16:20:00 GMT

The therapeutic value chain is the full sequence of work that carries a scientific discovery from a laboratory to a patient who is actually better for it. It runs through discovery, development, trials, regulatory approval and manufacture, and it does not end there, because a medicine that has been made has still not been received. The commercial system occupies the last and least examined stretch of that chain, where a therapy either reaches a person or quietly does not. Institutions rarely map the parts of their work they have not yet learned to govern.

In pharma, the commercial system is part of the therapeutic value chain. Experience is the mechanism by which that value is realized as patient and commercial impact. The rest of this page tries to earn those two sentences rather than assert them.

How the industry draws its own value chain

Draw the chain the way the industry draws it and a clean progression appears. Discovery leads to development, development to trials, trials to regulatory approval, approval to manufacture, and then the line reaches a cliff. Everything past that cliff gets filed under commercialization, as though the scientific work had ended and the selling had begun. That division may be the oldest and most consequential piece of architecture in the business, and it is wrong in one specific way.

The consequence is visible in how each half gets governed. Upstream of approval, claims are tested, methods are documented, and people are trained to doubt their own results. Downstream, the primary instrument of governance is a revenue number. Two halves of one chain are held to standards that have almost nothing in common with each other.

The chain does not actually end at approval, though, and it never did. It starts with the science and it ends with patient therapy. The clinical decision sits at the pivot point between those two ends, and that decision depends on the commercial model more than the industry tends to say out loud.

What the commercial system does in the chain

The commercial system has two jobs inside the chain, and both are easier to state than to do. The first is to put the state of the art in front of the clinical decision before that decision is made. The second is to see the decision through. Neither of those is selling.

Consider what the first job actually requires. A clinician has minutes and the evidence base has thousands of papers, which makes the transfer of scientific knowledge to the point of care a logistics problem as much as a persuasion one. Somebody has to carry what is known to where it will be used, in a form a working physician can act on. Call that selling if you like, though the chain treats it as knowledge transfer.

The second job is less glamorous and largely determines whether the first one mattered. Between a decision and a dose sit benefit verification, prior authorization, affordability support, pharmacy coordination and a first fill that may never happen. Operating that system is the work of the Path to Fulfill , and it is where the chain most often breaks after everyone involved has already agreed. The months that follow belong to the Path to Adhere, where therapy is either continued or quietly abandoned.

The clinical decision as the pivot point

Everything in the chain narrows to one moment and then widens again. Before the clinical decision, the chain concerns what is known, and the question is whether the right knowledge arrives in time to be used. After it, the chain concerns what happens, and the question is whether a decision survives contact with a system nobody designed as a whole.

That pivot depends on the commercial model in ways the industry rarely states plainly. The commercial model determines which clinicians encounter current evidence, how quickly, in what form, and with what support standing behind the decision they then make. Change the commercial model and you change the distribution of clinical decisions, which is a claim about therapy rather than a claim about share.

The same dependency runs backwards after the decision. A clinician who has watched three previous patients fail to obtain a therapy will weigh the fourth decision differently, and reasonably so. Experiential friction in fulfillment therefore feeds back into prescribing, which is one reason the two cannot be managed as separate businesses.

Why a failure there is a therapeutic failure

Here is where the argument turns. If the commercial system is a link in the chain rather than a layer bolted onto its end, then a failure there is a therapeutic failure and not only a revenue one. A molecule that works and does not reach a patient has the same clinical outcome as a molecule that does not work. The difference lies only in where the failure gets recorded.

The industry records one of those failures with great care and the other almost nowhere. A failed trial produces a publication, a post mortem and a change in method. A therapy that never reached the patient who was prescribed it produces a variance to forecast. Same outcome for the patient, two entirely different institutional responses.

This is the reason experience cannot sit where pharma has tended to put it, beside the brochure rather than inside the chain. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value, which is a harder sentence to accept than it first looks.

What does the arithmetic of leakage show?

Numbers make this case better than argument does. Work I published with TheyDo set out an illustrative compounded scenario rather than a benchmark, and its shape matters more than its precision. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled. It falls again after early discontinuation, and settles close to four hundred and fifty million realized after long term adherence erosion.

No competitor takes the difference, which is what makes the pattern value leakage rather than lost share. Read the ladder as a therapeutic measure and it changes character entirely. Every increment of that loss is a patient who was prescribed something and did not receive its benefit. The money is only how the industry happens to be keeping score.

Public evidence supports the shape of it. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. The same study found that 48.4 percent of those rejected prescriptions were never followed by a fill of that drug or anything in its class within ninety days. Cost does similar work further along the path. Of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients, according to IQVIA data reported in Managed Healthcare Executive .

Each of those percentages describes a decision that had already been made. The clinician judged, the patient agreed, and the chain then failed somewhere on the way to a dose. The commercialization label hides all of it, because nothing in it resembles selling.

The attrition that deserves respect

An argument like this can be pushed too far, and it usually is. Some attrition along the chain reflects sound clinical judgment or an informed patient choice, and those decisions deserve respect. A physician who reconsiders, or a patient who weighs a therapy against her own life and declines it, has not been failed by anybody. The chain worked in those cases, even though the script never became a sustained therapy.

The work is to separate those cases from the other kind. The other kind is where somebody could not move forward because information was unclear or responsibility was unresolved. A patient who stops because she chose to and a patient who stops because nobody told her what to expect are counted identically in most systems. I have rarely seen a company that could tell the two apart with any confidence.

That distinction is what keeps this argument honest. Without it, a case about commercial failure becomes a case for wanting patients on drugs rather than a case for wanting patients served. The point is not volume. The point is that nobody should lose a therapy to an unanswered question.

What standard does a link in the chain inherit?

Membership in the chain comes with obligations, which is the practical consequence here. Pharma already holds its science to an evidentiary standard and its manufacture to a precision standard. It holds its conduct to a reputational and trust standard that boards treat as a governance matter. The commercial system has never been held to a standard of its own.

That absence is a design gap rather than a failure of anybody's competence, which is why it survives inside companies full of capable people. No function was ever handed the brief to write the standard, so experience was left to default while brand and product were carefully designed. Consumer-Grade is what supplies the missing standard, expressed as a specification rather than an aspiration. Its conditions are recognition, anticipation, coherence, effort, resolution and visibility, with thresholds set per organization.

A standard without a measure stays decorative. The share of earned value that becomes sustained therapy is the Realization Rate , and earned value multiplied by one minus that rate gives Customer Value at Risk. Those two numbers put the last link of the chain into the currency a finance committee already uses. Pharma does not have a sales problem, it has a systemic value realization problem, and a Realization Rate is what makes that arguable rather than rhetorical.

What changes when the chain is drawn correctly

Redrawing the chain changes what experience is for. It stops being a service question and becomes the mechanism by which therapeutic value is realized. CX in pharma is not altruism, because it determines whether scientific and commercial value survives the journey. That sentence often lands badly with people who expected a softer argument, and it probably should.

Redrawing it also changes where the capability belongs on an organization chart. Launch excellence, marketing excellence and sales excellence are each treated as disciplines with owners, budgets and bodies of practice. Customer Excellence is the fourth of those domains and the one pharma never built, which is why it belongs beside them rather than beneath them. A fourth pillar reporting into one of the other three will keep losing every argument about priority.

In the work I have done inside large commercial organizations, the companies that moved furthest did one unglamorous thing first. They redrew their own value chain on a single page and found that it did not stop at approval. Almost everything else followed from having to look at that drawing.

Key Takeaways

The therapeutic value chain starts with the science and ends with patient therapy, which places the commercial system inside it rather than after it.
The commercial system has two jobs in the chain, putting the state of the art in front of the clinical decision and then seeing that decision through.
A molecule that works and does not reach a patient has the same clinical outcome as a molecule that does not work.
The value leakage ladder is an illustrative compounded scenario, and every increment of loss in it is a patient who did not receive a benefit.
Some attrition reflects sound clinical judgment or informed patient choice, and the work is to separate those cases from unresolved responsibility.
A link in the chain inherits the chain's standards, which is what Consumer-Grade supplies for a commercial system that has never had one.

Diagnostic Questions to Consider

Draw your own value chain and state whether it stops at approval or at sustained patient therapy.
Name the executive accountable for the stretch of chain between a clinical decision and a dose.
State your current Realization Rate and the method used to calculate it.
Describe how your organization distinguishes informed patient choice from attrition caused by unresolved responsibility.
Explain which standard your commercial system is held to today, and who set it.

Closing Reflection

Arguments about where a line sits on a diagram sound academic until you notice what the line decides. It decides what gets measured, who gets held accountable, and which failures a company is obliged to explain. Move the line and those three things move with it, often faster than anyone expected.

I have found that the hardest part of this case is not its logic but its implication. If the commercial system is part of the therapeutic value chain, then commercial leaders carry a therapeutic responsibility, and few of them were hired on that understanding. Some will experience it as a burden, and others may recognize it as the reason they came into this industry at all.

The science here is often extraordinary and the experience surrounding it is frequently ordinary. That gap may be the most solvable problem in pharma, because nothing about it requires a discovery. It requires a company willing to accept that its chain runs all the way to a patient who is better, and willing to be measured on the whole length of it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Omnichannel in Pharma, and Why It Underdelivers

Sat, 10 Oct 2026 15:50:00 GMT

Omnichannel in pharma is the coordination of a company's channels around a customer rather than around the company's own functions. Almost every program sold under that name does something narrower, which is coordinating message delivery across channels. That narrower thing is worth doing, though it remains a different thing, which is why the results so often disappoint relative to the investment.

Organizations coordinate most easily along the lines they already manage. A company that manages channels will coordinate channels, and a company that manages brands will coordinate brand messages. Coordinating around a customer requires acting along a line no function owns, which is the part that rarely survives contact with an operating plan. The word omnichannel came through that collision intact while the ambition inside it was quietly reduced.

The category is saturated with content produced by parties selling the narrower version, so the vocabulary has drifted toward what platforms can do. Message consistency across email, field, web and portal is a real capability with real engineering behind it. The question worth taking up is why a company can complete that work and still see no change in whether patients start therapy.

Channel coordination makes activity consistent, journey coordination makes progress continuous

Channel coordination makes a company's outbound activity consistent. The same claim, the same positioning and the same next step appear wherever a customer meets the brand. Journey coordination makes a customer's progress continuous, which means a case that starts in one channel can be finished in another without the customer restarting it. Those are two different achievements, and only the second shows up in whether anything actually moved.

A company can reach the first completely and leave the second untouched. Every channel can carry an identical message while an authorization still stalls, a benefit verification still asks for information already supplied, and a physician's unresolved question still dies in a queue. Consistency of message says nothing about whether anything moved. What the customer meets is a well coordinated company that cannot finish what it started.

The distinction matters because the two require different work. Channel coordination is largely a content and technology problem, solvable inside marketing with a platform and a governance process. Journey coordination is an accountability problem, because continuity requires somebody to hold a case across functional boundaries. Budget tends to follow the problem that has a product attached to it.

Why most maturity models measure the easier thing

Most omnichannel maturity models measure channel coordination and report it as journey coordination. They score channel breadth, message consistency, data unification, campaign orchestration and personalization depth. Every one of those is a property of the company's outbound machinery. None of them is a property of the customer's progress.

The scoring is honest enough, because it measures what a company can see from inside. A company knows its own channels and its own content, and it knows far less about whether a case closed. Maturity scores rise, dashboards improve, and the experience the customer has may not change at all. I have watched organizations reach a high rating on a model of this kind while their hardest cases took exactly as long as before.

The clearest evidence that something is missing sits in the gap between how companies rate themselves and how customers rate them. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs, against 82 percent of life sciences executives who say they are satisfied with those same strategies . A gap of that size is rarely a measurement error, and I read it as two parties scoring two different things under one word.

The six conditions a coordinated experience has to meet

The Consumer-Grade Specification is a closed set of six structural conditions. Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Felt attributes such as easy, simple, fast and transparent are reported outcomes that decompose into those six, with thresholds set per organization. Holding them as a specification rather than an aspiration is what makes them usable in an operating review.

Recognition is whether the company knows who it is dealing with and what has already happened. Anticipation is whether the next need is met before the customer has to raise it. Coherence is whether what the customer meets holds together across parties and over time. Effort is how much work the customer has to do to get a result.

Resolution is whether the thing the customer came for actually got finished. Visibility is whether the customer can see where matters stand and what happens next. Coherence is the condition most omnichannel programs are genuinely chasing, and it is one of six. A program can satisfy it fully and leave the other five roughly where they were.

Which conditions a message platform cannot deliver alone

Four of the six sit largely outside what channel orchestration reaches on its own. Recognition requires customer context and enterprise memory that persist across functions, rather than campaign history held inside a marketing stack. A platform can personalize using what marketing knows, while recognition requires what the hub, the field and the call center know as well.

Effort is set by the number of steps a customer has to complete, and most of those steps live in processes marketing does not own. Forms, verifications, documentation requests and repeat questions determine the effort level, and no amount of message coordination reduces them. A perfectly orchestrated sequence can escort a customer through an unchanged quantity of work.

Resolution requires somebody with authority to finish a case, which is an operating role rather than a channel capability. Visibility requires a single current view of where a case sits, assembled from systems never designed to report to one another. Anticipation and Coherence are the two conditions a platform contributes to most directly, which is a reasonable contribution and a partial one.

Why experience was framed as adjacent rather than connective

The reason this keeps recurring sits further back than any technology decision. Imported customer experience models framed the discipline as standalone and adjacent, a function with its own surveys, its own team and its own program calendar. That framing made experience something a company could place beside the commercial model. Imported customer experience was rejected in this industry for reasons that were largely rational, because the first iterations did not fit how pharma actually operates, and the wrong lesson was drawn from that reasonable rejection.

Experience is better understood as the connective fabric across functions and an embedded commercial construct. It belongs with the other named domains as the fourth domain of commercial excellence rather than as a layer added over the first three. A channel layer sits on top of an organization, while a fabric runs through it. That difference decides whether a customer's case can cross a boundary.

What happens when a horizontal surface meets vertical silos

Pharma's functional structure produces vertical interactions against engagement that runs horizontally. Medical, marketing, access, field and patient services each interact downward through their own channels, while an HCP engagement relationship and a patient's journey run sideways across all of them. Each function performs its own interaction competently, and the customer meets the places where those interactions are supposed to meet each other.

An omnichannel program that leaves those boundaries intact is building a horizontal surface over a vertical organization. The surface is genuine, and underneath it the handoffs, the ownership and the memory remain divided exactly as before. The seams show up as the customer's problem rather than the company's, which is why they persist through several otherwise successful programs. A physician asked the same question twice by two parts of one company is reading the structure accurately.

None of this reflects anyone's competence. Each function is staffed by people doing demanding work to a standard their own leadership set. The failures cluster in the spaces no organization chart describes, which makes this a design gap and therefore open to design. Gaps of that kind respond to ownership and instrumentation rather than to exhortation.

Will AI fix a fragmented commercial model?

The current expectation is that AI will resolve all of this, and that expectation deserves a direct answer. AI will not make a fragmented commercial model customer-centric. It makes whatever operating system exists faster and more scalable. That applies with full force to channel orchestration.

Applied to a company whose channels are coordinated and whose journeys are not, AI produces more coordinated messages arriving faster. Applied to a company that has closed its boundaries, the same capability compounds, because context travels and resolution follows. The technology is indifferent to which of those two organizations it is installed in.

This is the argument I make most often and find hardest to land. A capability that amplifies gets read as a capability that repairs, because the outputs improve immediately and visibly. Message quality rises, response times fall, and the case that stalled last quarter stalls again this quarter. Amplification and repair are different purchases, and only one of them changes a progression number.

What a properly instrumented program measures

Engagement is the standard currency here, and it reports attention rather than movement. Opens, reach, frequency, channel mix and content consumption describe what registered, and a program can raise every one of them while moving nobody closer to therapy.

Progression is the alternative. The stage ladder runs Scripts Written, Filled, Therapy Started, 90-Day and Persistence, and each stage names a state a customer either reached or did not. Measured that way, an interaction is judged by whether the next stage became more likely rather than by whether it was delivered. Every interaction either compounds value or creates drag, which is the sentence that turns an engagement metric into an economic one.

Instrumenting that is harder than instrumenting channels, which is the honest reason it remains rarer. It requires agreement on the stages, a view of where cases currently sit, and a named owner for the transitions between them. The approach to measuring experience in pharma that holds up is the one reporting movement between stages rather than activity within channels. In my experience a program that cannot say which stage it improved has reported effort rather than progress.

Key Takeaways

Omnichannel in pharma is the coordination of channels around a customer rather than around the company's own functions.
Channel coordination makes outbound activity consistent, while journey coordination makes a customer's progress continuous.
Most maturity models measure the first and report it as the second, which is why results disappoint relative to investment.
Coherence is one of six Consumer-Grade conditions, and Recognition, Effort, Resolution and Visibility sit largely outside what a message platform delivers alone.
A program leaving functional boundaries intact builds a horizontal surface over a vertical organization, and the seams become the customer's problem.
AI makes whatever operating system exists faster and more scalable rather than making a fragmented commercial model customer-centric.

Diagnostic Questions to Consider

State whether your omnichannel program coordinates message delivery or coordinates customer progress.
Name the owner accountable for a case that has to cross a functional boundary before it can be finished.
Score your program against each of the six conditions separately rather than against a composite maturity level.
Report the share of customer cases closed in a channel other than the one where they started.
Identify which stage of the progression ladder your last omnichannel investment measurably improved.

Closing Reflection

The word omnichannel describes an ambition this industry has largely accepted and an implementation that has largely been narrowed. Nobody narrowed it deliberately. It narrowed because channel coordination has a product, a budget line and a measurable output, while journey coordination has none of those and asks for authority across boundaries instead.

The useful consequence is that the remaining work is structural rather than technical. The platforms largely exist and the content is largely coordinated, which means the constraint has moved to ownership, memory and resolution. Those are decisions a commercial leadership team can make without buying anything further.

Exceptional science deserves an exceptional commercial system, and coordinated messaging is a modest portion of what that means. A customer judges a company by whether the thing she needed got finished, rather than by whether its channels agreed with one another. That standard was set outside this industry, by every other service in her life, and it will decide what omnichannel is eventually taken to mean.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Patient Access Barriers: Six Classes, Six Different Owners

Sat, 10 Oct 2026 15:30:00 GMT

A patient access barrier is anything standing between a prescribing decision made in a patient's favor and that patient actually starting and staying on therapy. The term is used loosely across this industry to mean coverage, and coverage is only one barrier class among several. That looseness decides which barriers get funded, instrumented and owned, and which ones keep their effect while losing their name.

Organizations tend to name a problem after the part of it they already measure. Coverage is measurable, contractible and owned by a function with a budget, so coverage became the whole of access in common usage. The classes that carry no instrument and no owner were never argued away. They were simply never counted.

Most writing on this question is either advocacy aimed at payers or a pitch for a support program. Neither of those leaves an operator with a usable taxonomy. Six classes recur often enough across therapeutic areas that I treat them as distinct, each with its own owner and its own remedy. Three of them a manufacturer already instruments reasonably well. The other three sit partly inside several functions and wholly inside none.

The three classes the industry already instruments

Coverage is the first and the most familiar. It asks whether a therapy sits on formulary and at what tier, and it is owned by market access and resolved through contracting. This is the one class with a mature instrument already behind it, which is why progress here is real and is often mistaken for progress on access as a whole.

Adjudication is the second class, covering prior authorization, step therapy and medical necessity review. Those are legitimate utilization mechanisms whose operating burden falls on a prescriber's office and on a patient. A 2024 AMA physician survey found 93 percent of physicians reported that prior authorization delays care. The mechanism is defensible and the distribution of the work is the problem, which is the subject of a separate piece on prior authorization burden .

Affordability is the third. It asks what a patient pays at the point of collection, and it is partly owned already through copay programs, foundations and bridge supply. Those instruments are well built and well staffed, which is why affordability is often reported as a handled problem. Whether a patient knows her cost before she arrives at the counter is a different question, and almost nobody owns that one.

The three classes nobody owns

Administrative barriers are forms, enrollment, benefit verification, documentation and repeat requests for information already supplied. Access owns the policy, the hub owns the case, the field owns the relationship, and the household owns the paperwork. No role in that arrangement is defined as accountable for how much work a patient and an office are asked to absorb.

Informational barriers are the absence of an answer to three questions a patient and an office ask continuously. What happens next, who is doing it, and when it will be done. This is the cheapest class to fix and the least often measured, because nothing in a standard business review asks whether anyone knew where a case stood.

Continuity is the sixth and the least visible of them. It asks whether responsibility is held when a case stalls, or whether a stalled case simply stops moving until somebody chases it. Most access operations have no named holder for a case that stops, and stalled cases are rarely the simple ones.

Why cost discovered at the counter is its own barrier

Affordability is usually treated as a question of price, and price is only half of what decides the outcome. A cost a patient learns about in advance is a decision she can prepare for, discuss with her physician and plan around. The same cost discovered at the point of collection arrives at the moment she has the least information and the least recourse. Those are two different barriers wearing one label, and they call for different work.

The evidence on what happens at that moment is unusually plain. Of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients . That figure describes a decision made at a register by someone who had no way to rehearse it. The wider pattern of prescriptions never collected is taken up in a separate piece on prescription abandonment .

Resolving cost itself requires contracting, foundations and funding, all of which take money and time. Resolving cost discovery requires telling a patient what she will pay before she stands at a counter. One of those is slow and expensive, while the other is largely an engineering exercise available this quarter.

Where a barrier stalls matters more than its type

Barriers are usually described by their type and are far better described by where they stall. Type tells you what an obstacle is made of, while location tells you what work will actually move it. A barrier that stops a patient before a first fill belongs to the Path to Fulfill , the stretch between a clinical decision and a medicine in hand. One that stops her in month three belongs to the Path to Adhere , where the question is continuation rather than initiation.

Before a first fill, an affordability barrier is usually a surprise, and the remedy is cost transparency, a bridge supply and a fast enrollment path. In month three it is rarely a surprise, because by then the patient knows her number. The remedy there is a renewal that does not break, a reauthorization handled before it lapses, and a plan year change somebody anticipated.

The same nominal barrier therefore needs different work depending on where it bites. Programs built by type tend to underperform for exactly this reason, because they apply one remedy across two mechanisms. Classification by location is what turns a barrier inventory into an operating plan.

Why this friction is unowned rather than mandated

The compliance explanation deserves examination, because it is the one most often offered. Regulation in this industry governs claims rather than burden. The rules are exacting about what a company may say regarding efficacy, safety and comparative benefit, and close to silent on how many forms a household completes. Almost none of the friction a patient meets between a prescription and a first dose is legally required.

That changes the category of the problem rather than its size. A constraint written into law has to be worked around, while a constraint nobody owns can be picked up by whichever party decides the outcome matters to it. Unowned friction is available in a way mandated friction never is. Six obstacles recur across these classes often enough that I name them, and they accumulate rather than arriving singly.

Administrative burden is the volume of work transferred to a practice or a household. Disconnected handoffs are the points where context stops traveling between parties. Lack of visibility is the absence of any single view of where a case currently sits. Fragmented support describes a patient helped by several programs and served by none of them.

Poor escalation is what happens when an exception meets a queue instead of a person, and process complexity is the compound effect of the other five arriving together. Friction is an economic variable, and accumulated friction becomes commercial drag. No single one of those obstacles ends a therapy, which is why each of them survives review on its own merits.

Why no one in this chain is failing

Every party in this chain is doing its own job competently, and that qualification belongs at the front of the argument rather than the end of it. The payer adjudicates against published criteria, the practice triages against finite clinic hours, the hub closes cases against a service level, and the manufacturer promotes against a share target. Each of those jobs is performed to standard by people who would recognize no failure anywhere in their own numbers.

The failures cluster in the spaces no organization chart describes. Between a benefit verification and an enrollment, between a hub case closing and a pharmacy stocking, between an approval and the patient being told about it. Those spaces have no owner because no function's mandate reaches across them. A design gap of that kind responds to design, which is a more useful finding than any judgment about effort.

I have found this to be the hardest point to carry inside an organization. A leader hearing that patients fall out of a journey will often look for the function that dropped them. The honest answer is usually that no function dropped them, because no function was holding them. Capable people and an incapable handoff can coexist for years without anybody noticing the difference.

How barrier resolution is actually measured

Resolution is almost always reported in activity. Enrollments completed, cases touched, calls answered and satisfaction scored all describe what a support organization did rather than what a patient achieved, which is why they can rise while access gets no better.

Progression is the alternative, and it is measured on a stage ladder. Scripts Written, Filled, Therapy Started, 90-Day, Persistence. Each stage names a state a patient either reached or did not, which makes the drop between any two stages the location of a barrier rather than an inference about one. Written prescriptions are intent, not realized value, and a ladder is what holds that distinction in view.

The economics follow directly from the ladder. The Realization Rate is realized value divided by earned value, which reports the share of what the science earned that became therapy. Customer Value at Risk is earned value multiplied by one minus that rate, which states the shortfall in money. Expressed that way, a barrier stops being a service complaint and becomes a line a commercial review already knows how to read.

What makes that number persuasive is that no competitor takes the value. A patient who never starts a therapy she was prescribed rarely moves to a rival product, because the therapy left her life rather than changing brands. Nobody gains from a loss of that kind, which makes access resolution a yield question with a named owner and a number attached to it.

Key Takeaways

A patient access barrier is anything standing between a prescribing decision and a patient starting and staying on therapy.
Coverage is one of six barrier classes, and it is the only one most manufacturers already instrument well.
Administrative, informational and continuity barriers sit partly inside several functions and wholly inside none of them.
Cost discovered at the point of collection is a different barrier from cost itself, and it is far cheaper to resolve.
Where a barrier stalls decides its remedy, which is why programs built by barrier type tend to underperform.
Resolution is measured as progression on a stage ladder and priced through the Realization Rate and Customer Value at Risk.

Diagnostic Questions to Consider

List your access barriers by class and name the single owner accountable for each one.
State the share of patients who know their out of pocket cost before they arrive at a pharmacy counter.
Describe what happens to a stalled case today, including who holds it and how long it typically sits.
Separate your barrier inventory by where it stalls, before a first fill and after it, rather than by type.
Report your largest brand's progression at each stage of the ladder rather than the activity your support programs completed.

Closing Reflection

An extraordinary amount of capable effort is spent in this chain to produce an outcome nobody wanted. Hub agents work their queues conscientiously, clinic staff spend afternoons on payer portals, and access teams negotiate positions they then defend. The effort is real, and the patient at the end of it has often concluded, reasonably enough, that her therapy was never going to happen.

The useful reading is that most of what stands between her and that therapy was never mandated and was never designed. It accumulated, piece by defensible piece, in the spaces between functions that each did their own work correctly. Burden distributed that way can also be withdrawn that way, which is why I treat access as an operating problem rather than an industry grievance.

Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. A company holding that sentence as a measurement commitment rather than a sentiment will find the six classes easier to see and harder to leave unowned. The barriers that cost the most are rarely the ones anybody chose.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Launch Excellence in Pharma, and What Its Window Cannot Reach

Sat, 10 Oct 2026 15:10:00 GMT

Launch excellence is the discipline of maximizing a brand's performance in the window where its long run trajectory is set. It is the most mature and best resourced discipline in pharmaceutical commercial practice, and the industry was right to build it that way. What it misses sits outside the window rather than inside the discipline. Almost everything a launch is measured on stops at the prescribing decision.

Organizations tend to govern what they can see inside a reporting period, and a launch is the most tightly bounded reporting period in commercial pharma. That boundary is the source of both its rigor and its blind spot. The discipline deserves respect before it deserves examination, so the respect comes first.

What launch excellence does well when it is resourced properly

A well run launch does several things no other commercial discipline in pharma attempts. It establishes cross functional readiness ahead of approval, so that medical, marketing, access and field are capable on day one rather than in month four. It orchestrates those functions against a single date that cannot move. It drives speed to first prescription and speed to peak, the two measures that most reliably predict a brand's lifetime performance.

The underappreciated part is the sequencing. A launch carries hundreds of dependencies, many of them owned by functions with different clock speeds and different definitions of ready. Holding that structure together against a fixed regulatory date is organizational discipline of a rare kind. People who have never run one tend to underestimate how much judgment it takes.

None of this is ceremonial. Launch excellence is where pharma's operating capability shows at its best, and it sits inside the wider category of commercial excellence in pharma as the most developed of the established domains. Any argument about what it misses has to start from that fact. A discipline this good does not fail by carelessness.

What a launch is actually measured on

A launch is measured on the formation of demand within a window. Awareness, trial, first prescriptions written, share of voice, formulary wins, depth of prescribing and breadth of prescribing are the standard instruments. Every one of them is real, properly constructed and genuinely useful. Every one of them is also an intent metric, which means each stops at the prescribing decision.

Intent is the right thing for a launch to create. The difficulty is that intent is also the last thing a launch is asked about. A brand can hit each of its uptake targets and still convert well under half of what it earned into patients on sustained therapy. That conversion happens after the window closes, by which point the team that produced the intent has usually been redeployed.

My first doctrinal position bears directly on this. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value. A launch scoreboard built entirely from intent metrics can read as a complete success while a large share of earned value quietly fails to arrive.

Why intent became the whole scoreboard

Launch metrics did not become intent metrics by accident. They became intent metrics because intent was the only thing the organization could observe inside the window and attribute to the launch. Fulfillment data arrives late, sits with third parties and resists attribution to any single commercial action. Choosing measurable intent over unmeasurable realization was a reasonable decision taken under real constraints.

What has changed is the constraint. Claims data, specialty pharmacy reporting and frontline intelligence now make progression observable in something close to operating time. The measurement problem that justified the intent scoreboard has largely been solved, while the scoreboard itself has not moved. That lag is ordinary institutional behavior rather than negligence.

Why the gap is structural rather than careless

The launch window and the realization window do not overlap. Prescribing intent forms in weeks. Fulfillment runs in days to months, through benefit verification, prior authorization, specialty pharmacy routing and copay support. Persistence runs in quarters and years, long after launch governance has been stood down.

A launch organization is therefore dissolved on a calendar that predates the outcome it was built to produce. Core team members move to the next asset, the war room is retired and the launch dashboard is archived. What remains in market is the first cohort of patients, handed to whoever happens to still be in the role. That handover may be the most consequential moment in a brand's life and the least designed one.

No individual decision inside that sequence is wrong. Redeploying scarce launch talent to the next asset is rational. Retiring a dashboard that measures a period which has ended is rational. The outcome is still that accountability for realization has no home at precisely the moment realization begins.

What happens to intent once the window closes

The scale of what happens after the window is now measurable. A 2026 JAMA study summarized by Johns Hopkins found that insurer rejections reached 40.7 percent of initial brand name attempts in 2024 . Of those rejected prescriptions, 48.4 percent were never followed by a fill of that drug or anything in its class within ninety days. The first figure describes friction, while the second describes abandonment.

Those outcomes land squarely inside the launch period for a new brand. A rejection at first attempt arrives within days of the prescribing decision the launch team worked two years to earn. Nobody on the launch scoreboard is measured on it, because it happens on the Path to Fulfill rather than the Path to Prescribe. The clinical intent was created exactly as designed, then met a system the launch was never instrumented to see.

Some share of that attrition reflects sound judgment and deserves respect. A rejection can be clinically appropriate, and a patient may reasonably decline a therapy once they understand what it asks of them. The portion that reflects pure friction is the portion belonging to the commercial system. Separating the two is work, though it costs considerably less than assuming the whole figure is unavoidable.

What a launch instrumented for realization adds

A launch built for realization keeps every instrument it already has. It adds four, and each can be built before approval rather than after the first stall. The first is progression measured from the first week rather than at the first annual review. The ladder I use runs from Scripts Written to Filled, then Therapy Started, then 90-Day, then Persistence.

The second is a named owner for the Path to Fulfill, appointed before launch rather than once a stall becomes visible in the numbers. The third is baseline friction mapped while the brand is still pre market. Every party that will administer that friction is known in advance, including payers, benefit managers, specialty pharmacies and the practices that submit the paperwork. Mapping how they behave is a readiness activity rather than a post launch investigation.

The fourth is a handover that transfers an operating measure rather than a dashboard. A dashboard tells the receiving team what happened. An operating measure tells them what they are accountable for changing, which is a different inheritance entirely. The Realization Rate works well in that role, because realized value divided by earned value survives a change of owner without losing its meaning.

What this changes about how launches are judged

Judging a launch on realized value rather than created intent reorders launch planning. Access and fulfillment design stop being a workstream reporting into readiness and become a condition of it. The question moves from whether the brand can be prescribed to whether it can be received. Value leakage is the term I use for the distance between those two, and it is often at its widest in the first year.

None of this requires a larger launch team. It requires a different allocation inside one, and a measure that outlives the window. Launch excellence remains the right discipline for the first window, while the fourth domain of commercial excellence is what carries the brand past it. The relationship between the two is set out in a separate piece on the fourth pillar of commercial excellence .

A launch is the best opportunity an organization ever gets to design realization in rather than retrofit it later. The team is cross functional, the funding is unusually available and the governance already exists. Those three conditions rarely coexist again in a brand's life. Spending some of that moment on the window after the window may be the highest return decision available to a launch leader.

Key Takeaways

Launch excellence is pharma's most mature commercial discipline and deserves to be treated as such. Readiness, orchestration, speed to first prescription and speed to peak are genuine operating achievements.
Almost every launch metric is an intent metric. Awareness, trial, formulary wins and depth of prescribing are all real measures that stop at the prescribing decision.
A launch can hit every target and still lose much of what it earned. The conversion from intent into sustained therapy happens after the window closes.
The gap is structural because the two windows do not overlap. Intent forms in weeks, fulfillment runs in days to months, and persistence runs in quarters and years.
The intent scoreboard was a rational response to a measurement problem that has largely been solved. Progression is now observable in close to operating time, while the scoreboard has not moved.
Four additions make a launch readable in realization terms. Progression measured from week one, a named Path to Fulfill owner, friction mapped pre market, and a handover that transfers an operating measure.

Diagnostic Questions to Consider

List every metric on the current launch scoreboard and mark which ones describe events occurring after the prescribing decision.
Name the person accountable for the Path to Fulfill on the next launch, and confirm the appointment exists before approval.
State the share of first prescriptions expected to be rejected at first attempt, using evidence rather than an estimate made in the room.
Identify what the launch team will hand to the receiving organization, and determine whether it is a dashboard or an operating measure.
Establish when the first cohort of patients will be reviewed for persistence, relative to the date the launch team is redeployed.

Closing Reflection

Launch excellence was built to answer a question the industry asked with great precision. How does a new medicine earn clinical conviction and reach peak as quickly as the evidence allows? Four decades of practice answered it, and the answer holds. The question nobody attached to the launch was what happened to the conviction once it existed.

I have come to see that omission as a matter of boundaries rather than of care. A launch is bounded by a date, and work that falls past the date falls past the mandate. People inside launch organizations are frequently aware of the problem long before the organization names it, which is usually how design gaps reveal themselves. They show up first as frustration among capable people doing exactly what they were asked to do.

The window where a brand's trajectory is set and the window where its value is realized are not the same window. Treating them as one has cost the industry more than any single launch failure ever has. A launch instrumented for realization asks for very little that the organization does not already have, which is probably the most encouraging thing about it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Commercial Excellence in Pharma: The Four Domains

Sat, 10 Oct 2026 14:50:00 GMT

Commercial excellence in pharma is the discipline of making the commercial system perform as well as the science it carries. Institutions tend to industrialize whatever they can name, and they leave unnamed work to whoever happens to be standing closest. In practice the discipline has been built as four domains, three of them long established and named, and a fourth that is now being named. The first three are launch excellence, marketing excellence and sales excellence. The fourth is Customer Excellence.

Most writing on this question stops at that list. The category deserves better treatment, because each of the three established domains carries a real body of practice, a real budget and people who have spent whole careers inside it. Understanding precisely what each one owns is the only honest way to see what none of them owns.

What launch excellence owns

Launch excellence secures early momentum in the window where a brand's long run trajectory is set. Its work is cross functional readiness ahead of approval, orchestration across medical, marketing, access and field, and speed from first prescription to peak. It sequences a very large number of dependencies against a fixed date, which is organizational discipline of a kind few other functions are asked to demonstrate. Of the four domains it is the most mature and usually the best resourced.

The reason for that maturity is sound. A brand's early trajectory tends to predict its lifetime trajectory, so the industry concentrated its sharpest operating discipline in the period where stakes compound fastest. Launch excellence is treated with more rigor than any other commercial domain because the evidence justified treating it that way. Anyone writing about the subject should say that before saying anything else.

What marketing excellence owns

Marketing excellence shapes how a medicine is understood. It governs narrative, evidence generation, segmentation and message discipline, which together determine whether a clinician meets the science in a form they can act on. Done well it converts clinical data into clinical conviction, then holds that conviction consistent across every channel a physician touches. Its instruments are among the most refined anywhere in the industry.

Message discipline in particular is harder than it looks from outside. A claim has to survive regulatory review, stay true to the label, remain legible to a specialist and still differentiate against comparators that may be clinically similar. Marketing excellence carries that burden continuously rather than at launch alone. It is rarely given credit for how much judgment the work actually requires.

What sales excellence owns

Sales excellence sustains presence and relationship capital in the clinical community. Its work runs through territory design, reach, frequency and call planning, and through the accumulated trust that lets a representative be useful rather than merely present. No channel in pharma carries more brand defining weight, and none costs more to operate.

Questions of field force effectiveness are usually framed as questions of efficiency. The more useful question is what the field is in a position to observe. A representative sitting in an office often sees a barrier forming months before any dashboard registers it. Sales excellence built the discipline of being there, which is the harder half. What it was never asked to build is the discipline of acting on what being there reveals.

The boundary condition the three domains share

Each of the three optimizes performance within a category that already exists. Each is accountable for creating clinical intent, and each is measured on how much of that intent forms and how quickly. Not one of them owns whether the intent survives the journey from decision to sustained therapy. That is a design gap rather than a failure of any discipline, which matters because the two call for entirely different remedies.

A launch can hit every readiness and uptake target while a meaningful share of first prescriptions never becomes a filled prescription. A campaign can achieve conviction while a prior authorization stalls. A field organization can hold strong relationships while patients fall out of therapy in the third quarter. None of those outcomes indicts the domain that produced them, because no domain was ever handed the mandate.

The gap is visible in what customers report about engagement they already receive. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs , against 82 percent of life sciences executives who say they are satisfied with those same strategies. Three mature domains produced that spread while each performed its own job competently. A system can be excellent in every part and still be experienced as incoherent by the person moving through it.

What is the fourth domain the industry is now naming?

Customer Excellence is the fourth domain. It is the enterprise capability that designs, delivers and scales coherent experiences across the three paths a customer travels, and that governs whether clinical intent becomes realized therapy. Those paths are the Path to Prescribe, the Path to Fulfill and the Path to Adhere. Intent created on the first can be lost on either of the other two, and often is.

Customer Excellence is CX 3.0, Fit-for-Pharma, a pharma specific interpretation rather than a method imported from retail or hospitality. The full case for treating it as a domain, including why earlier imported versions were rationally rejected, sits in a separate piece on the fourth pillar of commercial excellence . I will not re-argue it here. What belongs on this page is what the category looks like once the fourth domain is standing in it.

What separates a real function from a reporting one

Any commercial excellence function can be tested in about ten minutes. A real one carries five markers: a named discipline, an owner, a measure, a body of practice and a budget line. Anything with fewer than all five is an initiative, however senior its sponsor and however good its intentions. Initiatives produce decks, while functions produce decisions.

The marker that falls off most often is the budget line. A discipline without its own money depends on whoever does have money, which means it negotiates for attention rather than setting standards. The owner marker fails nearly as frequently, usually because accountability has been distributed across a steering committee. Shared accountability with no single name on it tends to behave like no accountability at all.

The body of practice marker is the slowest to earn and the easiest to imitate. It means documented methods, trained practitioners and some reliable way to tell competent work from incompetent work. Launch, marketing and sales excellence each cleared that bar over decades. A function claiming a place beside them should expect to be judged against the same standard.

The measures the function should carry

Commercial excellence becomes a reporting exercise the moment its measures only describe activity. The Realization Rate is realized value divided by earned value, which states plainly how much of what the enterprise earned reached a patient on sustained therapy. Customer Value at Risk is earned value multiplied by one minus that rate. The second number is the first one expressed in money, and finance conversations tend to move faster once it appears.

The distance between earned value and realized value is value leakage , and no competitor collects it. Work I published with TheyDo illustrated how the shortfall compounds. A billion dollars of earned value becomes roughly seven hundred million once prescriptions that are never filled are subtracted. Early discontinuation takes more, and long term adherence erosion leaves close to four hundred and fifty million in realized value.

That ladder is an illustrative compounded scenario rather than a benchmark, and the thresholds belong to each organization. The useful part is the shape. Losses of that kind accumulate quietly, acquire no owner and appear in no variance report, which is largely why they survive year after year.

Where the category is heading

The three established domains will keep earning their budgets, and they should. What changes is the question the function is asked to answer. Commercial excellence defined as the creation of intent has four decades of refinement behind it. Commercial excellence defined as the realization of value is a different job with a different measure, and most organizations have not yet decided which one they are running. The realization question belongs to the therapeutic value chain , which holds the discipline to the chain's standards rather than to its own.

Deciding is cheaper than drifting. A function that names the fourth domain, assigns it an owner and gives it a measure can begin reporting a Realization Rate inside a single planning cycle. A function that leaves the domain unnamed will keep paying for recovery through hub services, field escalations and the goodwill of colleagues who refuse to let a patient fall through a seam. That spending is already happening, largely without governance and almost always without credit.

Key Takeaways

Commercial excellence in pharma has four domains rather than three. Launch, marketing and sales excellence are named and mature, while Customer Excellence is the fourth and the one now being named.
Each established domain deserves to be understood on its own terms. Launch excellence owns the first window, marketing excellence owns understanding, and sales excellence owns presence in the clinical community.
All three create clinical intent and none governs whether it survives. That shared boundary is a design gap rather than a shortcoming in any of the three disciplines.
Five markers separate a real function from a reporting one. A named discipline, an owner, a measure, a body of practice and a budget line are all required, since anything short of five is an initiative.
The function needs measures that describe realization rather than activity. The Realization Rate and Customer Value at Risk put experience into terms a finance conversation already accepts.
Value leakage is spending that happens whether or not it is governed. Recovery work is already funded informally through hub services, escalations and the discretionary effort of colleagues.

Diagnostic Questions to Consider

Name the four domains your commercial excellence function actually covers today, and identify which of them has no owner.
Test the function against the five markers, and state which markers are missing rather than which are present.
State the current Realization Rate for the lead brand, without estimating the figure in the room.
Calculate Customer Value at Risk for that brand and set it beside next year's promotional investment.
Identify where recovery work is already being funded informally, and determine what that effort would cost if it appeared on a budget line.

Closing Reflection

Four decades of commercial refinement in pharma produced three genuinely excellent disciplines. Every one of them earned its place, and the industry would be poorer without any of them. What they share is a boundary nobody drew deliberately, which is the point at which a prescribing decision passes out of the commercial organization's field of view.

I have come to read that boundary as an artifact of sequence rather than of judgment. The domains were built in the order the problems presented themselves, and the problem of realization presented itself last, after the vocabulary was already settled. Work that arrives after the vocabulary tends to go unnamed, and unnamed work rarely acquires an owner or a measure.

Commercial excellence is now being asked a harder question than the one it was designed to answer. Not how much intent the system can create, but how much of that intent reaches a patient and stays with them. The organizations that take the question seriously will spend a few years looking slower than their peers, because governance work rarely photographs as well as campaign work. The science they carry deserves a commercial system built to finish what it starts.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Prescription Abandonment: Why It Happens and How to Reduce It

Sat, 10 Oct 2026 14:30:00 GMT

Prescription abandonment is what happens when a clinically justified decision has been made and the medicine never reaches the patient. It happens for two separate reasons that are routinely treated as one, which are cost arriving as a surprise and responsibility nobody holds. Reducing it is operating work rather than persuasion work. Almost nobody measures it as a commercial number.

Organizations measure the decisions they make and rarely measure what became of them. A prescription written is an event a commercial system can see, count and reward. A prescription never filled is an absence, and absences do not appear on dashboards built to count events. That accounting choice is why the largest and least contested loss in this industry is also the quietest.

The loss divides into two kinds, and the division carries the whole of the operating answer. Primary non-adherence is a prescription that is never filled at all. Early discontinuation is a prescription filled once or twice and then stopped. They have different causes, different owners and different remedies.

A qualification belongs at the front rather than buried in a footnote near the end. Some abandonment reflects sound clinical judgment or an informed patient choice, and those decisions deserve respect. The work is to separate them from the cases where somebody could not move forward because cost was unclear, information was missing or responsibility was unresolved.

The two kinds, and why the difference decides the work

Primary non-adherence happens in a window of days and usually at a price. A patient reaches a counter, hears a number she did not expect, and decides in seconds on incomplete information. The owner of that failure, where anyone owns it, sits in access and channel design rather than in patient support .

Early discontinuation happens in a window of weeks and usually at a question nobody answered. Side effects often arrive before any benefit does, a refill process has to work for the first time, and a pharmacy relationship has to be managed by somebody who has never managed one. The owner there sits in patient services, and the remedy is support that assumes inexperience rather than competence.

A program that treats the two as one thing will work on the wrong one, which is the pattern I meet most often. Copay support aimed at a patient who stopped because her injection technique was wrong solves nothing. Onboarding material sent to a patient who walked away from a price she could not afford arrives too late to matter. Both interventions are competent, and both are pointed at the wrong failure.

Separating a considered choice from a breakdown

What separates the two groups is whether the patient had what she needed in order to decide. A patient who declines a therapy after a frank conversation about cost and benefit has been well served. A patient who declines because she never learned that a lower cost route existed has not been. The two are indistinguishable in a dispense record, which is part of why this problem resists measurement.

Saying that plainly changes how the work gets framed internally. A program built without the distinction becomes a program to keep people on medicine, which is neither defensible nor particularly effective. A program built on the distinction has a narrower target and a much stronger claim, because it serves the patient who wanted to proceed and could not find out how.

Making the separation requires knowing why a particular patient stopped, reasonably close to when she stopped. Claims data reports the outcome and withholds the reason, which is why generic outreach tends to perform poorly against this problem. The reason usually exists somewhere in the system already, held by a pharmacist, a nurse or a field colleague who heard it directly.

What the evidence shows about cost at the counter

Cost is the clearest single predictor of a prescription never being collected. IQVIA data reported by Managed Healthcare Executive found that of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients. That describes a therapy prescribed, approved and dispensed, which then failed to begin. Every expensive step in the commercial system had already succeeded.

The decision at that counter is made in seconds and on partial information. Patients rarely have any way of knowing at that moment whether assistance exists, whether a different channel costs less, or whether the number on the screen is final. The design gap sits in what she was handed to decide with rather than in the decision she made.

The other large driver is the mechanism examined on the companion page about prior authorization burden . A 2024 AMA physician survey found 82 percent of physicians reported that prior authorization at least sometimes leads to patients abandoning treatment. Physicians are reporting on a process they operate daily, which makes that a description of effect rather than a complaint about intent.

Why a written prescription is only intent

The reframing that makes abandonment commercial rather than charitable is short to state. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value. A commercial system that counts scripts is counting its own intent and calling it performance.

That has consequences for how a brand team should read its own numbers. A strong prescription trend can coexist with a weak treated population, and the distance between them stays invisible in a scorecard built on the first figure. Growth reported in intent is eventually contradicted by revenue reported in reality.

Where one path hands off to the next

Abandonment is the Path to Fulfill failing into the Path to Adhere . The first runs from a clinical decision to a medicine in a patient's hand. The second runs from a first dose to the duration the trial actually demonstrated. Primary non-adherence belongs to the first and early discontinuation to the second, which is why one abandonment program usually sits properly in neither.

The handoff itself is where ownership disappears. A hub closes its case at a first fill, which is its defined success. A field team records a prescription written, which is its defined success. A patient who stops at week three has left both definitions behind while remaining inside the period her therapy was tested across.

What reduces a prescription never filled

Three pieces of operating work reduce primary non-adherence, and none of them is a message. The first is price transparency before the patient reaches the counter rather than after. A patient who learns her real cost in the exam room can discuss alternatives with a physician who is still in the room. A patient who learns it at a pharmacy learns it alone, standing up, with a queue behind her.

The second is benefit verification that happens before a patient is asked to act. Verification run after she has been told to collect a prescription converts a clinical decision into a personal errand with an unknown outcome. Running it first means she is only ever asked to do something that will actually work.

The third is a single named owner for a stalled case. Most access processes handle the standard path adequately and stall on the exception, which is where the clinically urgent cases concentrate. An exception with nowhere to go often becomes an abandonment by default, and nobody involved will ever learn that it did.

What reduces a prescription stopped early

Early discontinuation responds to onboarding that assumes a person has never done this before. Most onboarding I review reads as though the patient already has experience of specialty therapy, benefit renewals and injection devices. Writing it for a first time is accuracy about who is actually reading it rather than a courtesy.

The second piece is a working answer in the first three weeks, which is when side effects often arrive before any benefit does. A patient who can reach a person inside that window often continues. A patient who leaves a message and waits two days has already begun deciding.

The third is attention at the points where the process changes rather than at even intervals. A first refill, a ninety day renewal and an annual benefit reset are three moments when an administrative step may end a therapy that was working. Consumer-Grade is the standard a patient applies at each of them, because every other service in her life manages its own transitions without asking her to.

Why enrollment reporting hides the problem

The standard failure of hub reporting is measuring enrollment rather than progression. A hub that reports patients enrolled is reporting its own activity rather than the patient's progress. Enrollment counts can be made to rise in a period when fills are falling.

Progression measurement asks a different question at each stage. It asks how many prescriptions were written, how many were filled, how many started therapy, how many reached ninety days and how many persisted. Those stages make abandonment visible as a gap between two numbers rather than as an anecdote. The Realization Rate sits above that ladder as realized value divided by earned value.

How the loss compounds across the system

The scale becomes visible only when the stages are stacked on each other. An illustrative compounded scenario I published with TheyDo traces a billion dollars of earned value becoming roughly seven hundred million after prescriptions never filled. It falls again after early discontinuation, and settles close to four hundred and fifty million realized after long term adherence erosion. Those figures illustrate a shape rather than setting a benchmark.

The feature of that decline which should trouble a commercial leader most is that no competitor takes the difference. A prescription abandoned at a counter does not become a rival's prescription. It becomes nothing at all, which is why value leakage behaves unlike competitive loss and asks for a different kind of attention.

Competitive loss gets a war room, a counter detail and a pricing response. Leakage of this kind gets a line in a patient services update and no owner above it. That asymmetry reflects what the measurement system makes visible rather than anybody's priorities.

Key Takeaways

Prescription abandonment is a clinically justified decision that never reached the patient, and almost nobody measures it as a commercial number.
Primary non-adherence and early discontinuation have different causes, owners and remedies, so a program treating them as one will work on the wrong one.
Some abandonment reflects sound clinical judgment or informed patient choice, and the work is to separate those decisions from unresolved ones.
Cost arriving as a surprise at the counter is the clearest single predictor of a prescription never being collected.
Price transparency, benefit verification before the patient is asked to act, a named owner for stalled cases and onboarding written for a first time are the operating remedies.
A hub that reports patients enrolled is reporting its own activity rather than the patient's progress.

Diagnostic Questions to Consider

State what proportion of prescriptions written for your largest brand last quarter resulted in a dispense within thirty days.
Separate your abandonment into prescriptions never filled and prescriptions stopped early, then name the owner of each.
Describe how a patient learns her actual out of pocket cost, and at which point in the process she learns it.
Name the person a stalled case reaches today, and state how long reaching that person takes.
List what your patient services reporting would still show if enrollment counts were removed from it.

Closing Reflection

Abandonment has been discussed in this industry for a long time, mostly as a patient support concern and occasionally as a moral one. Neither framing ever earned it a budget line that survived a difficult quarter. Treated as the largest uncontested loss in the commercial system, it competes for funding on the same terms as everything else does.

The qualification set out at the top of this page holds throughout. Some patients decide against a therapy for reasons that are entirely sound, and no commercial system should be built to talk anybody out of a considered decision. The target is narrower and far more defensible, which is the patient who wanted to proceed and could not find out how.

What this asks for is a company willing to count what happened to its prescriptions rather than how many it wrote. That is a measurement change before it becomes an operating change, and the measurement change is the harder of the two. Everything useful follows from being able to see the gap at all.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Prior Authorization Burden: What a Manufacturer Can Actually Do

Sat, 10 Oct 2026 14:10:00 GMT

Prior authorization burden is the administrative work that a payer's approval requirement transfers onto a prescriber's office and a patient. A manufacturer cannot change the payer's coverage criteria or the adjudication decision, though it can change almost everything about how that work gets done. That distinction carries the whole of the operating answer, and most writing on this subject never reaches it. Advocacy asks the payer to stop. Operating guidance asks what already sits inside a manufacturer's control.

Institutions rarely distribute work to whoever is best equipped to absorb it. They distribute it to whoever cannot refuse. Prior authorization is a legitimate utilization management mechanism, and that belongs at the front of any honest account of it. Payers use it to confirm that an expensive therapy is being used as indicated, which is a reasonable thing for the party carrying the cost to want established.

The problem was never that the mechanism exists. The problem is that the burden of operating it has been distributed to the two parties least equipped to absorb it. Those two parties are a prescriber's office and a patient. Neither of them designed the process, and neither of them holds any authority over how it runs.

A second gap sits underneath the first and does more damage. No party in the chain is accountable for the outcome of the process as a whole. A payer is accountable for an adjudication, a practice for clinic throughput, a hub for case closure, and a manufacturer for prescriptions written. Nobody is accountable for whether the patient reaches the therapy her physician selected.

Why the mechanism is legitimate and the burden is not

A payer reviewing a high cost therapy against its indication is doing something defensible. Specialty products carry real cost exposure, and some share of prescribing does fall outside the evidence supporting it. A mechanism that checks for that is a reasonable instrument rather than a hostile one.

Where the design turns punitive is in volume, repetition and opacity. A single authorization is manageable for a practice that has done one before. The same request arriving from many payers, each with its own criteria, portal and documentation standard, becomes a staffing problem rather than a clinical one. Every individual step can be defended while the sequence as a whole remains impossible to navigate.

The patient experiences none of that detail and all of its consequence. She was told a therapy had been chosen for her, and then nothing happened for a period nobody could specify. A person with no visibility into a process will often conclude that the process has ended.

What the evidence actually shows

The public evidence here is unusually clear for a commercial topic. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. The same study found that 48.4 percent of those rejected prescriptions were never followed by a fill of that drug or anything in its class within ninety days. Almost half of those rejections turn out to be an ending rather than a stage.

The view from inside the practice supplies the other half of the picture. A 2024 AMA physician survey found 93 percent of physicians reported that prior authorization delays care, and 82 percent reported that it at least sometimes leads to patients abandoning treatment. Those are the people operating the mechanism daily, reporting on its effects rather than its intent. Neither figure implicates anyone's competence, and the two together describe a process working as designed while producing an outcome none of its parts was asked to prevent.

Is any of this friction legally required?

The compliance explanation deserves examination, because it is the one most often offered. Regulation in this industry governs claims rather than burden. The rules are exacting about what a company may say regarding efficacy, safety and comparative benefit, and close to silent on how long an office spends assembling a payer submission. Almost none of the friction inside an authorization is required by law.

That changes the category of the problem. Constraints written into law get worked around. Constraints nobody owns get picked up by whichever party decides the outcome matters to it. This process sits in the second category, which is a more hopeful finding than it first sounds.

The six hurdles that turn burden into drag

Authorization sits on the Path to Fulfill , the stretch between a clinical decision and a medicine in a patient's hand. Friction on that stretch accumulates as several distinct obstacles, and six of them recur often enough that I name them. Administrative burden is the volume of work transferred to a practice or a household. Disconnected handoffs are the points where context stops traveling between parties.

Lack of visibility is the absence of any single view of where a case currently sits. Fragmented support describes a patient helped by several programs and served by none of them. Poor escalation is what happens when an exception meets a queue instead of a person. Process complexity is the compound effect of the other five arriving at once.

Authorization is the one process on which all six tend to appear together. Friction is an economic variable, and accumulated friction becomes commercial drag. A practice that meets all six will, rationally enough, begin steering toward products that do not demand the whole sequence. That steering rarely appears in any report as a consequence of burden.

What a manufacturer controls and what it does not

The useful question is narrower than the debate usually allows. Two things sit outside a manufacturer's control entirely, which are the payer's coverage criteria and the adjudication decision itself. Everything else about the operation of this process is addressable, and most of it is addressable without anyone's permission. Confusing those two categories produces the two standard failures.

The first failure is lobbying when the work to be done is operating. A company convinced that the criteria are the whole problem directs its energy at policy, which may be worthwhile and will not change a single case this quarter. The second failure is giving up, on the reasoning that none of this belongs to us. Both conclusions follow from the same category error.

Five moves that sit inside that boundary

The first is documentation quality. A manufacturer can equip an office with clinical support material that matches what payers actually ask for, rather than material built for a promotional purpose and repurposed under pressure. Completeness at first submission is often the largest single determinant of how long a case takes.

The second is the time an office spends assembling that material. Hours of clinic staff time per case are a cost the manufacturer's requirements caused and the practice absorbs. Reducing those hours is a design exercise in forms, templates, prefilled fields and criteria mapping, and it needs no external approval. Practices remember which products are cheap to prescribe administratively, and that memory outlasts any campaign.

The third is visibility into where a case currently sits. A practice that can see status stops making the calls that consume its afternoon, and a patient who can see status stops concluding that nothing is happening. Visibility is one of the six Consumer-Grade conditions for a reason, because a person's tolerance for waiting depends largely on knowing what she is waiting for.

The fourth is a named owner for exceptions. Most authorization processes handle the standard case adequately and collapse on the unusual one, which is where the clinically urgent cases tend to concentrate. An escalation lottery, in which an exception travels wherever the last person sent it, is the arrangement I find most often rather than a deliberate one. Replacing it means naming a person, giving that person authority, and publishing how a practice reaches them.

The fifth is measurement, and it is the one most often missing. A manufacturer that cannot state how many of its authorizations reach approval, and how long they take, has no basis for improving either. Approval rate and cycle time are the two numbers that turn this process into something managed rather than endured.

How the burden becomes a commercial number

Burden stays a complaint until somebody expresses it in the currency a business review already reads. The Realization Rate is realized value divided by earned value, which reports the share of what the science earned that actually became therapy. Customer Value at Risk is earned value multiplied by one minus that rate, which states the shortfall as money. Authorization failure tends to be among the larger contributors to that shortfall.

What makes the number persuasive is that no competitor takes the value. An unresolved authorization frequently does not move the patient to a rival therapy, because it removes the therapy from her life altogether. That pattern is what I mean by value leakage , and its distinguishing feature is that nobody gains from it. The wider accounting of it is the subject of a practice note on the value lost between script and patient .

Why nobody in this chain is failing

Everyone involved here is doing their own job competently. The payer reviews against published criteria. The practice triages against finite clinic hours. The hub closes cases against a defined service level, and the manufacturer promotes against a share target.

The failure sits above all of those jobs, at a level where nobody holds a mandate. No role in the current arrangement is defined as accountable for whether a clinically justified decision becomes a therapy. That absence is structural rather than cultural, which means it responds to design rather than to exhortation. Design gaps can be closed in ways that character gaps never can.

What closes it is an operating loop rather than a program. Capturing the signal when a case stalls, classifying the barrier, assigning an owner, intervening, measuring progression and learning from the result is the sequence, and the frontline usually sees the signal first. In my experience a field colleague knows which practice has quietly stopped submitting authorizations weeks before fill data reveals the same pattern. The standard that loop has to meet was set outside this industry, by every other service in a patient's life.

Key Takeaways

Prior authorization is a legitimate utilization management mechanism, and the problem is how the burden of operating it has been distributed.
The two parties least equipped to absorb that burden, a prescriber's office and a patient, are the two now carrying most of it.
The payer's coverage criteria and the adjudication decision sit outside a manufacturer's control, while almost everything about the operation of the process sits inside it.
Documentation completeness, assembly time, case visibility, a named exception owner and measurement are the five moves available without anyone's permission.
Regulation in this industry governs claims rather than burden, which leaves almost none of this friction legally required.
No role in the current arrangement is accountable for whether a clinically justified decision becomes a therapy, which makes this a design gap.

Diagnostic Questions to Consider

Name the single executive accountable for whether an authorization on your largest brand reaches approval.
State your current approval rate and your median cycle time for authorizations on that brand.
Estimate the hours of clinic staff time your access requirements consume per case, supported by evidence rather than assumption.
Describe what happens to an urgent exception today, including who receives it and how a practice reaches that person.
List which parts of your authorization documentation exist because a payer requires them and which exist because nobody has reviewed them.

Closing Reflection

This process consumes an extraordinary amount of capable human effort to produce an outcome nobody wanted. Clinic staff spend afternoons on portals, hub agents work queues conscientiously, and payer reviewers apply criteria as written. The effort is real, and the result is often a patient who concluded, reasonably enough, that her therapy was never going to happen.

The honest reading is that the mechanism is defensible and its operation is unowned. A manufacturer that accepts the first half of that sentence and acts on the second half has far more room to move than most assume. The payer's criteria will stay where they are for now, while the time, the clarity, the visibility and the ownership are all available this quarter.

What this asks for is a company willing to treat burden as an economic variable rather than as an industry grievance. Measured that way, authorization stops being a policy topic and becomes a yield question with a named owner and a number attached. That is a change in category rather than a change in effort, and it is available to any organization that decides to make it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

The Path to Adhere: From First Fill to Demonstrated Duration

Sat, 10 Oct 2026 13:50:00 GMT

The Path to Adhere runs from a first fill to the duration the clinical trial actually demonstrated, and it is the third of three paths on which pharmaceutical value survives or is lost. It covers the unglamorous months in which an efficacy claim either becomes true for a particular person or does not. Organizations tend to be attentive at the start of a relationship and distracted by the middle. This path is almost entirely middle.

A qualification belongs at the front of any page about adherence. Some attrition here reflects sound clinical judgment, a tolerability problem, a change in circumstance, or an informed decision by a patient who has weighed it and chosen otherwise. Those decisions deserve respect rather than remediation. The work on this path is to separate them from the cases where somebody could not move forward because information was unclear or responsibility was unresolved.

The three paths are separate because they fail for unrelated reasons and respond to unrelated work. The Path to Prescribe fails before a decision exists. The Path to Fulfill fails in the administrative space immediately after it. This one fails slowly, across a period when a patient has stopped being anyone's active concern.

A journey with no name has no owner, no budget line and no place on a scorecard. That may be why this path persists largely untouched inside organizations otherwise exacting about cost. The model underneath all three is the move from a commercial funnel to a flywheel, and a funnel stops at the purchase. In pharma the written prescription occupies that position, which places this path several stages beyond where commercial attention usually ends.

What the Path to Adhere actually covers

The path begins at the moment a patient has the medicine and has to live with it. Titration, side effect management, injection technique, refill timing, insurance renewals and the slow administrative attrition of a specialty pharmacy relationship all sit inside it. None of that is clinically dramatic and all of it is consequential.

Three transitions carry most of the loss I see on this path. The first weeks are the hardest, because side effects often arrive before any benefit does. The point around ninety days matters because an initial supply runs out and a renewal process has to work. The annual benefit reset matters because a formulary change can end a working therapy without anyone intending it.

The parties present at each transition are different again. A prescriber sees the patient at intervals measured in months. A specialty pharmacy sees a transaction. A manufacturer sees a dispense record arriving with a lag. Nobody in that arrangement is watching the week in which the patient actually decided.

Which discontinuations deserve respect

The distinction between a reasoned stop and an unsupported one carries the whole ethical content of this path. A patient who discontinues after a frank conversation about tolerability has been well served. A patient who discontinues because she could not get an answer about a refill has not been. The two look identical in persistence data, which is part of why this path resists measurement.

A page about adherence that skips this distinction reads as wanting patients on drugs rather than wanting patients served. The commercial interest and the patient interest align only in the second group, where they align completely. Clearing unclear information and unresolved responsibility does not push anyone toward a therapy they do not want. It removes the obstacles between a decision somebody already made and the outcome that decision was meant to produce.

Separating the two groups requires something I have rarely found inside an adherence program. It requires knowing why a particular patient stopped, at the time she stopped, from a source closer than a claims record. That is a listening problem before it becomes an intervention problem, which is why generic adherence messaging often performs poorly.

How this path fails

This path fails slowly, in a period when the patient has stopped being anyone's active concern. The prescriber has moved on to the next presenting problem. The hub has closed the case as a success, because by its own definition it was one. The field has recorded the win and moved its attention to the next account.

Each of those actions can be defended inside its own frame. A hub that keeps every case open forever cannot operate. A field colleague who never moves on cannot cover a territory. The design gap is that nobody's frame extends as far as month seven, so the patient leaves the system's field of view while still inside the period her therapy was tested across. A closed case is not necessarily a continuing patient.

An efficacy claim is a claim about duration

The reframing that makes this path commercial rather than charitable is simple to state and harder to absorb. An efficacy claim is a claim about a duration. A trial demonstrated a result over a defined period, under defined conditions of continuation. A patient who stops at week six did not receive the product that was tested.

That has consequences for how a brand team should think about its own evidence. The label describes a therapy taken as studied. Every month of early discontinuation moves the delivered product further from the studied one. A company can hold a strong efficacy claim and still deliver, across its real patient population, something measurably weaker than the claim.

The tenet I work from states it plainly. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value. This path is where continuation and benefit either happen or fail to, which makes it the final arbiter of whether the science did what it was shown to do.

Where the cost of a first fill still decides

This path begins slightly earlier than most organizations assume, at the pharmacy counter. Abandonment at that counter is the first discontinuation, and cost is the clearest predictor of it. IQVIA data reported by Managed Healthcare Executive found that of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients. A therapy that was prescribed, approved and dispensed can still fail to begin.

That figure describes a decision made in a few seconds on incomplete information. The patient at the counter rarely knows whether a copay card exists, whether a lower cost channel is available, or whether the price she was quoted is the real price. She makes a rational choice inside the information she holds. The design gap sits in what she was given to decide with.

Why the commercial funnel ends too early

The tenet that matters most here concerns the boundary of the commercial system itself. The commercial funnel in pharma ends too early, and prescribe, fulfill and adhere belong inside one commercial system. Three paths measured on three scorecards by three functions will behave as three separate businesses. Value does not travel that way, because it either survives the whole distance or it does not.

Experience is the third leg of the value proposition and the one this industry never built, which Customer Excellence exists to build as an enterprise capability rather than a program. The fourth pillar of commercial excellence sits alongside launch, marketing and sales excellence for the same reason. The first three were each built to operate on one path. The fourth is the one accountable for the whole distance.

How progression on this path is measured

Progression on all three paths is measured on one ladder, which is what makes them a single system rather than three initiatives. The stages are Scripts Written, Filled, Therapy Started, 90-Day and Persistence. This path owns the last two and shares the third. Those are also the stages most commercial organizations report least often and understand least well.

The yield measures sit above the ladder. The Realization Rate is realized value divided by earned value, which reports what share of what the science earned actually became therapy. Customer Value at Risk is earned value multiplied by one minus that rate, which puts the shortfall into the currency a finance committee already reads. Measured that way, adherence stops being a patient support topic and becomes a yield question belonging in a business review.

An illustrative compounded scenario I published with TheyDo traced the shape of the erosion across all three paths. A billion dollars of earned value becomes roughly seven hundred million after prescriptions never filled, falls again after early discontinuation, and settles close to four hundred and fifty million in realized value once long term adherence erosion is counted. No competitor takes the difference. The final two steps of that decline belong to this path.

What ownership on this path would look like

Ownership here means something rather different from the other two paths. On the Path to Fulfill, ownership means holding a chain of parties to an outcome none of them individually owns. On this path, it means sustaining attention across a period during which nothing is scheduled to happen. That is an operating model question rather than a messaging one.

Practically, it means a named owner for the 90-Day and Persistence stages and a signal source closer to the patient than claims data. It also means a mechanism that assigns each identified barrier to somebody able to clear it. Consumer-Grade is the standard that applies here, because the expectation a patient brings to month seven was set by every other service in her life. None of those services forget she exists after the first transaction.

Key Takeaways

The Path to Adhere runs from a first fill to the duration the trial actually demonstrated, across the months in which an efficacy claim becomes true or does not.
It fails slowly, in a period when the prescriber has moved on, the hub has closed the case and the field has recorded the win.
Some attrition reflects sound clinical judgment or informed patient choice, and the work is to separate those decisions from unresolved ones.
An efficacy claim is a claim about a duration, so a patient who stops at week six did not receive the product that was tested.
Of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients, which makes abandonment the first discontinuation.
Progression is measured on one ladder across all three paths, and this path owns the 90-Day and Persistence stages.

Diagnostic Questions to Consider

Name the person accountable for a patient in month seven of therapy on your largest brand.
State your current persistence rate at twelve months and the method used to establish it.
Describe how you currently distinguish a clinically reasoned discontinuation from an unsupported one.
Identify your earliest available signal that a patient has stopped, and how many weeks it lags her decision.
List what changes in a business review when adherence is reported as a yield figure rather than a support metric.

Closing Reflection

Adherence has been discussed in this industry for decades, mostly as a patient support topic and occasionally as a moral one. Neither framing ever gave it a budget line that survived a difficult quarter. Treating it as the final stage of value realization does, because a yield figure competes for funding on the same terms as everything else in a commercial review.

The qualification from the opening of this page holds all the way through it. Some patients stop for reasons that are entirely sound, and no commercial system should be built to talk anyone out of a considered decision. The target is narrower and more defensible, which is the patient who wanted to continue and could not find out how.

The destination is three paths measured on one ladder, with a single owner accountable for the whole distance. That arrangement is unusual in this industry and entirely available to it, because nothing in the regulation or the science prevents it. What it asks for is a company willing to measure what its science earned against what its patients actually realized.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

The Path to Fulfill: From Clinical Decision to Medicine in Hand

Sat, 10 Oct 2026 13:30:00 GMT

The Path to Fulfill runs from a clinical decision to the medicine in a patient's hand, and it is the second of three paths on which pharmaceutical value survives or is lost. It passes through benefit verification, prior authorization, affordability support, specialty pharmacy coordination, onboarding and first fill. Most organizations are precise about the things they control and vague about the things they merely influence. This path is made almost entirely of the second kind.

Each step here is administered by a different party operating under different incentives. A payer is managing cost exposure, a pharmacy is managing throughput, a hub is managing case closure, and a prescriber's office is managing clinic time. Every one of those parties is behaving rationally inside its own mandate. Each handoff between them is a point at which a clinically justified decision can stall or quietly end.

The three paths are separate because the reasons they fail have almost nothing in common. The Path to Prescribe fails before a decision exists, through patients who never arrive and diagnoses that come late. This path fails after the decision, in the administrative space where no single party is accountable for the outcome. The Path to Adhere fails later still, across months in which a patient has stopped being anyone's active concern.

That separation matters because a journey without a name has no owner, no budget line and no place on a scorecard. It may be the reason this path has survived largely as it is inside organizations otherwise exacting about cost. The model behind all three is the move from a commercial funnel to a flywheel, and a funnel conventionally ends at the purchase. In pharma the written prescription stands where the purchase stands, which leaves this path on the far side of where commercial attention usually stops.

What the Path to Fulfill actually covers

The path opens the moment a prescriber decides and closes when a patient takes a first dose. Between those two points sits a sequence that varies by product, payer and geography, and rarely looks the same twice. Benefit verification establishes whether coverage exists. Prior authorization establishes whether the payer agrees with the prescriber. Affordability support establishes whether the remaining cost is survivable for a household.

Then come the steps that look administrative and behave decisively. Specialty pharmacy coordination moves a product through a restricted channel carrying its own enrollment requirements. Onboarding covers training, devices, shipping windows and the conversation in which somebody explains what to expect. First fill is the only one of these a commercial organization usually counts, and it arrives last.

The shape of this path deserves stating plainly. No single organization designed it, which means nobody is in a position to redesign it alone. It assembled itself out of the separate rational decisions of payers, pharmacies, providers, hubs and manufacturers across several decades. A system that nobody designed will rarely behave as though somebody had.

How this path fails

This path fails administratively, which is the least dramatic and most expensive of the three failure modes. Nothing breaks in any visible way. Forms sit, queues advance, and a patient with no view of any queue concludes that the therapy is not happening. The decision was made, the clinical judgment was sound, and the outcome quietly diverged from both.

The accountability gap is the mechanism rather than anyone's indifference. A payer is accountable for an adjudication rather than for a therapy started. A hub is accountable for closing a case, which can be closed in either direction. No party in the chain carries accountability for whether the patient ends up on treatment. The six classes of access barrier on this path each have a different owner, which is why no single intervention clears them all.

What the rejection evidence shows

This is the path with the clearest public evidence. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. The same study found that 48.4 percent of those rejected prescriptions were never followed by a fill of that drug or anything in its class within ninety days. The first figure describes a negotiation. The second describes an ending.

No competitor took that value. Almost half the time, a rejection that goes unresolved does not move a patient to a rival therapy, because it removes the therapy from her life altogether. That pattern is what we call value leakage , and its distinguishing feature is that it benefits nobody at all. An illustrative compounded scenario I published with TheyDo traced it as a billion dollars of earned value becoming roughly seven hundred million once prescriptions never filled are counted.

The wider accounting of that gap is the subject of a practice note on the value lost between script and patient . The short version is that the loss concentrates here rather than distributing itself evenly across the three paths. A decision has already been made by the time this path begins, which means the expensive work of persuasion is complete. Losing the patient afterwards wastes the most costly asset the commercial system has.

The six hurdles that accumulate into commercial drag

Friction here arrives as a set of obstacles rather than one, and I name six because six is what organizations consistently find. Administrative burden is the volume of work transferred to a patient or a practice. Disconnected handoffs are the seams between parties where context fails to travel. Lack of visibility is the absence of any single view of where a case actually stands.

Fragmented support is the condition of a patient being helped by several programs and served by none of them. Poor escalation is what happens when an exception has nowhere to go. Process complexity is the compound effect, in which each step is defensible while the sequence is not navigable. Individually these are irritations, and accumulated they become commercial drag, which is friction expressed as an economic variable.

Accumulation is the part most improvement programs miss. A single prior authorization is manageable for a practice that has done it before. The same authorization layered onto a benefit check, a copay enrollment, a pharmacy transfer and a device training session is a different proposition entirely. Every interaction on this path either compounds value or creates drag, and these six hurdles are how the drag gets made.

Is any of this friction legally required?

Regulation takes most of the blame for this path and deserves a good deal less of it. Regulation in this industry governs claims rather than burden. It is exacting about what a company may say regarding efficacy, safety and comparative benefit, and nearly silent on how many times a patient must repeat a date of birth. Almost none of the friction a patient meets between a prescription and a first dose is legally required.

That distinction changes what kind of problem this is. A mandated constraint is something to work within. An unowned one is something available to whoever decides to own it. Compliance review is real and demanding work, though it rarely explains why a hub closes a case without resolving it.

What the companies shortening this path have done

Several companies have already shortened this path, and the method rewards careful reading. They set a cash price and routed around the access sequence altogether, which removes benefit verification, prior authorization and copay administration from the patient's experience in a single move. What Lilly changed with LillyDirect and Novo Nordisk's consumer business are both examined elsewhere in this practice. What matters here is where the decision came from.

It came from commercial leadership, as a pricing and channel decision. No experience function proposed it, no journey map produced it, and no satisfaction score triggered it. A pricing decision turned out to be the most consequential experience intervention available on this path, which says something uncomfortable about where authority over experience sits. The companies that read this correctly understood the obstacle as structural rather than attitudinal.

The move also sets a standard that now applies to everyone, including the companies with no intention of following it. A patient who has obtained one medicine in four minutes on a phone holds that as her reference point. Her next therapy gets compared to it rather than to the category's own history. Consumer-Grade is the name we give that expectation, and it does not adjust downward for the complexity of the science.

How progression on this path is measured

Progression on all three paths is measured on one ladder, which is what makes them a single commercial system rather than three programs. The stages are Scripts Written, Filled, Therapy Started, 90-Day and Persistence. This path owns the distance between the first two stages and most of the distance to the third, which very little else in the commercial measurement stack reports at all.

The yield measures sit on top of the ladder. The Realization Rate is realized value divided by earned value, which is the share of what the science earned that actually became therapy. Customer Value at Risk is earned value multiplied by one minus that rate, which states the shortfall in the currency a finance committee already uses. A company able to quote both numbers can argue about which path to fund, where a company without them is still arguing about whether experience matters.

The signals on this path reach the frontline first, often weeks before any dashboard registers a pattern. A field colleague knows which practice has stopped submitting authorizations long before fill data makes the same observation. Capturing the signal, classifying the barrier, assigning an owner, intervening, measuring progression and learning from the result is the closed loop this path needs and rarely has.

Key Takeaways

The Path to Fulfill runs from a clinical decision to a first dose, through verification, authorization, affordability, pharmacy coordination and onboarding.
Each step is administered by a different party with different incentives, and no party is accountable for whether the patient reaches treatment.
Insurer rejections reached 40.7 percent of initial brand name attempts in 2024, and 48.4 percent of rejected prescriptions were never followed by any fill in that class within ninety days.
Six hurdles accumulate here into commercial drag, namely administrative burden, disconnected handoffs, lack of visibility, fragmented support, poor escalation and process complexity.
Regulation in this industry governs claims rather than burden, so most of this friction is unowned rather than mandated.
Companies that set a cash price and routed around access made a pricing and channel decision that functioned as an experience intervention.

Diagnostic Questions to Consider

Name the single executive accountable for the whole distance between a written prescription and a first dose.
State what proportion of prescriptions written for your brand last quarter resulted in a dispense within thirty days.
List which of the six commercial drag hurdles your patients meet most often, supported by evidence rather than assumption.
Identify which elements of friction in your access sequence are legally required and which are simply inherited.
Describe how a rejected prior authorization in a single practice becomes known to somebody with authority to act on it.

Closing Reflection

This path is where the industry's most expensive work is most often wasted. A clinical decision represents the successful conclusion of everything the commercial system does on the path before it. Losing the patient immediately afterwards, for administrative reasons nobody intended, is a poor return on four decades of accumulated capability.

The honest reading is that this path is unowned rather than broken. Every party in it performs its own role competently, and the gap sits in the spaces between the roles where nobody holds a mandate. That makes it a design gap, and design gaps are fixable in ways that character gaps never are.

The commercial funnel in pharma ends too early, and this path is the first thing waiting on the other side of where it stops. Prescribe, fulfill and adhere belong inside one commercial system, measured on one ladder and owned by somebody who holds the whole distance. I have yet to meet a company that did that work and regretted it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

The Path to Prescribe: From Undiagnosed Patient to Clinical Decision

Sat, 10 Oct 2026 13:10:00 GMT

The Path to Prescribe is the journey that runs from an undiagnosed patient to a clinical decision, and it is the first of three paths on which pharmaceutical value survives or is lost. It covers everything that has to happen before a prescriber can act, including the patient arriving, the condition being recognized, the evidence being available and the moment being right. Institutions tend to measure the things they already know how to see. That habit explains a good deal about why this path is the best instrumented of the three and still incomplete.

Three paths exist rather than one because they fail for entirely different reasons, sit with different functions and respond to different work. This one fails before a decision is ever made. The Path to Fulfill fails in the administrative space after it, and the Path to Adhere fails during the months when nobody is watching. Collapsing them into a single journey produces a diagram rather than a diagnosis.

The model behind all three is the move from a commercial funnel to a flywheel, which I worked through in the chapter on commercial DNA. A funnel is built to acquire and is sub-optimized for everything that follows acquisition. In pharma the written prescription sits roughly where the purchase sits in a consumer funnel, and the industry has largely organized itself to reach that point and stop.

What the Path to Prescribe actually covers

This path begins long before a brand team becomes involved, with a person who has symptoms and no name for them. It continues through primary care, referral, diagnostic workup and specialist assessment, each of which can add months to the elapsed time. It ends at the point the therapeutic value chain treats as its pivot, the clinical decision itself. Everything the commercial system does here has one purpose, which is to put the state of the art in front of that decision before it is made.

The path carries the work of several functions that rarely share a scorecard. Medical Affairs carries scientific exchange and the evidence environment a clinician actually reads. The Field Force carries the relationship and the account context that determine whether any of it lands. Marketing carries the message, the channel mix and the demand generation that brings patients into care at all. The Brand Team sits above all of it as the named owner, here and on the other two paths.

Why three paths rather than one journey

A single journey map flattens three different kinds of failure into one picture, which makes the picture useless for allocating work. Each path has its own failure mode, its own cast of parties and its own remedy. Treating them as one encourages a company to fund a general improvement effort and then wonder why so little moved.

There is a second reason, and it is the more uncomfortable one. An unnamed journey has no owner, no budget line and no place on a scorecard. That may explain why these paths survive untouched inside organizations that are otherwise exacting about cost. Naming them is less a semantic exercise than a precondition, because a name is what makes accountability assignable.

How this path fails

This path fails quietly, which is what makes it the hardest of the three to argue about in a commercial review. Patients who never arrive leave no record. Diagnoses that come late tend to appear in the data simply as diagnoses. A condition carried for years without a name is invisible to every system this industry has built.

The clinician side fails just as quietly. A specialist may hold the evidence and never meet the moment where it would have changed a decision. A guideline may be current while a habit is considerably older. Nothing on a dashboard registers a patient who was never seen, so the loss on this path is real and almost entirely unbooked.

The one path pharma genuinely industrialized

Fairness matters here more than provocation. Of the three paths, this is the only one pharma has genuinely industrialized, and it has done so across roughly four decades. Launch excellence, marketing excellence and sales excellence were each built to operate on this path, and they operate well. The instruments are strong, the talent is deep, and the practice behind them is real.

That strength is also the reason the gap is so easy to miss. Excellence concentrated in one place can read as excellence overall, particularly when the measurement system lives in the same place. A company can run a textbook launch, win share of voice, hold a strong recall position and still lose most of what its science earned. The losses occur on paths the instruments do not reach.

Where the brand team's instruments run out

The structural problem sits in a mismatch between what the brand team owns and what it can see. The brand team ostensibly owns the brand end to end, which means across all three paths. Its instruments sit almost entirely in this one, namely prescribing data, market research, message testing, share tracking and promotional response. Each of those is a capable instrument for the question it was built to answer, which is whether a prescriber can be persuaded.

None of them was built to answer whether a decision survived. A share tracker cannot report that a clinically justified prescription was rejected by a payer in February. Market research cannot report that a patient stopped at week six because a form went unanswered. Those events belong to the Path to Fulfill and the Path to Adhere, where the brand team holds accountability and very little instrumentation.

That asymmetry is why a company can be excellent on this path and still lose most of what it earns. Excellence at generating intent does not confer visibility into whether intent became therapy. The written prescription is intent rather than realized value, which is the first of the tenets I work from. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written.

What customer consciousness asks of this path

The best work on this path happens before a market exists. Customer consciousness in its upstream sense means reading a customer's world deeply enough that what their life is making them need becomes visible before any market has formed around it. That is a research posture rather than a forecasting exercise, and it is rarer in this industry than the sheer volume of market research would suggest.

In our practice that question sits inside the Convergence Readiness Model, which names seven conditions that tend to precede a category forming. They are persistent need, normalized burden, identity intensity, cultural readiness, self recognition, scientific unlock and ecosystem potential. Categories that look sudden from the outside often satisfy most of those conditions years in advance. The GLP-1 phenomenon is the clearest recent instance, and its signals were legible well before the market was.

Reading those conditions early is a Path to Prescribe capability, though it rarely sits where the rest of the path's instruments sit. It asks a brand team to study a life rather than a market. It also asks for patience, because the signal appears long before the revenue does. Companies able to do both tend to arrive in a category as its author rather than its fourth entrant.

How progression on this path is measured

Progression on all three paths is measured on one ladder, which is what makes them a single commercial system rather than three initiatives. The stages are Scripts Written, Filled, Therapy Started, 90-Day and Persistence. This path is accountable for the first stage and, more importantly, for the size of the population that reaches it at all. A company counting only that first stage is measuring intent and reporting it as performance.

The yield question follows from the ladder. The Realization Rate is realized value divided by earned value, and it reports what share of what the science earned actually became therapy. Customer Value at Risk is earned value multiplied by one minus that rate, which converts a shortfall into a figure a finance committee already knows how to read. Both measures span the three paths, because a shortfall can originate in diagnosis, in fulfillment or in the months after a first fill.

The ladder also changes what field intelligence is for. Field intelligence is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke. That combination makes it the most unimpeachable and actionable intelligence in the commercial system, and it is largely uncollected. An operating blueprint for field intelligence and activation exists to turn that observation into assigned work rather than anecdote.

Read that way, field force effectiveness stops being a question about coverage and call plans. It becomes a question about how much of what the field already sees survives the trip into a decision somebody makes. Very little of the friction on this path is discovered by headquarters first. Almost all of it is seen by somebody in a parking lot outside a clinic.

Key Takeaways

The Path to Prescribe runs from an undiagnosed patient to a clinical decision, and it is the first of three paths where earned value survives or is lost.
It fails quietly, through patients who never arrive and diagnoses that come late, which leaves the loss real and almost entirely unbooked.
Pharma has genuinely industrialized this path across four decades of launch, marketing and sales practice, and its instruments are strong.
The brand team owns all three paths while its instruments sit almost entirely in this one, which is why excellence here can coexist with large losses elsewhere.
Customer consciousness in its upstream sense reads a customer's world before any market has formed around it, which is where new categories become visible.
Progression is measured on one stage ladder across all three paths, running from Scripts Written through Persistence.

Diagnostic Questions to Consider

Name the function accountable for the patients in your category who never reach a diagnosis at all.
List the instruments your brand team currently holds that report on anything occurring after a prescription is written.
State how long a patient in your category typically carries the condition before it is named.
Describe the signals you would have needed in order to see a converging category three years before it formed.
Identify your current Realization Rate and which of the three paths accounts for most of the shortfall.

Closing Reflection

The Path to Prescribe is the path this industry knows how to work, and that deserves saying plainly rather than grudgingly. Four decades of launch, marketing and sales practice produced real capability, and the people who built it were not wrong about what they were building. The limitation is one of scope rather than quality.

What follows is a question about boundaries rather than about effort. The commercial funnel in pharma ends too early, at the written prescription, and prescribe, fulfill and adhere belong inside one commercial system. A company that accepts that proposition then has to extend its instruments past the point where its current ones stop, which is an uncomfortable budget conversation rather than a philosophical one.

I have rarely found an organization that lacked the will to do this. What tends to be missing is a named path, an owner who holds it whole, and a number that makes its condition visible in a quarterly review. Those three things are structural decisions, available to any company prepared to make them.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Resequencing Organizational DNA in Pharma

Sat, 10 Oct 2026 11:15:00 GMT

Companies rarely fail their customers in the places they have studied most carefully. They fail at the handoffs, where no single function has been asked to carry an outcome all the way through. A pharmaceutical commercial organization makes this easy to see, because it is often well designed at the center of each function and largely silent at the joins.

Benefit verification, prior authorization, affordability, specialty pharmacy coordination, onboarding and first fill each sit partly inside a function and wholly inside none. The failures cluster precisely in the spaces no organization chart describes. That pattern is a design gap rather than a character gap, and the people working inside it deserve respect.

In most companies the clearest evidence of the gap is the small customer facing team that keeps rescuing those joins. Heroics are a subsidy, because they let an organization deliver promises its routine processes cannot reliably support. The cost is absorbed through discretionary effort, where nobody records it and nobody budgets for it.

Chapter eight of my book calls the remedy resequencing organizational DNA, and its objective is easy to state and hard to install. Customer outcomes have to become a shared accountability rather than the private burden of a few committed people. This layer sits directly after Leadership DNA , which decides whether a customer commitment survives contact with a quarterly target.

Becoming the kind of company that helps requires a shift in organizational orientation rather than a shift in effort. The aim is an enterprise structurally predisposed to help, instead of one that places that responsibility on the shoulders of a few individuals. Getting there demands attention to the under-appreciated soft factors inside organizations.

Institutional mindsets, beliefs, mental models and behaviors form the collective consciousness of a company. They drive how it thinks, how it functions and how it interprets its place in the world. Instilling shared accountability is a cultural change with a philosophical dimension and a practical one, and it tends to prove more enduring than routine cost takeout or technology led transformation.

Mental models decide what an organization believes is possible

Corporate mental models are the cognitive frameworks through which organizations make sense of the world. They work behind the scenes, quietly guiding corporate behavior long after anyone remembers choosing them. Two practices sit underneath the first bold move, which is to reimagine the art of the possible.

The first is to decode what customer experience outliers actually do, rather than what they claim in an annual report. Customers now carry the same standards into every interaction regardless of category, so the outlier in another industry is already setting the expectation in this one. The second practice is to ask why not us, as a counterpunch to the mental block that says it will not work here.

In pharma that block takes a specific and respectable sounding form, which is that regulation prevents it. Regulation here governs claims rather than burden, and almost none of the friction a patient meets between a prescription and a first dose is legally required. I have watched capable teams retire a sound idea on a regulatory objection that nobody had actually tested. That objection is one of four beliefs that hold the experience gap in place , and each of the four moves under a different kind of pressure.

Benchmarking against peers guarantees the wrong standard

Admiring outliers from a distance changes nothing. The second move is to seek outside perspectives, which means creating thought partnerships that bring an organization angles it does not have on its own. Peer sounding boards let a company test and de-risk an idea before it commits capital or reputation to it.

My own schooling came at the Ritz-Carlton, a two time recipient of the Malcolm Baldrige National Quality Award. One condition of that award is that the recipient codify its methodologies and make them available to others, which is how an outsider can study a standard rather than admire it. Very little of what I learned there was proprietary, and almost none of it was expensive.

Pharma's instinct is to benchmark against pharma, which guarantees that the standard it meets is the one its patients are not applying. A company can be comfortably above the industry median and still sit well below what a patient considers ordinary. That gap rarely shows up in a competitive review, because the comparison set was chosen before the question was asked.

Principles turn good intentions into something teachable

The third move is to codify the obligation to customers. Company specific customer excellence principles turn the good intentions of customer centricity into something that can be understood, trained, implemented and sustained. These principles have to embody the specific experiential factors a company chooses as its basis of competition, tailored to its own context, because borrowed language rarely survives first contact with a real operating decision.

The Ritz-Carlton expresses personalization in its Service Values with a single line an employee can act on. I am empowered to create unique, memorable, and personal experiences for our guests. Notice what that sentence does. It names the behavior, grants the authority and leaves no room to pass the obligation along to somebody else. The line is also short enough to recall under pressure, which is the only test a principle really has to pass.

Pharma has an advantage here that it rarely uses. The obligation to patients is already the stated reason the company exists, so the principles do not have to be invented from nothing. They have to be translated out of mission language and into behavior language that a colleague can apply inside a single interaction.

Enterprise scale matters more than a central function

The fourth move is to create a framework for sustainability. Rather than isolating principles inside a centralized function, the aim is enterprise scale and enterprise wide consistency, so that experiences feel the same across channels and interactions. Adoption can then be de-risked through co-design, because a customer centric culture has to be created and owned from inside the organization.

Outsiders can facilitate the design process, though the culture itself has to flow from the collective consciousness of the company. Employee led co-design is an activation strategy in its own right, because it produces ownership and therefore accountability. Teams rarely argue with principles they helped write, which quietly changes the answer to the question of who owns customer experience inside a commercial organization.

Designing principles and activating them are different jobs

The fifth move is to document the principles. Codifying them through purposeful and creative documentation removes ambiguity about what a company expects of itself. Zappos publishes an annual Culture Book, HubSpot maintains its Culture Code, and the Ritz-Carlton carries its Gold Standards. The format matters less than the fact that an employee can hold the obligation in their hands and point to it.

Documentation also does something quieter. It makes a commitment auditable, which means a decision that contradicts the commitment shows up as a contradiction rather than passing as a trade off. Most organizations do not need more conviction. They need fewer places to hide a shortcut.

Accountability concentrated in one team is a design flaw

In many companies accountability for customer outcomes is relegated to a small group of employees in customer care, customer experience or customer success roles. Those colleagues carry the weight of customer centricity for an entire organization, and some of them do it remarkably well. That is the condition the sixth move dissolves, because concentrated accountability caps the result at whatever a few people can personally absorb.

Cascading customer excellence promotes knowledge diffusion, so that how customers are treated becomes a shared endeavor rather than one team's remit. In practice that means the market access colleague, the medical liaison and the contact center representative all read the same obligation and recognize their own part in it. The work is less about training volume and more about removing the assumption that somebody else is handling the seam.

Diffusion also protects a company when a dedicated team is reorganized or reduced. A capability held in one place can be removed in a single decision.

No single layer of DNA holds on its own

Leadership DNA determines whether the commitment survives contact with a quarterly target. Organizational DNA determines who owns the seams. Operational DNA determines whether helpfulness is repeatable without an exceptional colleague. Commercial DNA determines whether measures, incentives and investment decisions reward realized value rather than declared intent.

No one of the four holds on its own, and the second is the one most often skipped. A company can appoint a credible leader, rebuild a process and still watch the outcome fall into a seam nobody owns. The organizational layer is what converts a stated intention into an assigned one.

Sequence matters less than coverage. A company that works on all four layers at a modest pace tends to outperform one that perfects a single layer and leaves the rest to goodwill. The seams are where that choice gets tested, which is why the organizational layer deserves more patience than it usually receives.

Key Takeaways

Pharmaceutical commercial organizations are often strongest at the center of each function and weakest at the joins between them.
Customer failures tend to cluster in the seams no organization chart describes, which makes them a design problem rather than a performance problem.
Heroics from a small customer facing team subsidize promises the routine process cannot keep, and the cost is rarely recorded anywhere.
Shared accountability can be installed through mental models, outside perspective, codified principles, documentation and diffusion rather than through a new function.
Organizational DNA is the layer that decides who owns the seams, and it holds only alongside leadership, operational and commercial DNA.

Diagnostic Questions to Consider

Name the single accountable owner for benefit verification, prior authorization and first fill, and note whether that owner exists.
Identify the customer promises your organization keeps only because specific individuals go beyond their role to keep them.
Describe the experiential standards your company has chosen as its basis of competition, in language a colleague could act on tomorrow.
List the outside organizations your commercial leaders learn from, and count how many of them sell medicines.
Assess whether a decision that contradicts your customer principles would be visible as a contradiction or absorbed as a trade off.

Closing Reflection

The soft factors are the ones most often postponed, because they resist a business case and they rarely arrive with a vendor attached. They also tend to outlast the things that do. A company can reorganize twice and reinstall its technology stack and still treat customers exactly as it did before, because the mental models underneath were never examined.

Shared accountability asks something uncomfortable of senior commercial leaders. It asks them to stop congratulating the people who rescue the seams and to start asking why the seams needed rescuing at all. The first instinct is to reward the heroics, which is generous and which quietly guarantees that the design never changes.

Organizational DNA is slow work, and it is the layer that makes everything downstream possible. Once accountability is genuinely shared, an operating model can be rebuilt without needing an exceptional person in every role. That is what a company structurally predisposed to help looks like from the inside.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Refocusing Leadership DNA in Pharma

Sat, 10 Oct 2026 10:55:00 GMT

The beliefs a company truly values and the behaviors it exhibits are largely a function of the leadership tone set at the highest levels. That holds in every industry, and it holds with unusual force in pharma, where the distance between a scientific promise and a patient outcome runs through dozens of handoffs. Leaders rarely touch those handoffs directly. What they do touch is the question of whether anyone is expected to own the whole of them.

Pharma has no shortage of leaders who believe in the customer. The belief tends to live in sentiment rather than in structure, which is why it rarely survives a quarter that comes in light. Commitment that is built into how leaders are evaluated, how capital is allocated and what the board reviews behaves differently.

The gap between those two conditions shows up in how differently leaders and customers describe the same engagement. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs, against 82 percent of life sciences executives who say they are satisfied with those same strategies. A spread of that size may not be an information problem. Executives are reading accurate reports about activity while providers are describing their experience of the system.

Leadership acumen is not a charismatic gift or a title

Exceptional leadership of this kind is not an innate trait that only a few charismatic leaders possess, nor does it belong to anyone holding a Chief Customer Officer or Chief Experience Officer title. What leaders at every level need is a belief that exceptional customer experiences can change the basis of competition in their favor. That belief can be learned, and it can be tested against how a leader spends time, attention and money.

In the book this work sits in the first of four layers, Leadership DNA, ahead of Organizational, Operational and Commercial DNA. The sequence matters more than the taxonomy. Leadership DNA is the layer that determines whether a commitment to the customer survives contact with a quarterly target. Without it the other three layers remain optional. That is the quiet reason so many pharma customer experience programs fail while every initiative inside them performs as designed.

Reframe the theory of the firm around relationship value

The theory of the firm was developed by economists to explain why firms exist and why they organize themselves as they do. Most early conceptions emphasized efficiency, minimized transaction costs and other mass production era factors. Reframing it means recalibrating value drivers and growth vectors around customer relationship value, goodwill, reciprocity and trust. In pharma this is the move from a firm that exists to discover and promote medicines. The reframed firm exists to see those medicines reach and stay with patients.

A firm organized around discovery and promotion funds reach, frequency and share of voice. A firm organized around reaching and staying with patients funds the removal of friction between a decision and a therapy. Both can be reported as growth, and only one of them accumulates something that compounds.

Treat each customer relationship as a quantifiable asset

"Our customers are our most important asset" is one of the most repeated platitudes in business. Treating it as substance means each customer relationship becomes an intangible but quantifiable unit of value on a virtual balance sheet. That brings visibility to which relationships are appreciating, which are depreciating and which are worth further investment. Some of that accounting may be imperfect, and it remains more honest than treating relationships as free.

In pharma the relationships in question are a prescriber's confidence and a patient's willingness to stay on therapy, and both are routinely spent without being counted. A difficult prior authorization draws down prescriber confidence, and a confusing copay conversation draws down patient willingness. Neither withdrawal appears anywhere, which is why value leakage can run for years without a line item.

Experience-led growth belongs inside corporate strategy

An experience-led growth strategy has to be a subset of corporate strategy rather than something created in a vacuum. It has to name the experiential battlefields the company chooses to compete on beyond its core products. It also has to act as a revenue driver across every stage of the lifecycle. Treating experience as a post purchase concern caps what it can return. Strategies written outside those three conditions often produce activity that is admired internally and invisible commercially.

In pharma that means choosing which of the three paths the company intends to be visibly better at, and funding it. The Path to Prescribe, the Path to Fulfill and the Path to Adhere behave differently and fail differently. Most organizations hold strong opinions about the first and carry almost no stated ambition about the other two. Choosing one of them as a battlefield is a strategy decision rather than a program.

Employees read their leaders for what is acceptable

Modeling customer-centric behaviors has less to do with declarations than with what the organization sees leaders repeat. Three practices carry most of the weight.

A cadence of communications brings the customer perspective into management systems rather than leaving it to an annual offsite. Consistency of intent matters because variable experiences across channels produce customer and employee dissonance in equal measure. The third practice is celebration, so that Customer Excellence is visibly rewarded rather than quietly assumed.

What gets celebrated tells employees where discretionary effort can be safely spent. Being this kind of enterprise also means resisting the temptation to chase fleeting management trends and quick fixes. Enduring value comes from structural change, and structural change rarely photographs well in a town hall.

Empowerment turns autonomy into accountability for customer outcomes

When leaders empower employees they entrust them with autonomy and authority, and in return employees feel trusted and accept accountability for customer outcomes. Two components do most of this work, and the first is prioritization, which means putting the customer and the employee on business review and board agendas.

The second is permission, which means granting the institutional permission employees need to uphold brand promises. In pharma, and in my own experience of commercial organizations, the permission question is sharpest in the field. Colleagues there routinely see what is failing a patient and have no sanctioned route to act on it. Field teams in this position are not underperforming, and the structure around them is not built to receive what they know.

Governance is where the commitment becomes verifiable

Governance is the proof that the commitment is real, and it escalates in three steps. The first is to incorporate Customer Excellence into strategic transactions, where diligence usually ignores it entirely. The second is to form a dedicated board committee or sub-committee tasked with championing customer centricity and holding the organization accountable. The third is to integrate customer outcome metrics and narratives into quarterly filings, annual reports and other disclosures.

Each step raises the cost of walking the commitment back, which is largely the point of governance. I have watched organizations complete the first step and treat it as the whole program. The step that changes behavior most reliably is a smaller one. Strategic customer experience metrics belong in executive leadership evaluations, so that leaders are held accountable rather than merely supportive. Culture change that leaves the measurement system untouched tends to stall, which is why the evaluation question comes before the values question.

Pharma's defensible numbers conceal the gap nobody owns

Every function in a commercial organization can defend its own number, and each defense is accurate. Marketing can defend awareness and recall. Sales can defend reach and frequency. Medical can defend scientific exchange, and market access can defend coverage secured. Patient services can defend enrolled patients supported to service levels.

I have sat through reviews where each of those numbers was sound and the patient's path through them was never discussed. Every leader in the room can defend a number while providers and patients continue to experience delay and abandonment. No individual in that room is failing. The structure is not built to surface the thing none of them owns, which is whether earned value becomes realized therapy.

That question has no functional home, so it often gets treated as a measurement problem rather than an accountability one. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled. It falls again after early discontinuation, and settles close to four hundred and fifty million in realized value after long term adherence erosion. No competitor takes the difference, and the Realization Rate is the number that would make the loss visible.

Leadership DNA creates the conditions for the layer beneath it to function. Organizational DNA is the next layer, where structure, roles and incentives either carry the commitment or quietly absorb it. Operational DNA and Commercial DNA follow it in turn, and leaders who skip the first layer tend to buy capability they cannot govern.

Heroics are a subsidy the enterprise never books

Capable people prevent most of these gaps from becoming visible failures. Someone calls a payer a second time, reworks a form, or stays late to keep a patient from falling out of a program. Leadership usually sees the resolution without seeing the effort required to produce it, because the system looks like it works when somebody makes it work.

Heroics are a subsidy. They are paid by employees, they go unrecorded in reporting, and they run out when the people paying them leave or tire. The alternative is an enterprise that is structurally predisposed to help, where the right outcome arrives as the default rather than the achievement. Leadership DNA is what decides which of those two enterprises a company becomes.

Key Takeaways

Leadership tone, rather than title or temperament, largely determines whether a customer commitment survives a quarter that comes in light.
Reframing the theory of the firm means funding the distance between a prescription earned and a therapy sustained.
Prescriber confidence and patient willingness behave like assets that appreciate or depreciate, and most organizations spend them without counting them.
An experience-led growth strategy only works when it names a battlefield and receives funding inside corporate strategy.
Governance makes the commitment verifiable, and executive evaluations are where accountability stops being sponsorship.
Heroics can hold a broken path together for some time, and they remain a subsidy rather than a capability.

Diagnostic Questions to Consider

Name the experiential battlefield your company has chosen to compete on beyond its molecules.
Identify where prescriber confidence and patient willingness appear in any document the board reviews.
Describe the sanctioned route a field colleague uses when they see something failing a patient.
State which executive evaluation carries a customer outcome metric with real weight attached to it.
Estimate how much of current performance may depend on effort that nobody reports.

Closing Reflection

The move described here is modest in language and large in consequence. Leaders do not have to become experience designers, and they do have to become the principal advocates for customers inside their own management systems. That advocacy is most useful when it is repetitive, unglamorous and attached to money. A belief expressed once a year at an offsite can be sincere and still change nothing.

Pharma has earned the right to be judged on more than molecules, and the layer that would let it be judged that way is largely unbuilt. The three legs of the value proposition are product, brand and experience, and pharma built two of them well. Leadership DNA is where the third leg gets its budget, its owner and its place on an agenda.

I have come to see this layer as the least technical and the most difficult of the four. Structure can be redrawn, processes can be rebuilt and commercial models can be redesigned, often within a single planning cycle. Changing what leaders reliably ask about takes longer, because it asks them to be measured on something they used to sponsor. The organizations willing to make that trade tend to stop needing heroes.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Customer Excellence: The Fourth Pillar of Commercial Excellence

Sat, 10 Oct 2026 10:35:00 GMT

Pharma has built three domains of commercial excellence and named all three: launch excellence, marketing excellence and sales excellence. The fourth domain, the one the industry has not yet named, is Customer Excellence . Institutions tend to perfect whatever they can already describe, and they rarely notice the thing they have no vocabulary for. That is roughly where the commercial model sits after four decades of refinement.

Launch excellence secures early momentum in the window where a brand's trajectory is set. Marketing excellence shapes narrative, evidence and credibility. Sales excellence sustains presence and relationship capital in the clinical community. Each of the three has a body of practice, a budget, a function, a vocabulary and people who have spent entire careers inside it.

Why three named domains are no longer sufficient

None of the three is outdated and all three remain necessary. What has changed is the sufficiency of the three taken together. Each one optimizes performance within a category that already exists, and each shares a single boundary condition that four decades of refinement never removed. Not one of them owns whether the value the enterprise earns is actually realized.

A launch can be excellent and the medicine still not reach the patient. A campaign can be excellent and a prior authorization still fail. A sales organization can be excellent and a prescription still go unfilled. The three domains are each accountable for creating clinical intent. No single one of them is accountable for whether that intent survives the journey.

The gap shows up most plainly in what customers say about engagement they already receive. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs , against 82 percent of life sciences executives who say they are satisfied with those same strategies. A gap of that size is not a measurement error. Two populations are looking at the same commercial system and seeing different things, which usually means one of them has been measuring the wrong variable.

What is the fourth domain of commercial excellence?

Customer Excellence is the fourth domain. I define it as the enterprise capability that designs, delivers and scales coherent experiences across the three paths a customer travels, and that governs whether clinical intent becomes realized therapy. It is not a program, an initiative or a layer added to the other three. Customer Excellence is the discipline that makes the organization behave in alignment with what it claims to stand for.

The three paths a customer travels are concrete rather than conceptual. The Path to Prescribe carries evidence into clinical decision. The Path to Fulfill carries that decision through access, authorization and dispensing. The Path to Adhere carries the therapy through the months and years in which benefit either accumulates or quietly disappears. Intent created on the first path can be lost on either of the other two, and often is.

Why a domain rather than a function

Launch, marketing and sales excellence are not departments either. They are disciplines with owners, measures and standards that cut across departments. Customer Excellence belongs beside them on that same plane, not beneath them as a service function, and not inside any one of them as a workstream. The moment it is filed under marketing, it inherits marketing's boundary and loses the authority that was the whole point of creating it.

The question of who owns the customer inside a pharma commercial organization is rarely settled by an org chart. Placement decides more than title does. A capability positioned as a service to three stronger functions will spend its time producing material those functions request, which is useful work and almost never governing work. Reporting lines express what an enterprise actually believes about priority, whatever the strategy deck says.

What the fourth domain is accountable for

Accountability becomes real only when it can be stated without adjectives. The fourth domain owns the consequential handoffs between functions and between the enterprise and outside parties. It sets standards for resolving exceptions rather than relying on heroics to rescue them. It measures progression rather than sentiment. It carries explicit authority to act across organizational boundaries, which is the part most customer programs are never granted.

Each of those four commitments can be tested without much ceremony. A handoff either has a named owner or it does not. An exception either has a documented resolution standard or it waits for someone willing to make a call that falls outside their role. Progression either appears on a dashboard leadership reviews or it survives only in anecdote. Authority either exists in writing or it has to be borrowed every time it is needed, which is another way of saying the authority was never really there.

Its number is the Realization Rate , the share of earned value that survives all the way into sustained therapy. The distance between earned and realized value is value leakage . Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk, which needs no translation in a finance conversation. Heroics operate as a subsidy in this territory, quietly paying down context debt that no budget has ever recognized.

Work I published with TheyDo put a shape on the shortfall. A billion dollars of earned value becomes roughly seven hundred million once prescriptions that are never filled are subtracted. Early discontinuation then takes a further share of what remains. Long term adherence erosion leaves close to four hundred and fifty million in realized value. No competitor takes the difference, because the money does not move to a rival at all.

Why imported customer experience never became this discipline

Customer experience arrived in pharma largely intact from retail, hospitality and financial services, where one organization controls the full transaction. Here the prescribing decision is made by a physician, funded by a payer, adjudicated by a pharmacy benefit manager, dispensed by a specialty pharmacy and lived by a patient. A manufacturer controls none of those actors and can rarely compel any of them. The imported discipline measured how a journey felt while holding no authority over whether that journey progressed. Measurement without governance produces awareness without change.

That structural mismatch explains why well run customer experience programs in pharma so often produce insight nobody can act on . The teams doing that work are capable and their methods are sound. The structure they were dropped into gives them no standing at the seams where value is actually lost. Design gaps of that kind rarely yield to better effort, though they tend to absorb years of it before anyone says so out loud.

The honest objection about cost and ceremony

The objection deserves respect rather than a rebuttal. Adding a fourth domain looks like adding cost and ceremony to a commercial organization that already carries plenty of both. The answer is repricing rather than addition. If less than half of created intent survives to realization, then the marginal dollar spent creating more intent competes directly against the marginal dollar spent protecting intent that already exists. In most portfolios the second dollar now earns more.

The fourth domain is simply where that second dollar gets spent deliberately instead of accidentally. Some of it is already being spent today, inside hub services, case management, field escalations and the quiet work of colleagues who refuse to let a patient fall through a seam. What the organization lacks is a discipline that governs the spending and measures its return. Unmanaged recovery is expensive, and it tends to look like goodwill rather than the operating cost it has become.

What makes the fourth domain hold

A capability of this kind rarely survives on a mandate alone. It becomes durable when Customer Excellence is embedded in four layers rather than assigned to a function. Leadership DNA determines whether the commitment survives contact with a quarterly target. Organizational DNA determines who owns the seams between functions when nobody is watching.

Operational DNA determines whether helpfulness is repeatable without an exceptional colleague in the room. Commercial DNA determines whether measures, incentives and investment decisions reward realized value rather than declared intent. Companies that get the first two layers right and leave the last two alone usually end up with conviction at the top and unchanged behavior nearly everywhere else. I have seen that outcome often enough to treat the final two layers as the real test of commitment.

The three existing domains will keep earning their budgets, and they should. The fourth domain decides what those budgets actually produce in realized terms. A commercial model organized around realized value looks materially different from one organized around reach and frequency. The industry is already drifting toward the first of those without naming the discipline that would make the drift deliberate. Five forces are now deciding the timing of the next chapter of commercial excellence , and AI is the decisive one.

Key Takeaways

Three domains of commercial excellence are named, funded and mature. Launch, marketing and sales excellence each optimize performance inside a category that already exists.
All three create clinical intent and none governs its survival. That shared boundary condition is the gap Customer Excellence exists to close.
Customer Excellence is a domain rather than a function. Filed under marketing, it inherits marketing's boundary and loses the authority that justified creating it.
The fourth domain carries a measurable number. The Realization Rate, value leakage and Customer Value at Risk translate experience into language a finance conversation already accepts.
Imported customer experience could not become this discipline. Measuring how a journey felt without authority over whether it progressed produces awareness without change.
Durability comes from four layers rather than a mandate. Leadership, Organizational, Operational and Commercial DNA together determine whether the capability outlives the executive who sponsored it.

Diagnostic Questions to Consider

Identify the single executive accountable for whether created clinical intent becomes realized therapy, and confirm the accountability appears in writing.
State the current Realization Rate for the lead brand from prescribing decision through sustained therapy, without estimating the figure in the room.
List the handoffs between internal functions and outside parties that carry no named owner and no exception standard.
Calculate Customer Value at Risk for one brand and set it beside next year's promotional investment for the same brand.
Determine whether incentive plans reward declared intent or realized value, and name which measures would have to change.

Closing Reflection

Commercial organizations become very good at the work they have named. Pharma named launch, marketing and sales excellence, built real disciplines around each, and produced four decades of genuine improvement inside those boundaries. What went unnamed went ungoverned, which is why the distance between a prescribing decision and a patient on sustained therapy remains the least managed stretch of the commercial system.

Naming the fourth domain is not an administrative act. It assigns ownership to a stretch of the journey where ownership has been ambiguous, and ambiguity in that position has a price the enterprise pays whether or not it measures it. The companies that move first will likely look slower for a while, because governance work rarely photographs as well as campaign work does.

The work ahead belongs to whoever decides that the next commercial model should be judged by realized value rather than by created intent. Three domains got the industry to extraordinary science. The fourth determines how much of that science ever reaches the person it was made for.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Experience: The Third Leg of Pharma's Value Proposition

Sat, 10 Oct 2026 10:15:00 GMT

The third leg of a pharmaceutical value proposition is experience, meaning the practical work a patient and a prescriber must do to obtain a medicine and stay on it. It belongs beside product and brand because it largely determines whether either of those two ever reaches the person they were made for. Most industries discover late that they have been selling three things rather than two. Pharma industrialized two of them and left the third to assemble itself.

The product is engineered to a standard almost no other industry can approach, through decades of regulated rigor and patient capital. The brand is built with evidence, governance and very large investment, by people who are rarely amateurs at the work. The third leg has no comparable history, because no function was ever handed the brief to build it. That absence is a design gap rather than a failure of competence, which is why it survives inside companies full of capable people.

Experience here operates as something other than a softer companion to the other two legs. A therapy may change biology. The experience around it decides whether that biology arrives.

What the first two legs have that the third does not

Product and brand each have four things the third leg has never had. Each has a named owner, a budget line, a measurement system the executive committee recognizes, and a professional body of practice that trains people to do the work. Experience in this industry has fragments of the fourth and almost none of the first three. A capability without those supports can be described, discussed and even admired, yet it cannot be managed.

That is why the third leg tends to appear in strategy documents and disappear in operating reviews. Nobody defends what nobody has been asked to hold. The question of who owns the experience returns a list of partial owners in most commercial organizations, each accountable for a stage and none accountable for the path. The arrangement produces activity without authority, and it can run for years without anyone behaving badly.

Why does the third leg matter more now than before?

Three forces have moved experience from a courtesy to a condition of competing. Clinical differentiation is narrowing across crowded categories, where profiles converge faster than brand teams can plan around. Product and brand can both be excellent and still fail to separate one company from the next. When the molecule stops doing the separating, something else has to.

The second force is defensibility. Experience is harder to copy than either of the other two legs, because it is produced by how an enterprise is built rather than by what it makes or what it says. A competitor can read a label and a campaign. It cannot read an operating model.

The third force is the standard itself, which patients and prescribers now set outside the category. Someone tracks a parcel to the minute and changes a flight on a phone in ninety seconds. Then she calls a manufacturer's hub and repeats a date of birth four times. She compares the company to the last competent transaction she had, not to another pharmaceutical company.

That bar has a name in our practice. Consumer-Grade describes the expectation a customer carries into a therapeutic category from everywhere else in her life, and it does not adjust downward for the difficulty of the science. The distance between that bar and the industry's view of itself is wide. Deloitte research published in 2025 found only 28 percent of HCPs believe pharma's engagement strategies meet their needs, against 82 percent of life sciences executives who say they are satisfied with those same strategies. A gap that wide is rarely a shortage of information.

Where the third leg is built or lost

The third leg is built or lost along three paths, each of which crosses functions, systems and parties that were never organized around one another. The Path to Prescribe runs from an undiagnosed patient to a clinical decision. The Path to Fulfill runs from that decision to the medicine in a hand, through benefit verification, prior authorization, affordability support, specialty pharmacy coordination and first fill. The Path to Adhere runs from first fill to the duration the trial actually demonstrated.

Each path carries its own failure mode, and the three are not interchangeable. The Path to Prescribe fails quietly, through patients who never arrive and diagnoses that come late. The Path to Fulfill fails administratively, in the space between a decision and a dispense where no single party is accountable for the outcome. The Path to Adhere fails slowly, during the months when a patient stops being anyone's active concern.

The middle path is where the clearest public evidence sits. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. The same study found that 48.4 percent of those rejected prescriptions were never followed by a fill of that drug or anything in its class within ninety days. Read the second figure slowly. A clinical decision had been made, a patient had agreed to it, and nearly half the time the therapy simply stopped existing for her.

No competitor took that value. Work I published with TheyDo traced the shape of the erosion as an illustrative compounded scenario rather than a benchmark. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled. It falls again after early discontinuation, and settles near four hundred and fifty million once adherence erosion is counted. The pattern has a name in our practice, value leakage , and it is what converts a question of service into a question of yield.

The relationship between the three legs is multiplicative rather than additive, which is the reason a weak third leg is so expensive. I express it as a formula in our work. Realized value is brand multiplied by product multiplied by experience, raised to the power of culture, and then discounted by one minus Customer Value at Risk. A company can hold two strong factors and a weak third one and still watch the product of the three collapse, because nothing in a multiplication survives a weak term.

Why has the third leg stayed unbuilt?

An unnamed leg has no owner, no budget line and no place on a scorecard. Imported consumer customer experience could describe this system, though it was never given authority over it. The discipline arrived from industries where one company controls the whole transaction, sets the price and employs the person the customer meets. Pharma controls almost none of that, so a method built on single party control describes the problem accurately and cannot move it.

What follows is measurement without governance, which produces awareness without change. Surveys accumulate, dashboards improve, and the friction a patient meets on the way to therapy stays roughly where it was. Some commercial leaders read that as evidence the work does not pay. The more likely reading is that insight without authority has no mechanism by which to pay.

Regulation takes most of the remaining blame, and it deserves less of it than it receives. Regulation here governs claims rather than burden, which means almost none of the friction a patient meets is legally required. Four identity checks in one call are not a compliance obligation. The leg is unowned rather than mandated, and that distinction is what makes it available to anyone willing to build it.

How to tell whether the leg exists in your company

A leg is load bearing or it is decorative, and the difference shows up in measurement rather than in language. The share of earned value that becomes sustained therapy is the Realization Rate , and the distance between earned and realized value is where the third leg either works or does not. Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk, expressed in the currency a finance committee already uses. A company with no Realization Rate does not have a third leg, it has a hope.

That single number does more than report. It forces the three paths into one conversation, because a shortfall can originate in diagnosis, in fulfillment or in the months after first fill. Leaders who hold a Realization Rate stop debating whether experience is worth funding and start arguing about which path is costing them the most. That argument is the beginning of a third leg, though it is rarely a comfortable one to start.

What holds the third leg up

Experience of this kind cannot rest on discretionary effort, which is how most of it is currently delivered. Capable people routinely prevent these gaps from becoming visible failures, often by working outside the process they were given. Their effort deserves respect rather than audit. Heroics operate as a subsidy, letting an organization deliver promises its routine processes cannot reliably support.

A subsidy of that kind has two properties that matter here. It conceals the design gap from the people who could fix it, and it runs out, usually at the moment volume arrives. The leg becomes load bearing only when the enterprise is structurally predisposed to help, which means the easy path and the right path are the same path.

That condition is built in the operating model rather than in the campaign, and it is the work of Customer Excellence as a discipline. In the work I have done inside large commercial organizations, the companies that got furthest treated the third leg as architecture rather than attitude. They did not ask people to care more. They changed what the system made easy.

Key Takeaways

Pharma industrialized product and brand, then left the third leg of its value proposition to assemble itself.
Experience determines whether a product's biology and a brand's promise ever reach the patient they were built for.
The third leg is built or lost along the Path to Prescribe, the Path to Fulfill and the Path to Adhere.
Rejection and abandonment evidence shows that much of the loss occurs after a clinical decision has already been made.
A company with no Realization Rate cannot claim a third leg, because it has no measure of what it realizes.
The leg becomes load bearing only when the enterprise is structurally predisposed to help rather than dependent on heroics.

Diagnostic Questions to Consider

Name the executive accountable for the whole Path to Fulfill rather than for one stage of it.
State your current Realization Rate and the method used to calculate it.
Identify which of the three paths is costing you the most earned value this year.
Describe how much of your experience delivery depends on individual effort rather than designed process.
Explain which pieces of patient friction in your category are legally required and which are simply inherited.

Closing Reflection

Most companies do not need to be persuaded that experience matters. They need a name for the thing, an owner for it, and a number that makes its absence visible on a scorecard. Once those three exist, the work stops being advocacy and becomes engineering, which is a far more comfortable register for this industry.

The science here is often extraordinary and the experience surrounding it is frequently ordinary. That gap is not a verdict on anyone's character or capability, and I have rarely found a company where it was. It is the predictable output of a value proposition built on two legs and asked to stand on three.

A third leg does not arrive through conviction. It arrives when somebody is made accountable for the distance between what a therapy earned and what a patient realized, and given the authority to close it. That is a structural decision, available to any company prepared to make it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Why BMS Discounted Sotyktu by 86% and Eliquis by 40%

Sat, 10 Oct 2026 02:05:33 GMT

Bristol Myers Squibb ran two of these at once, in two different categories, at two very different discounts. The gap between 40% and 86% is the most instructive number published in this entire wave, and almost nobody has asked why it exists.

The gap does not come down to generosity in one case and restraint in the other. It comes down to market position expressed as arithmetic, and once a commercial team can read it that way the same arithmetic sets its own defensible cash price.

BMS announced two direct channels inside ten weeks

Two medicines with nothing in common, announced ten weeks apart, amount to a controlled experiment the industry can read for free. The first went live in September 2025. A joint announcement with Pfizer offered Eliquis to uninsured, underinsured and self pay patients at more than 40% below list. The medicine is bought through Eliquis 360 Support and shipped to all fifty states and Puerto Rico.

Christopher Boerner, board chair and chief executive of Bristol Myers Squibb, said the program "passes more savings directly to patients." The release notes more than 15 million Americans have been prescribed the medicine since launch. The second channel was announced on 25 September 2025.

BMS Patient Connect launches in January 2026 offering Sotyktu, an oral treatment for moderate to severe plaque psoriasis, at more than 80% below list. Fierce Pharma got the actual figures, reporting a list price of $6,828 for a thirty day supply against a cash price of $950, with BMS putting the discount at 86%. Boerner framed the platform as making medicines "more accessible and affordable for patients living with serious conditions."

Hold those two numbers next to each other. Eliquis runs at roughly 40% off a list around $606 a month, while Sotyktu arrives at 86% off $6,828. Same company, same quarter, same stated rationale.

Competitive position sets the discount rather than generosity

The two channels are doing entirely different jobs, which is why the discount is set by competitive position rather than by how much the company wants to help. Eliquis is an incumbent with enormous installed volume and most of its business running through coverage. A deep cash discount there would undercut the covered book for very little gain, because the patients who need it are a thin slice of fifteen million. Forty percent is a retention and goodwill instrument sized not to disturb the main business.

Sotyktu sits in a crowded psoriasis market against several well established biologics, which makes it the challenger. For a challenger a cash channel is a share acquisition instrument rather than a goodwill gesture, and 86% is what it costs to make one viable. Neither of those is a criticism, because both are the rational move from where each brand actually stands.

That is exactly why copying the percentage rather than the logic tends to produce a number that makes no sense. The rule worth taking away is that a defensible cash discount is a function of how much covered business a brand would cannibalize set against how much new volume it could win. Both sides of that calculation deserve working out before anyone picks a percentage.

$950 buys a price a patient might actually pay

The same disease has just produced the opposite demonstration. Novartis set a cash price for Cosentyx in the same indication, and Managed Healthcare Executive reported the Cosentyx list at $7,936.48 a month and the discount at 55%, which leaves roughly $3,571. Sotyktu arrives at $950, which is roughly a quarter of the price in the same disease.

That comparison has not appeared anywhere in the trade press and it is the single most useful fact in this wave. The difference is not that one company cares more. Cosentyx is Novartis's top selling US product, so an 86% cash price would compete with its own covered revenue, while Sotyktu has far less covered revenue to protect.

Position sets the floor, and I set out the Cosentyx case in what Novartis is testing . What it means for a patient is more interesting than what it means for either company. At $950 a month the cash channel can be a genuine option during a deductible phase or a coverage gap, and at $3,571 it largely is not.

The arithmetic often decides whether a program is an offer or a gesture. Patients tend to work that out faster than a brand team does.

Both programs solve affordability inside one path

Both releases are notably quiet about everything else, and naming the boundary is what makes the case usable. The distance between science and patient can be modeled as three sequential paths. The Path to Prescribe , where a patient is identified, diagnosed, referred and a clinician decides. The Path to Fulfill , where that decision survives coverage, prior authorization, cost and dispensing. The Path to Adhere , where the patient stays on therapy long enough to get the benefit the trial demonstrated.

Read both announcements for what they promise and what they do not. Discounted pricing, direct shipping, transparency into cost and patient support resources are all there. Neither mentions telehealth, and neither mentions benefit verification or prior authorization help for the patients who do have coverage. That is a price and logistics solution on the Path to Fulfill, real and bounded.

Now consider Sotyktu specifically. It is a daily oral medicine for a chronic condition, which means the Path to Adhere is where the value is won or lost over years rather than a secondary concern. A monthly shipment is a useful start, and it is not an adherence program.

The burden on the path these platforms do not touch is heavy and documented. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment.

Two brand level front doors make the patient inherit the org chart

Each brand built its own, which is the most transferable finding here and the least comfortable. Eliquis runs through Eliquis 360 Support, while Sotyktu will run through BMS Patient Connect. The BMS release does not say the Eliquis program moves onto the new platform, and it describes Patient Connect as somewhere other medicines may be added later.

So a company with two direct programs has two addresses, two sets of eligibility rules and two support experiences. Each one is sensible on its own terms, and nobody set out to build a maze. That is what brand level ownership produces.

When each brand funds its own access solution, the patient inherits the organization chart, and no function is accountable for the whole distance. In the commercial organizations I have worked inside, that accountability rarely sits anywhere in particular. I have argued the structural fix in who should own customer experience in a pharma company .

Any portfolio can be checked against this before anyone feels superior. Count the patient support addresses, the copay programs, the hubs and the portals, then ask who inside the company could tell a newly diagnosed patient which one is hers.

Independent observers expect the next move here to be routing rather than pricing. In Pharmaceutical Commerce , Chip Parkinson of Gifthealth expects platforms to stop defaulting to cash pay and instead send each patient down whichever path, cash or insurance, is cheapest and fastest. If that is where this lands, the durable asset is the routing logic rather than the discount.

Policy pressure on net price is driving the wave

The driver is policy pressure on net price rather than a conversion to customer thinking, and that matters to how every one of these announcements reads. Fierce Pharma notes that the Sotyktu move followed letters sent in July 2025 from President Trump to seventeen pharmaceutical chief executives urging more direct to consumer sales. Programs like these have now arrived at six large manufacturers inside two years.

Every one is a pricing and channel decision made by commercial leadership, and not one began inside an experience function. That is not cynicism and it is not a complaint. Planning should simply account for it, because a wave driven by price transparency will not, by itself, fix anything on the two paths where earned value actually leaks.

Two rules and one number follow from the comparison

The first rule is that a cash discount is set by position, with cannibalization weighed against acquisition brand by brand before anyone picks a percentage. BMS has shown both ends of that calculation inside one company. The second rule is that a direct channel solves a seam rather than a system.

Price and shipping sit on the Path to Fulfill, while the Path to Prescribe and the Path to Adhere are where most of the remaining money is, and no portal reaches them. The number is what arrives. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

So the work is to find the gate, name the seams, give each one an owner, and measure what arrives against what was earned. The money in that interval is value leakage , and the share of earned decisions that becomes therapy is the brand's Realization Rate . The bar patients already apply is Consumer-Grade , the discipline that recovers the value is Customer Excellence , and the whole argument sits in the future of the pharma commercial model .

Key Takeaways

BMS announced two direct channels ten weeks apart at radically different discounts, 40% off Eliquis and 86% off Sotyktu, and the gap is explained by competitive position rather than intent.
Sotyktu arrives at $950 a month against a $6,828 list, roughly a quarter of the cash price Novartis set for Cosentyx in the same indication.
A defensible cash discount is cannibalization of covered business set against new volume won, calculated brand by brand before anyone picks a number.
Both programs solve price and shipping on the Path to Fulfill, and neither mentions telehealth, benefit verification or prior authorization help, nor touches the Path to Adhere.
One company now has two front doors, because each brand built its own, which is often what happens when no function owns the whole distance to the patient.

Diagnostic Questions to Consider

Work out what a cash price would have to be before a real patient on your lead brand used it, and what that would cost in covered revenue.
Decide whether your brand is the incumbent protecting a covered book or the challenger buying share, then check that your access strategy matches that answer.
Count the separate patient support addresses across your portfolio, and name the person who could list them all.
Separate the barriers between your prescription and your patient into price on one side and paperwork, coordination and persistence on the other.
Decide now what the response would be if a competitor priced direct at a quarter of your cash price tomorrow, and who would make that call.

Closing Reflection

BMS has handed the industry a free lesson in pricing logic, and both halves of it deserve credit rather than scoring. Forty percent on an incumbent and 86% on a challenger are each the rational move from where that brand actually stands, and the logic rather than the percentage is the part worth copying. Neither number was generosity, and neither was restraint.

The uncomfortable part of the case does not sit with BMS. Two front doors inside one company is what brand level funding produces anywhere it operates, and most portfolios carry more than two, built one sensible program at a time. The patient inherits that chart, and no function is accountable for the whole distance she has to travel.

So the question the case leaves on another leader's desk has little to do with discounts. It is which job a direct channel would be doing for a given brand, and whether anyone has done the subtraction. The second question is who inside the company could tell a newly diagnosed patient which door is hers, and in most organizations nobody has been asked to answer it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

What Novartis Is Testing With Cosentyx Direct

Sat, 10 Oct 2026 01:59:29 GMT

Novartis did not copy Lilly. The company ran a structurally similar play in a category where the arithmetic cannot work the same way, and that difference is the whole case. Cosentyx direct is the first of these moves that transfers to most of the covered specialty brands large manufacturers actually run.

Lilly and Novo removed the payer from a transaction patients could plausibly fund themselves. A covered specialty biologic does not allow that, and Novartis said so in its own language. The interesting part is what the company is testing instead.

Novartis set a cash price and called it an experiment

The media release of 29 September 2025 announced a direct to patient platform effective 1 November, offering Cosentyx to cash paying patients at 55% off list. The company described the price as one that "reflects the average savings that insurers and pharmacy benefit managers receive." Two phrases in that release are worth more than the platform itself.

Novartis called the program a proof of concept for selling specialty medicines directly, and Victor Bultó, President US for Novartis, called the launch "a first step." Note the restraint. Those are the words of a company running a test rather than announcing a solution, and they can be read literally rather than as modesty.

The release also disclosed something easier to miss. Novartis is exploring a direct to business model that would sell Cosentyx, and possibly other medicines, to large employers.

The arithmetic of a specialty biologic works differently

Fifty five percent off a very large number is still a very large number, which is the first thing to notice. Managed Healthcare Executive reported the July 2025 list price at $7,936.48 a month for a self injection package. Take 55% off and the result is roughly $3,600 a month, which is about $43,000 a year.

That is not a consumer price. No patient with a chronic inflammatory condition funds that out of pocket across years, which means the cash channel here is not aimed at the population a GLP-1 cash price reaches.

So the question becomes who the channel is for, and naming that population precisely is the whole value of the case. Patients inside a high deductible phase, where $3,600 beats the full list they would otherwise face. Patients between coverage. Then, if the direct to business idea develops, employers who would rather buy at net than through a rebate chain.

Novartis is not deleting the payer. The company is testing whether the net price can reach the buyer without the intermediary, which is a different and considerably more ambitious question.

The test is net price transparency rather than channel convenience

This is where the Cosentyx move separates from the two before it. LillyDirect shortened a route, while Novartis is pricing against the rebate system and saying out loud that the discount approximates what insurers and pharmacy benefit managers already receive. Read that as a positioning statement about where the money currently goes.

Whether it holds commercially is unproven, and the company has not claimed otherwise. The direct to business thread is the one I would watch, because selling a specialty biologic to a large employer at net price targets the pharmacy benefit manager rather than the pharmacy. If that works it changes more about the market than any patient portal will.

Context from Pharmaceutical Commerce is useful here. Chip Parkinson, CEO of Gifthealth, points out that specialty medicines are more than half of drug spend while reaching only about 2% of patients. That concentration is why specialty is the next place these models go, and why the economics are harder when they arrive.

Cosentyx direct addresses one seam of one path

Naming the boundary of what a cash price solves is what makes the case usable. The distance between science and patient can be modeled as three sequential paths. The Path to Prescribe , where a patient is identified, diagnosed, referred and a clinician decides. The Path to Fulfill , where that decision survives coverage, prior authorization, cost and dispensing. The Path to Adhere , where the patient stays on therapy long enough to get the benefit the trial demonstrated.

Cosentyx direct addresses affordability inside the Path to Fulfill, for a defined population. That is a real contribution, it is also a narrow one, and the narrowness is the part most commercial teams can learn from.

Consider what a specialty biologic actually puts a patient through, and how much of it a cash price leaves untouched. Benefit verification, prior authorization, specialty pharmacy coordination, injection training and refill logistics all sit outside the price. The published burden on that path is heavy.

In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. The Path to Adhere is untouched entirely. For a self injected biologic taken over years, that is where most of the earned value actually sits, which is a statement about the structure of the problem rather than about Novartis.

Four legitimate doors exist and nobody owns the orientation

For a covered biologic the binding constraint has quietly stopped being price and become finding the right door. Read the affordability routes Novartis lists in its own release, all of them legitimate and well intended. Eligible commercially insured patients may pay as little as $0 through a copay program. Patients appealing an initial coverage denial may receive the medicine at no cost for up to two years.

Uninsured or government insured patients meeting income criteria may receive it free through the Novartis Patient Assistance Foundation. Cash paying patients may now buy at 55% off list. Four doors, each one solving a real problem for a real population, and none of them the wrong answer.

Now take the chair of a newly diagnosed patient, or the office manager helping her. Which door applies depends on insurance status, income, whether a denial has already happened, and where the patient sits against the deductible. Nobody in the system is accountable for telling her which one she is standing in front of.

That is an unowned problem, it is structural rather than anybody's failing, and in the commercial organizations I have worked inside it rarely has a named owner. Gartner found 62% of customer service channel transitions are high effort in industries that can watch the transition happen. Pharma cannot watch its own, and it has more doors than they do.

Adding a door improves the menu. It does not reduce the effort of choosing, and effort is what often determines whether a decision the science already won turns into therapy.

No uptake number has been published and the absence is the finding

Nobody has published a number, and nearly a year after launch that absence deserves care rather than conclusion. No uptake figure has been released for Cosentyx direct, which is not evidence of failure and not evidence of success. It is evidence that the category is being run without public measurement, which is exactly the condition in which everyone copies everyone.

The useful independent read is directional. Parkinson describes the industry as "moving past pilot mode" and expects platforms to stop defaulting to cash pay, instead routing each patient down whichever path, cash or insurance, is cheapest and fastest. If that is where this goes, the enduring asset is the routing logic rather than the price.

There is also a regulatory overhang any company in this space inherits. The same reporting notes that the HHS Office of Inspector General has sought public feedback on a full safe harbor for direct to patient arrangements, with rulemaking possibly advancing in 2027. Anyone planning one of these is designing for a rule that does not exist yet.

Price is one seam and most gates sit elsewhere

Three of these moves have now run inside two years, and the industry pattern is clear enough to name. Managed Healthcare Executive records Bristol Myers Squibb at more than 80% off Sotyktu's list from January 2026. Every one of them is a pricing and channel decision made by commercial leaders, and not one of them began as an experience program.

That is the transferable lesson, and in my reading it is the same one the Lilly and Novo cases produced. These companies found the specific structural gate between their science and their patients, then changed the structure rather than improving the experience around it.

Every portfolio has a different gate. For most covered specialty brands it is the interval between the prescription and the first dose, and the quiet attrition after it. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

So the work is to find the gate, name the seams, put an owner on each one, and measure what arrives. The money sitting in that interval is value leakage , and the share of earned decisions that becomes therapy is the brand's Realization Rate . The bar patients are already applying is Consumer-Grade , the discipline that recovers the value is Customer Excellence , and the whole argument sits in the future of the pharma commercial model .

Key Takeaways

Cosentyx direct is a net price experiment rather than a channel convenience play, and Novartis describes it as a proof of concept rather than a solution.
Fifty five percent off a list price Managed Healthcare Executive put at $7,936.48 a month still leaves roughly $43,000 a year, so the cash channel reaches a narrow population rather than a consumer one.
The direct to business thread may matter more than the patient platform, because selling at net to large employers targets the pharmacy benefit manager rather than the pharmacy.
It addresses affordability inside the Path to Fulfill and leaves benefit verification, prior authorization, specialty coordination and the entire Path to Adhere where they were.
For a covered biologic with four affordability doors, the binding constraint is orientation rather than price, and no function owns that.

Diagnostic Questions to Consider

Count the affordability routes on your lead brand, then name the person who tells a patient which one applies to her.
Work out what a cash price set at the average rebate you currently give away would be, and who would object internally.
Establish whether a large self insured employer would buy your brand at net, and whether anyone has ever asked one.
Separate the barriers on your Path to Fulfill into price on one side and paperwork and coordination on the other.
Find the share of earned decisions on your brand that becomes therapy at twelve months, and when it was last measured.

Closing Reflection

Novartis is testing the hardest version of this in the open, and the restraint in its own language deserves respect. A proof of concept for selling specialty medicines directly is a smaller claim than the coverage made of it, and the company has not claimed more. What I take from the case is that a net price can be put in front of a buyer without the intermediary, at least for a defined population.

The uncomfortable part of the case does not sit with Novartis at all. Four legitimate doors now exist on one brand, and the same multiplication has happened quietly across most portfolios, built one well intended program at a time. Each new door improves the menu without reducing the effort of choosing, and that effort is what often decides whether a decision the science already won becomes therapy.

The case therefore leaves a question on every other commercial leader's desk, and it concerns their own portfolio rather than Novartis. Which of those doors is a patient standing in front of right now, and who inside the company knows? That can be answered, and until someone owns it the answer tends to arrive from the patient rather than from the system.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

What Is Realization Rate, and How Do You Calculate It?

Sat, 10 Oct 2026 01:46:36 GMT

The Realization Rate of a pharmaceutical brand answers one question. Of the prescriptions the commercial system earned, how many became patients on therapy long enough to get the benefit the trial demonstrated? Dividing the second number by the first gives the rate. It can be stated in money as realized value divided by earned value, or in people as patients sustained divided by prescriptions written. Both produce the same answer, because the value per patient sits on each side of the division and cancels.

That ratio is the only measure in this field a finance director often accepts without an argument, because it compares money to money rather than offering a score about feelings. Most companies cannot produce it. The inputs sit in four different systems owned by four different functions, and nobody has ever been asked to put them in the same sentence.

Why does this measure survive a finance conversation?

The measure survives because it does not ask anyone to believe that sentiment causes revenue. Consider how most customer experience numbers die inside a commercial organization. Somebody presents a satisfaction score, somebody senior asks what it is worth, and the answer involves a correlation borrowed from another industry. The conversation ends there, politely, and the program is quietly defunded over the following two years.

Realization Rate skips that fight. Science and promotion earned a decision, and either that decision became therapy or it did not, which makes the gap a return the investment was made to produce and did not.

Realization Rate also starts on the sufficient side of a sentence the loyalty literature has already conceded. Bain found that goodwill is "a necessary but insufficient condition for generating revenue growth."

How is it calculated?

Four inputs are needed, and three of them already sit inside the business. The first is earned prescriptions , the count of clinical decisions made in the brand's favor during the period, which includes prescriptions written, orders placed and referrals made to the therapy. Sales and prescription data already holds that count.

The second is realized therapy , the count of those decisions that became a patient on therapy at a clinically meaningful duration. That duration should come from the label and the trial rather than from a reporting convention. The third is value per patient , which is the existing net revenue per patient at that duration, and finance can usually hand it over in an afternoon.

The fourth is the seam map , meaning where between the decision and sustained therapy the losses happen. This is the input nobody has, and building it is most of the work. Everything else is arithmetic that fits on a napkin. Realized therapy divided by earned prescriptions gives the rate, and earned value multiplied by one minus the rate gives the money at stake, which is Customer Value at Risk. The rate belongs at brand level rather than company level, because a portfolio average hides the only thing worth knowing, which is which brand is leaking and where.

One question comes up the first time the number meets a finance team, and it is worth knowing the answer rather than meeting it cold. Realized therapy is counted strictly, so a patient who stopped at six weeks does not count, which means the realized figure will sit below the revenue finance already reports. That is a feature rather than an error, because the trial duration is what the efficacy claim rests on. The glossary sets out how the two reconcile for anyone who has to build the measure rather than read about it.

Two brands with the same revenue and very different exposure

The measure is easiest to see with two brands beside each other. Both of these are illustrations rather than client work, and the numbers are deliberately round so the arithmetic stays visible. Assume the two treat the same condition, both are worth twelve thousand dollars a year in net revenue for a patient who stays on therapy, and both are measured at twelve months because that is where their trials demonstrated benefit.

Brand A had forty thousand prescriptions written last year, and twenty four thousand of those patients were still on therapy at twelve months. Brand B had eighty thousand prescriptions written and the same twenty four thousand sustained patients. Both brands therefore realized 288 million dollars, so on a revenue line they look like the same business.

They are not the same business at all. Brand A realized 60 percent of what it earned while Brand B realized 30 percent, and that gap shows up as money rather than as a quality score. Brand A is carrying 192 million dollars of Customer Value at Risk, against 672 million for Brand B, which is three and a half times the exposure on identical reported revenue.

The example also shows why the two forms of the rate agree. Brand B's twenty four thousand sustained patients divided by eighty thousand prescriptions is 30 percent, and its 288 million dollars realized divided by 960 million earned is also 30 percent. The value per patient sits on both sides of the division and cancels, which is why the rate can be quoted in people or in money without changing the answer.

The uncomfortable part is what the existing scoreboard says about these two. Brand B writes twice the prescriptions, which on most commercial dashboards reads as the stronger performer, and its team is probably being congratulated for demand growth. The Realization Rate says Brand B is earning demand it cannot convert, so another dollar of demand investment mostly produces prescriptions that will not become therapy. Its constraint sits after the script, which is precisely where nobody is measuring.

That is the allocation question the number answers. If one of these two brands gets the next investment it is Brand B, and the money belongs on the seams rather than on share of voice.

What is a good Realization Rate for a brand?

Nobody really knows, because almost nobody publishes one, and that absence can be read as an opportunity rather than a problem. The published evidence does suggest the scale of the loss in the US. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

Cost finishes what paperwork starts. IQVIA Institute data reported by Managed Healthcare Executive found that of prescriptions with a final cost above $250, 61% are not picked up.

Any single benchmark deserves caution, because the real variance across studies is enormous. An earlier review in the American Journal of Pharmacy Benefits reported that findings on primary nonadherence "range from as little as 2% of new prescriptions going unfilled to as many as 30%" .

Chasing an industry number is therefore the wrong instinct, and measuring a brand's own rate before trying to beat it is the better one. A first calculation becomes the baseline, and every quarter after that is the comparison that matters.

Where the value actually leaks

Value leaks along three sequential paths, and the answer differs for every brand in a portfolio. The Path to Prescribe runs from an undiagnosed patient to a clinical decision, where losses are identification and diagnosis problems rather than experience problems. Those losses sit outside the Realization Rate, because no value has been earned yet.

The Path to Fulfill runs from the decision to the medicine in a hand, and this is where most US leakage lives. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment.

The Path to Adhere runs from first fill to clinically meaningful duration, where losses are quieter, slower and larger than most brand teams believe, largely because nobody is watching month four. The discipline is to name the seam, put an owner on it and measure the time it takes to clear. In the organizations I have worked inside, the money sitting in those seams is what I call value leakage , and the Realization Rate expresses that leakage as a rate rather than an anecdote.

What changes once the number exists

The number belongs on the commercial scorecard beside share and growth, with one person accountable for moving it. Three things often change the moment it exists.

The investment debate gains a denominator. Spending on promotion grows earned decisions, while spending on the seams grows the share that gets realized. For the first time the two can be compared with the same arithmetic instead of argued about as philosophy.

The forecast gets honest. A brand running at a low realization rate is carrying a known, sizeable and recoverable loss, and treating that loss as Customer Value at Risk puts it in a plan rather than in a complaint.

Experience work gets funded, because it stops being a quality initiative and becomes a revenue recovery program with a number attached. The supporting measures are set out in how to measure customer experience in pharma , and the ownership question is handled in who should own customer experience in a pharma company .

Three ways companies get this wrong

All three failures are avoidable and all three are common. The first is measuring at company level, where an average across a portfolio tells a leadership team nothing it can act on. The brand with the access problem and the brand with the persistence problem need completely different work.

The second is picking the duration that flatters the brand. If a trial demonstrated benefit at twelve months, realization at thirty days is a vanity number, so the science rather than the reporting calendar should set the denominator.

The third is handing the measure to the insights team. A measure owned by a function that cannot change the operation becomes a report, which is why it belongs with whoever can convene market access, patient services and the field in the same room.

The opportunity stays open for a reason worth remembering. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied. Most competitors are working from the 82% number, which means they are not looking for this loss at all.

Where this sits in the wider argument

This is the measurement end of the argument, and the standard above it is a different question. The Realization Rate of a brand describes how much of its earned value arrives, while Consumer-Grade describes the quality bar customers are already applying while it does or does not arrive. Customer Excellence is the discipline that moves the rate, and the future of the pharma commercial model is why the whole thing matters more every year.

Key Takeaways

The Realization Rate of a brand is realized therapy divided by earned prescriptions, counted per brand rather than per company.
It survives a finance conversation because it compares money to money rather than asking anyone to believe that sentiment causes revenue.
Three of the four inputs already exist inside most companies, and the missing one is a map of where between decision and therapy patients are lost.
There is no credible industry benchmark, so a first calculation becomes the baseline and the quarterly comparison is the measure that counts.
Letting the trial duration set the denominator keeps the rate honest, because a shorter window measures a number designed to flatter.

Diagnostic Questions to Consider

The share of clinical decisions made in the lead brand's favor that becomes therapy at clinically meaningful duration is worth establishing before anything else.
Somebody in the company could produce that number this month, and it is worth knowing what they would have to ask four other functions for.
The duration in use deserves examination, including whether the science or the reporting calendar chose it.
Earned value multiplied by one minus the Realization Rate produces a figure that may or may not change what gets funded next year.
Ownership of the number matters, and so does whether that owner can convene market access, patient services and the field.

Closing Reflection

A sensible start is one brand and one quarter. The number often comes back worse than expected and more recoverable than feared, which is the combination that makes it useful rather than discouraging. Nothing about the calculation requires new technology, and most of it requires only that four functions agree to put their data in the same sentence.

What the rate changes is the conversation. A commercial system that can express the gap between earned and realized value in money has a denominator for its investment debate, an honest forecast and a funded case for closing the seams. In the organizations I have worked inside, that move from argument to arithmetic tends to do more for experience work than any score ever did.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: What is value leakage in pharma? , The future of the pharma commercial model , What is Customer Excellence? , Pharma's realization blind spot and Pharma customer experience, why it stalls and what replaces it

The Calibration Trap in Synthetic Research

Sat, 10 Oct 2026 01:44:32 GMT

Organizations tend to trust an instrument that agrees with them. When a vendor says a synthetic persona has been calibrated against a company's own research, the claim deserves to be heard for what it actually says. The company's blind spots have been encoded, and they will now be reproduced faster, at scale, in complete sentences.

That is the calibration trap, and it may be the least discussed risk in this category as well as the most likely to cost a decision. The uncomfortable part is that calibration is the step that makes everyone comfortable. It is the word that gets a model past procurement and into a brand plan.

Calibration tunes a model to data an organization already holds

Calibration means adjusting a model's outputs until they resemble distributions the organization already has. In practice that means survey history, the tracking study, the segmentation and the syndicated category research. The vendor tunes the simulation until it produces numbers in the neighborhood of numbers the team recognizes, then shows the match.

Watch what that demonstration actually proves, which is that the model can reproduce existing data. That is a statement about agreement rather than about accuracy, and the two look identical on a slide. The circularity is easy to miss, because the model gets validated against the research it was tuned to match. Of course it matches.

Agreement with an organization's own history is the one result the process guarantees in advance. Treating that agreement as evidence is like marking an exam with the answer sheet the candidate wrote.

Four biases get inherited, and none show up in the output

Four things get inherited, and none of them are visible in the output. The first is sampling bias. If the research reaches only the physicians who agree to be reached, the model learns that population and presents it as the market. The clinicians who never answer a survey do not become visible because a model started generating them.

The second is question design. Every survey encodes assumptions about what matters, so a model trained on that instrument inherits the framing and cannot surface the thing nobody thought to ask about.

The third is measurement error. If satisfaction scores were not predicting commercial outcome before, a model grounded in them will produce confident numbers with the same predictive failure built in. Precision goes up while accuracy stays exactly where it was.

The fourth is an institutional preference for comfortable answers. This one is cultural and it may be the worst of the four. Research that contradicted leadership tended not to survive to the archive, so the archive leans optimistic, and the model now leans with it.

Each of these biases existed long before anything was bought. What simulation changes is the speed and the confidence, which is a meaningful difference. A wrong assumption in a quarterly tracker moves slowly, while a wrong assumption in a system that answers any question in four seconds is everywhere by Friday.

Pharma's historic data makes an especially poor anchor

A good deal of what pharma has been collecting was never predictive in the first place. Look at the instrument that produced most of the archive. Bain's own published material says net promoter differences "explain anywhere from 10% to 70% of the variation in subsequent revenue growth rates" .

A range that wide is not a calibration target so much as an admission that the relationship varies enormously by context, and pharma's context is the hardest one. Goodwill is "a necessary but insufficient condition for generating revenue growth," as Bain made explicit elsewhere. Calibrate a model to the necessary but insufficient part and the result is a necessary but insufficient model.

The market makes it worse in three specific ways. The customer is three people with different interests, so an aggregate sentiment score averages parties who disagree. The patient voice is mostly missing by law, so the archive is thin exactly where the risk is highest. The value event happens months after the data was collected, so the historic file rarely contains the outcome worth predicting.

I have set out why borrowed instruments break here in does NPS work with physicians and why consumer CX does not translate to pharma . In the organizations I have worked inside, the archive was usually treated as a record of the market rather than as a record of what the company had thought to ask.

Four signs show when calibration has become circular

Four signs are worth checking, and in my experience all four can be checked inside a week. The first is that the model never surprises anyone, because everything it returns is something somebody in the room already believed. Agreement is the symptom rather than the proof.

The second is that it has no opinion about known failures. Ask it where patients abandon a therapy and watch whether it finds the seam the field force already complains about. A model that cannot name a problem the organization knows is real does not know the market.

The third is that it is confident about things the data never covered. A model grounded in physician research will still answer a question about payer committee politics, fluently, with nothing underneath it. The fourth is that its error rate has never been published, meaning a comparison against realized outcomes rather than a fidelity score the vendor computed. That protocol is set out in how to validate a synthetic audience .

Calibrate against behavior rather than against opinion

The better anchors are behavior that cost somebody something and outcomes that exist independently of the research function. Sentiment anchors can be replaced with progression anchors in most cases. Script to start conversion, time to therapy, persistence at six and twelve months, and barrier resolution speed are observable, they have a price attached, and nobody filled in a form to produce them.

There is plenty of external truth to anchor against. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by any fill in that class within 90 days. Calibrating to that anchors a model to something the market did rather than something it said.

The frontline can serve as the correction layer. A field force, hub agents and patient support staff observe failures that never reach a survey, which often makes them the cheapest independent check available. That route is in voice of the frontline .

The whole thing can then be held against the measures in how to measure customer experience in pharma . A model calibrated to a scorecard that does not move money will produce advice that does not move money.

Calibration stays useful under three rules

None of this is an argument against calibration. It is an argument for calibrating to outcomes rather than to opinions, and for keeping a record of what was calibrated to. Three rules are enough to make that workable in practice.

The first is to write down the anchor. Whatever the model was tuned against belongs in a document that travels with every output, so a reader knows which archive is speaking. The second is to weight observed data above stated data in the anchor set, since behavior wins when both exist, and a vendor should be able to state the ratio.

The third is to hold back a cohort the model has never seen and never will. One clean holdout, protected and used only for scoring, is enough. The moment it becomes training material the organization has lost its only independent read. Do all three and calibration goes back to being what the word implies, which is an instrument checked against reality rather than against the company's own filing cabinet.

The stakes are higher than the word suggests

The industry has already demonstrated that it can believe a comfortable number for years. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies. That 54 point spread was produced by human beings reading their own research.

Now imagine that archive turned into a system that answers instantly and never hesitates. The 82% view gets automated, and the 28% view has no route in at all. Nobody notices, because the output still sounds like research.

The layer that would have told the truth is the one simulation structurally cannot reach, which is Predisposition . The whole argument this sits inside is the future of the pharma commercial model , and the discipline that keeps listening honest is Customer Excellence .

Key Takeaways

Calibrating a synthetic persona against an organization's own research guarantees agreement with its archive, which is not the same thing as accuracy.
Four biases get inherited invisibly, namely sampling bias, question design, measurement error and an institutional preference for comfortable answers.
Pharma's archive is a poor anchor because much of it came from sentiment instruments that never predicted commercial outcome.
A model that never surprises anyone and holds no view on failures already known to be real has learned the file rather than the market.
The working discipline is to anchor to behavior with a cost attached, record the anchor in writing, and protect one cohort the model will never see.

Diagnostic Questions to Consider

A research team should be able to say exactly what the model was calibrated against, and whether that is written down where a reader of the output would find it.
The anchor set should carry a stated ratio of observed behavior to stated opinion.
One cohort should be protected from the model, with a named person enforcing that protection.
The team should be able to name one thing the simulation has reported that nobody in the room already believed.
If the old satisfaction data was not predicting revenue, what is expected of a model trained on it deserves to be stated plainly.

Closing Reflection

Calibration is not the enemy. Calibrating to an organization's own reflection is, because the exercise cannot return much that the archive does not already contain. What looks like rigor is agreement, arriving faster and in better prose than before.

The repair is unglamorous and mostly clerical. Name the anchor, weight observed behavior above stated opinion, protect one cohort, and the instrument can be checked against something other than itself. An organization that does none of that may still get fluent answers every quarter, with no way of knowing when they stop being true.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

How to Validate a Synthetic Audience

Sat, 10 Oct 2026 01:41:56 GMT

Every instrument that claims to describe a customer should be held to the standard applied to any other instrument, and a synthetic audience is no exception. The test is to give the model a cohort whose outcome is already known, hide that outcome, ask the model to predict it, then publish how wrong it was. Repeat the exercise every quarter, because the model underneath changes without announcing itself.

That is the whole protocol, and what follows is how to run it without being talked out of it. I am not arguing against synthetic audiences. Almost nobody in this market applies that standard today, which is my reason for setting the test down in writing.

Validation measures predictive value, not fluency

The question is not whether the output sounds like a physician, but whether it predicts what a physician does. Those two get conflated constantly, and the conflation is where the money tends to go. A vendor demonstration shows fluency, with a simulated prescriber speaking in the right register, citing the right guideline and raising the objection that was expected. It reads like insight.

Fluency is the easy part, and any competent model clears it. What a buyer is paying for is predictive value, and nothing in a demonstration says whether there is any. Three questions separate the two.

The first is direction, meaning whether the model ranks options the way the market actually ranked them. The second is magnitude, meaning whether the gap between options is approximately the real gap. The third is surprise, meaning whether the model ever reports something the organization did not already believe.

That third one matters more than it looks, because a model that confirms the existing view every time has not been validated. It is agreeable rather than accurate. The surprises are where the money sits, and they tend to live in friction nobody articulates.

Gartner found 62% of customer service channel transitions are high effort in industries that can watch the transition happen. A simulated customer rarely reports being worn down, because that is something people quit over rather than describe.

A proper validation runs in six steps

The sequence runs in six steps, and the whole thing can be completed inside a quarter. The first step is to pick a cohort whose outcome is already known. A brand launch that can be seen in full, a market with twelve months of behavior behind it, or an indication expansion that has already played out will all serve. What matters is truth that exists and that the model cannot have seen.

The second step is to blind it properly. The vendor gets no outcome, no time period and nothing identifying the cohort, because a vendor already holding historic data may flatter its own error rate.

The third step is to write the prediction down before anyone looks. That means in advance, in a document, with the specific numbers the simulation is expected to produce. This is the step most often skipped, and it is the only thing standing between a buyer and hindsight.

The fourth step is to score it against behavior rather than sentiment. Script to start conversion, time to therapy, persistence at six and twelve months, and barrier resolution speed are the measures set out in how to measure customer experience in pharma . Those are the measures a simulation should be answerable to.

The fifth step is to publish the error rate internally. One number, visible and owned, carries more weight than a fidelity score the vendor computed on its own work. The sixth step is to repeat the exercise quarterly, because models get retrained, replaced and tuned underneath a buyer and nobody sends a memo. An accuracy check at purchase may describe a model that no longer exists.

Score against outcomes that cost someone something

The outcomes worth scoring against are the ones where real people already voted with effort, money or time. Validation targets should come from behavior that cost somebody something, such as a prescription written, a prior authorization appealed or abandoned, or a refill collected or not. Each of those has a price attached, which is what makes it worth predicting.

The appeal is a good place to start, because the burden is documented. In the American Medical Association's latest survey, 82% of physicians said prior authorization at least sometimes leads patients to abandon treatment. A useful exercise is to ask the model which accounts will give up, and then go and look.

There is plenty of this kind of truth available. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. A vendor can be asked to predict a number in that family, and the prediction can then be checked.

Some care is needed about how wide real variance is before a tidy answer gets accepted. An earlier review in the American Journal of Pharmacy Benefits reported that findings on primary nonadherence "range from as little as 2% of new prescriptions going unfilled to as many as 30%" . A simulation that hands over a confident point estimate inside a range that wide has said nothing, however precise the decimal looks.

Good enough means beating the alternative without flattery

Good enough means better than the thing it replaces, measured without flattery. That is a lower bar than vendors claim and a higher one than most procurement applies. The honest move is to work out what the alternative actually is for the decision in front of the team, and there are three cases carrying three different bars.

If the alternative is one brand manager's assumption formed in a meeting, the bar is low. Simulation beats assumption in that case, and it should be used, with the reasoning written into the document. If the alternative is real research that could have been commissioned, the bar is high, and the simulation has to get close enough that the difference does not change the decision. It will often fail that test on anything subtle.

If the alternative is a number that will be reported upward, there is no bar at all. A simulated output does not become a reported figure, ever, at any accuracy level. Use it to decide what to measure, never as the measure.

Vendors resist a published error rate for a reason

A published error rate is the one artifact that makes the category comparable, and nobody selling into an unmeasured market wants a measurement. Expect four objections, each of which has an answer.

The first objection is that the fidelity score is already ninety something. A score the vendor defines, computes and reports on its own work is marketing rather than evidence. Asking what it is a percentage of, then watching what happens, tends to settle the question.

The second objection is that synthetic research is directional rather than predictive. That is a reasonable position, and the right response is to hold the vendor to it. Then ask why the pricing, the dashboards and the sales deck are all built as though it were predictive.

The third objection is that patients cannot be validated against. That is correct, and it is the finding rather than an excuse, because it limits where the tool belongs rather than licensing the claim. I have set out why the patient audience is the weakest ground in synthetic personas in pharma .

The fourth objection is that nobody else asks for this. That is true today, which is beside the point for an organization buying something that has to work rather than buying what everybody else is buying. A vendor who runs this test and comes back with an unflattering number has said more about the product than any demonstration could, and that is the vendor to buy from.

Where validation is impossible, label it and bound it

Where validation is genuinely impossible, the answer is to label the output, bound its use, and keep the real listening funded. Patients are the hard case, because in most markets they cannot be spoken to, so there is no real voice available to score the simulated one against. The audience most worth simulating is the one that can least be checked.

Notice why the pressure to skip the test keeps rising. Veeva Pulse data reported by BioSpace put HCP accessibility at 45%, down from 60% eighteen months earlier. As real access closes, simulated access gets easier to sell and harder to check.

Three rules hold in that situation. Any chart built on simulated respondents carries that fact in the title rather than a footnote. No unvalidated simulation touches a decision that cannot be reversed. Spending on real listening does not fall because simulation got cheaper, which is the failure mode this whole category tends to create.

There is a cheaper source of real patient signal most companies already own, and almost nobody collects it. Nurses, hub agents and patient support staff hear from patients daily, and that route is set out in voice of the frontline .

Revalidation belongs with whoever reports the number

Revalidation belongs with whoever reports the number rather than with whoever bought the tool. The error rate should sit in the same hands as the commercial scorecard. A research team that owns the vendor relationship has an interest in the tool looking good, which is not a character flaw so much as how incentives work.

Watch what happens when nobody independent holds the measure. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied. The industry is already capable of believing a comfortable number for years, and in my experience a confident simulation makes that easier rather than harder.

The reason a model cannot reach what actually drives the decision is in Predisposition . The three routes to real signal are in voice of the customer in pharma , and the argument all of it serves is the future of the pharma commercial model .

Key Takeaways

Validation means a blind prediction against a cohort whose outcome is already known, with the error rate published and repeated quarterly.
The thing being validated is predictive value rather than fluency, since any competent model clears fluency and a demonstration says nothing about prediction.
Scoring should run against behavior that cost somebody something, such as conversion, time to therapy, persistence and barrier resolution speed.
A vendor defined fidelity score is marketing, while an error rate against an organization's own realized outcomes is evidence.
Where validation is impossible, as with patients, the output carries its label in the chart title and never becomes a reported number.

Diagnostic Questions to Consider

A buyer should be able to name the cohort the validation will run against, and the vendor should be able to prove it has never seen that outcome.
The vendor should be able to say exactly what its fidelity score is a percentage of.
A vendor should be able to show one engagement where the validation came back unflattering, and what was done about it.
Someone inside the company should own the error rate, and that person should be independent of the contract.
The vendor should be willing to name the decisions it would advise against making on its own output.

Closing Reflection

Validated, a simulation becomes a real instrument. Skipped, the test leaves an organization holding a very articulate way of agreeing with itself, and the agreement will feel like insight every time. The difference between those two states is one published number, repeated quarterly.

The protocol is not complicated, which may be part of why it goes unrun. A blind prediction against a known cohort, a written forecast, a scored result and an owner independent of the contract can be assembled by any commercial team that wants them. What tends to be missing is the appetite for a number that could come back unflattering.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

What Is Predisposition, and Why Does It Beat Heroics?

Sat, 10 Oct 2026 01:33:26 GMT

Predisposition is a property of how a company is built, not a property of how a customer feels. A predisposed organization delivers exceptional experiences because of its structure, rather than because exceptional people rescue outcomes inside it. In pharma, where the commercial system is a working link in the therapeutic value chain, that distinction decides whether the science reaches the patient it was made for.

Most of the vocabulary a commercial organization uses describes the customer. Awareness, preference, loyalty, intent and satisfaction are all readings taken from the person on the other side of the table. Predisposition runs the other way, because it describes the enterprise and what the enterprise is disposed to produce. That inversion is the reason the word earns its place, and it is what separates predisposition from preference.

The word is worth reclaiming for a practical reason. A company can influence what it is disposed to do far more directly than it can influence what a physician has come to believe. One of those is a design question that can be worked on this quarter, and the other is a long accumulation that may take years to move.

What predisposition means inside a company

The test of a predisposed organization is ordinary. Take a routine day, with routine staffing, no executive visit and no quarter end pressure, then watch what the customer actually receives. If the experience holds, the capability sits in the design. If it holds only because a particular person noticed and intervened, the capability sits in that person, and it leaves when they do.

This is a structural reading of excellence rather than a cultural one. A structurally predisposed company has made the helpful outcome the path of least resistance for its own people. The helpful outcome arrives because the process produces it, the data supports it, the ownership is clear and the incentives do not quietly argue against it. Companies can be full of committed people and still fail this test.

Predisposition in this sense is cumulative rather than declared. Every unresolved seam leaves context debt behind it, and the debt is paid later by whoever happens to be standing closest to the customer. Over enough quarters, the accumulated debt becomes the real operating model, whatever the strategy document says.

Predisposition is also directional rather than binary. No organization is fully predisposed across every path a customer takes, and most are strong in one and thin in another. A company may be well built for the Path to Prescribe and largely improvised on the Path to Fulfill, because the first was designed and the second was inherited. The useful question is rarely whether a company is predisposed, but where it stops being predisposed.

Why heroics are the clearest diagnostic

Capable people rarely let a design gap become a visible failure. Field colleagues make the extra call nobody asked them to make. Access specialists pursue the exception the standard process cannot handle. Support teams work past the edge of their remit because a patient is waiting, and the outcome lands anyway.

Leadership sees the resolution. It rarely sees the effort that produced the resolution. That asymmetry is what makes heroics a subsidy, because an organization can deliver promises its routine processes cannot reliably support, and the cost is paid in discretionary effort nobody books. A recurring design problem can survive for years inside a company where committed people keep rescuing the outcome.

So the presence of heroics is not evidence of a strong culture. It signals a system that has not been predisposed to produce the outcome on its own. Deloitte's 2025 research puts a number near this gap, finding that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who report satisfaction. Two populations are describing the same commercial system, and one of them is describing the version that heroics have already repaired.

None of this diminishes the people. Their effort deserves respect, and in every commercial organization I have worked inside it was the reason outcomes landed at all. The argument is about where the burden should sit, because effort spent compensating for a design is effort that cannot be spent on the customer in front of them. Heroics also conceal the location of the problem, which is largely why a company can run a goodwill measure for years without ever finding the seam that keeps breaking.

The subsidy also distorts investment, because a problem that never shows up as a failure never competes for funding. Planning cycles allocate against visible gaps, and heroics make the gap invisible by closing it in real time. Every interaction either compounds value or creates drag, yet drag absorbed by a colleague looks identical on a dashboard to drag that was designed out. That blind spot is one reason unpredisposed systems can persist inside companies that measure a great deal.

What predisposition is not

Four readings of the word should be set aside. Predisposition is not the customer's lean toward a brand, which is preference, and preference belongs to a different conversation about demand. Predisposition is also not satisfaction, since a satisfied customer may still be moving through a system that depends on rescue. Bain's own work qualified the loyalty case usefully, finding that goodwill is "a necessary but insufficient condition for generating revenue growth."

Predisposition is not culture in the sense of values printed on a wall, because stated values can coexist with a process that makes the right action expensive. Nor is it the heroics described above, which are the symptom of its absence rather than the proof of its presence. Each of the four readings points at something real. None of them tells a leader whether the company would still deliver tomorrow with a different set of people in the chairs.

How an organization becomes predisposed

Predisposition is built through the four DNA layers, which is where this term earns its place in the platform. Each layer governs a different reason excellence fails to become routine, and no single layer holds on its own. A company can repair one of them and watch the gain drain away through the other three.

Leadership DNA determines whether the commitment survives contact with a quarterly target. Most leaders mean what they say about the customer, so the real question is what happens to that commitment in the week a number comes in short. Organizational DNA determines who owns the seams between functions, which is where most customer outcomes are decided. An unowned handoff will often default to the customer, who then becomes the integration layer the company never built.

Operational DNA determines whether helpfulness is repeatable without an exceptional colleague somewhere in the chain. The work of rewiring Operational DNA is unglamorous, since it lives in escalation paths, case ownership, data visibility and small decisions nobody writes a strategy about. Gartner found that 62% of customer service channel transitions are high effort , and each of those transitions is a place where a system asks a person to absorb its design.

Commercial DNA determines whether measures, incentives and investment decisions reward realized value rather than declared intent. Reimagining Commercial DNA is the layer most often skipped, because it asks a company to change what it counts. Prior authorization makes the point plainly. The American Medical Association reports that 93% of physicians say prior authorization delays care, which is a structural cost that rarely appears on any brand's commercial scorecard.

Taken together, the four layers describe Customer Excellence as an enterprise capability rather than another program, department or training initiative. That phrasing carries weight, because a program can be staffed by heroes and still leave the system unpredisposed. Capability means the outcome survives the people.

How to tell whether a company is predisposed

The reading comes from observation rather than from a survey instrument. Four tests do most of the work, and none of them requires asking the customer anything. The first is ownership, meaning whether a stalled case has a named owner inside the company or waits until someone outside chases it. An organization that cannot name the owner has already answered the question.

The second test is recurrence. If the same barrier appears across several quarters with no design change behind it, the system is absorbing that barrier through effort rather than removing it. The third is description, meaning whether the organization can explain what happens at a handoff without naming a specific person. A process described through individuals is largely a process that does not yet exist.

The fourth test is the most uncomfortable and the most useful. Remove the best three people from a core process, then ask whether the customer's outcome would change. If it would change materially, the capability was never in the system to begin with. These four readings can be run inside a single quarter, which is part of why they tend to survive contact with an operating review.

The measure that settles the argument

A predisposed enterprise produces a higher Realization Rate for a pharmaceutical brand , which is realized value divided by earned value. Earned value is what the science and the clinical evidence have already justified. Realized value is what the patient population receives after every seam in the commercial system has taken its cut. The ratio between them is not an opinion about culture, and it moves when the design moves.

That is why the measure belongs at the end of this definition rather than the start. Every other reading of predisposition can be argued about by people with different vantage points inside the same company. The ratio of realized to earned value does not care which of them is right. Bain's work on commercial productivity found that roughly 40% of a physician's drug recommendations relate to overall experience rather than the product itself, which puts the structural question inside the revenue line.

Key Takeaways

Predisposition describes the enterprise rather than the customer, meaning a company built to deliver exceptional experiences structurally and systematically.
The test is what the customer receives on an ordinary day, with ordinary staffing, when nobody senior is watching.
Heroics operate as a subsidy, letting an organization deliver promises its routine processes cannot reliably support at a cost nobody books.
Predisposition is distinct from preference, from satisfaction, from values on a wall and from the rescue work that hides a design gap.
The four DNA layers are how an organization becomes predisposed, and no single layer holds on its own.
A predisposed enterprise produces a higher ratio of realized value to earned value, which is the only test that does not rest on an opinion.

Diagnostic Questions to Consider

Whether a stalled case has a named owner inside the company, rather than waiting for someone outside to chase it, is worth establishing before anything else.
The barriers that have recurred across the last four quarters without a design change behind them deserve to be listed by name.
Describing what happens at a handoff without naming a specific person is a test most organizations have never tried to pass.
Removing the best three people from a core process raises the question of what the customer would then experience.
The measures that reward realized value rather than declared intent can usually be counted on one hand, and the count itself is the finding.

Closing Reflection

Reclaiming this word costs something, because it moves the subject of the sentence from the customer to the company. That move is less comfortable than it sounds. A reading of the customer can be commissioned, presented and filed, while a reading of the enterprise implicates the people in the room who built it.

In my experience the hardest conversation was rarely about what customers wanted. It concerned how much of the current result was being carried by people working beyond what the design supported. Once that is visible, it tends to be difficult to unsee, and the budget conversation changes shape.

I have come to treat the heroics question as the first diagnostic rather than a closing observation. A company with no heroics may simply have a system that works. A company that depends on them is running a subsidy it has never priced, and the vocabulary of Customer Excellence exists largely to make that subsidy visible before a competitor prices it first.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

The Future of the Pharma Commercial Model

Sat, 10 Oct 2026 01:30:57 GMT

The next decade of commercial advantage in pharma will be won in the distance between an approved medicine and a patient who stays on it. Not in the promotion of the medicine. That distance is where the value your science already earned goes missing, and in most companies nobody owns it.

This page is the whole argument in one place. Four conditions that make your market structurally different from every market consumer playbooks were written for. Three paths where earned value is lost. One number that tells you how much. One standard you are being held to whether you accept it or not.

Everything else on this site is a branch of what follows.

What is actually changing?

The scarce resource moved. It used to be access to the physician. Now it is completion of the decision she has already made.

Your commercial system was designed for the first problem. Share of voice, reach and frequency, call plans, message recall. Every one of those instruments measures whether you were present at the moment of choice. None of them measures whether the choice survived contact with your company.

Look at what happens after the choice. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024, up from 24.3% in 2018. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. Your medicine was chosen. The patient went without.

That is not a marketing failure. It is a system that stops measuring at the point where the money is actually lost.

Access to the room is closing at the same time. Veeva Pulse data reported by BioSpace put HCP accessibility at 45%, down from 60% eighteen months earlier. So the lever you have spent forty years refining is getting weaker, and the lever nobody is pulling is getting heavier. That is the shift, stated plainly.

Why does your current model miss it?

Because four conditions in your market break the assumptions every consumer experience playbook rests on. Most companies import the playbook anyway, and then wonder why the program dies.

One. Your customer is three people. A physician chooses, a payer covers, a patient uses. Loyalty, repeat purchase and advocacy all assume those are the same person with the same interest. Ask one of the three and you have heard a third of the decision, usually from the party least exposed to what went wrong.

Two. Your feedback loop is closed by law and invisible by structure. In most markets you may not discuss the product with the patient. The people who abandon you do it quietly and without a complaint, which means you are being graded by a jury you are not allowed to interview.

Three. Your value event happens months after the transaction you count. Revenue is recognized at dispensing. Benefit is realized at sustained therapy. The gap between those two is handled by parties you do not employ, in a process you did not design, and your scorecard closes before it starts.

Four. Regulation governs claims, not burden. This is the hinge, and it is the one you can use tomorrow. Almost none of the friction your customers meet is legally required. It is unowned.

Your industry has spent two decades treating operational burden as a compliance constraint. That turns the excuse into unclaimed ground for whoever reads the rules properly.

I have set out the consequences at length in why consumer CX does not translate to pharma . The short version is that a borrowed model will give you a satisfaction score and no money.

Where exactly does the value go?

Three paths, in sequence. Name them and you can fund them. Leave them unnamed and the loss stays invisible.

The Path to Prescribe runs from an undiagnosed patient to a clinical decision. Identification, diagnosis, referral, and a clinician who chooses. This is the only path your current commercial model fully funds.

The Path to Fulfill runs from that decision to the medicine in a hand. Coverage, prior authorization, cost, dispensing. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. Cost finishes what paperwork starts. IQVIA Institute data reported by Managed Healthcare Executive found that of prescriptions with a final cost above $250, 61% are not picked up.

The Path to Adhere runs from a first fill to the duration your trial actually demonstrated. Persistence, refill, support, the second and third unglamorous months where your efficacy claim either becomes true for this person or does not.

Ask your team which of the three they have a named owner for, a budget line against, and a measure on the commercial scorecard. In most companies the honest answer is one out of three.

What is the number that matters?

The share of the value you already earned that you actually realize. We call it your Realization Rate , and it is the only number in this argument that a finance director will recognize as a number.

Start with the value your science and your promotion have already created. A clinical decision made in your favor is earned value. Then measure what arrives.

Script to start conversion. Time to therapy. Persistence at six and twelve months. Barrier resolution speed. The difference between earned and realized is value leakage , and it is the largest unmanaged line item in your commercial budget.

Two things follow from measuring it this way, and both matter to you.

The first is that the loss becomes forecastable rather than anecdotal. Once you can size the leak by brand and by path, you can hold it as Customer Value at Risk and put it in a plan, which is how any other function gets funded.

The second is that you stop arguing about sentiment. Bain's analysis of pharma commercial productivity found that roughly 40% of a physician's drug recommendations relate to overall experience rather than the product itself. That is a real finding and it is still not a scorecard. Progression measures are. The full set is in how to measure customer experience in pharma .

What standard are you being held to?

The one your patient met this morning, somewhere else, before she met you.

She tracked a parcel to the minute. She changed a flight on her phone in ninety seconds. Then she called your hub and was asked for her date of birth four times. She is not comparing you to Merck. She is comparing you to the last competent transaction she had, and you do not get a pass for being a pharma company.

That is the bar I call Consumer-Grade . Not a tone of voice, not a design system. A standard of operational performance applied to the three paths above, in a market where the three person structure makes it harder and the stakes make it matter more. What meeting it changes, slowly, is Predisposition , the lean your customer already holds before you ask.

Your own customers are already scoring you against it. Only 16% of respondents in DHC Group research reported by eMarketer view the pharma industry as patient centric. Effort is the mechanism underneath that number. Gartner found 62% of customer service channel transitions are high effort in industries that can watch the transition happen. You usually cannot watch yours.

Who is going to own this?

Nobody, in your current structure, which is precisely why the work does not happen.

Count the functions with a claim on the three paths. Marketing owns the message. Sales owns the relationship. Market access owns the formulary. Patient services owns the hub.

Medical owns the science. Every one of them touches a seam and none of them owns the whole distance, so the seams belong to the organization chart rather than to a person.

My argument is that realized value needs a fourth pillar beside brand, field and access. Not a CX department. A commercial function accountable for the conversion of earned decisions into realized therapy, with a scorecard, a budget and a seat where the money is allocated.

Watch the evidence for the gap. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies. A 54 point spread is not a measurement error. It is what an unowned system looks like from the outside, and I have written on where it should sit in who should own customer experience in a pharma company .

What happens to the companies that wait?

They get the structure rewritten around them by companies that moved first, and then they copy the artifact instead of the decision.

Look at what the direct channels actually did. Lilly did not build a better experience. It set a cash price, routed around access and shortened the Path to Fulfill, which I have taken apart in what Lilly actually changed . Novo followed into the same path, and the one I examine in the consumer business question is why both still leave the other two paths open.

The lesson is available to you without a cash paying category. Those companies found the specific structural gate between their science and their patients, then changed the structure rather than improving the experience around it. Your gate is different. The method is the same.

If you want the sequence rather than the thesis, start where the diagnosis is, in why pharma CX programs fail . Take the money case next, in what the ROI of customer experience actually is . Then work out what you should be listening to, in voice of the customer in pharma . The discipline that holds the whole thing together is Customer Excellence . If somebody is selling you simulated customers while you do it, read how to validate a synthetic audience and the calibration trap first.

Exceptional science deserves an exceptional commercial system. Yours already has the first half.

Key takeaways

Commercial advantage is moving from winning the prescribing decision to completing it, because the decision increasingly fails after it is made.
Four structural conditions break the consumer playbook in pharma, and the fourth is the opening: regulation governs claims, not burden.
Value is lost along three sequential paths, and most companies fund only the first one.
Realization Rate converts the argument into a number a finance director accepts, and the gap it exposes is value leakage.
Consumer-Grade is the standard your patients already apply, and no function in your current structure owns the whole distance it covers.

Questions to ask your leadership team

For your lead brand, what share of clinical decisions made in your favor turns into sustained therapy, and who reports that number?
Which of the three paths has a named owner, a budget line and a measure on the commercial scorecard?
Of the friction your customers meet, how much is a regulatory claims rule and how much have you simply never challenged?
What would you stop funding if you could size value leakage by brand tomorrow?
Who in your company would lose if the Path to Adhere improved, and how are you going to handle that?

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: What Consumer-Grade means in pharma , What is value leakage in pharma? and What is Customer Excellence?

What Is a Synthetic Persona? The Definition for Pharma

Sat, 10 Oct 2026 01:20:08 GMT

A synthetic persona is a model generated stand in for a customer, built from existing research and public data, used to produce simulated answers to questions otherwise put to a real person. That is the whole thing. Everything else is implementation detail, and most of the confusion in this market comes from vendors describing the detail instead of the definition.

This page sets out what they are, how they are built, and what they are worth in each of pharma's three audiences. It also covers where they fail, and the test any of them should pass before touching a commercial decision.

What is a synthetic persona, precisely?

Three things have to be true, or what is being sold is something else. It stands in for a specific customer type rather than a general audience, and it generates responses rather than retrieving them. Its outputs are then treated as if they were research, which is the part that creates all the risk.

The related terms are used loosely, so here is the vocabulary as it is actually used. A synthetic respondent is one simulated individual answering a question, while a synthetic panel or synthetic audience is many of them queried together to produce something resembling survey results. An AI persona usually means the same thing with the emphasis on characterization rather than sampling. A digital twin is a different idea borrowed from engineering and applied loosely here, normally meaning a simulated individual built from that specific person's own data rather than from a segment. In the research literature the practice of using a language model to stand in for survey respondents is sometimes called silicon sampling.

What none of them are is a measurement, since a synthetic persona produces an estimate of what a category of person might say. That is a hypothesis, and treating it as a finding is the single most common error in this field.

How are they actually built?

Source material is the first of three layers, and it sets the quality of the whole thing. Prior survey research, claims or behavioral data, public literature, transcripts, and whatever the vendor holds in its own library all feed it, and that defines what the persona can know.

The model is the second layer, a large language model that generates plausible responses in character, which defines how the persona talks. Calibration is the third, adjusting outputs so they resemble known distributions, usually by benchmarking against the client's historic data or syndicated category research. This defines how confident everybody feels, which is not the same as how accurate it is.

Notice the dependency, because a synthetic persona cannot know anything its source material does not contain and can only recombine, extrapolate and phrase. When a vendor says a persona is grounded in a company's research, read that as inheriting that research, including everything the research got wrong.

Are they equally useful across the three audiences?

Not remotely, and this is the distinction nobody selling them makes. Pharma has three customers, since a physician chooses, a payer covers and a patient uses. Simulation fidelity differs so much across the three that treating them as one capability is often the first mistake.

Physicians sit at medium fidelity and are checkable, because there is abundant public material in a clinician's professional register, from literature to guidelines to conference commentary. A model can produce a credible HCP voice, and more importantly it can be checked, because real prescribing behavior exists to score the simulation against. This is the audience where synthetic work is most defensible.

Patients sit at low fidelity and are unverifiable, which is where the pitch is strongest and the ground is weakest. A manufacturer usually cannot speak to patients, so there is no real voice available to validate the simulated one. The audience a company most wants to simulate is the one it can least check. In the organizations I have worked inside, a confident simulation that cannot be falsified is a well written assumption rather than evidence.

The behavior a company would want it to predict is also severe. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. No simulated patient told anyone that was coming.

Payers sit at the lowest fidelity of the three, since formulary decisions run largely on contracts, rebate economics, net price and committee politics. Almost none of that is in the text a model learned from, and the parts that matter most are confidential by design. A simulated payer will produce an articulate account of clinical value and miss the actual decision rule entirely.

So the honest ranking, as I would set it out, is physician first, patient a distant second with disclosure, payer last and mostly not worth doing. The temptation is strong for a reason. Veeva Pulse data reported by BioSpace put HCP accessibility at 45%, down from 60% eighteen months earlier. As real access closes, simulated access gets easier to sell.

What are they legitimately good for?

Replacing an assumption is the first of four jobs, all of them upstream of real research rather than instead of it. At the design stage the choice is rarely between a synthetic persona and real data, because the live alternative is one brand manager's opinion, formed in a meeting and left unchallenged. Simulation beats opinion, which is a genuine gain and the strongest case for the whole category.

Generating hypotheses to test is the second, which means running a hundred simulated reactions, finding the three objections nobody anticipated, then going to check those three with real people. The simulation has been used to aim the expensive instrument.

Pressure testing a design before it gets built is the third. Walk a simulated patient through an access workflow and the step where the instructions make no sense may surface. That is a usability review, and it is a reasonable thing to automate.

Reaching what cannot be reached in time is the fourth, whether that is a rare disease population, a market where recruitment takes four months, or a decision due in three weeks. Simulation here is a considered compromise rather than a shortcut, provided it is labelled as one.

Where do they fail?

Modelling the rationale rather than the decision is the first of four failure modes, and it is structural rather than fixable. A language model learns how people explain choices rather than how people make them. A physician decides on context, habit, trust and the difficult patient she saw on Tuesday, then produces a tidy reason when asked. The model reproduces the reason, which yields a fluent account of why someone would do something they will not actually do.

That gap matters more in pharma than in most markets, because predisposition rather than stated preference is what moves prescribing. Simulated reasoning is a good model of the part of the customer that does not decide.

The calibration trap is the second, since grounding a persona in a company's own survey history encodes the existing blind spots at speed. If the sentiment data was not predicting commercial outcome before, a model trained on it will reproduce that failure faster and with more confidence.

Homogenization is the third, because models regress toward the center of their training distribution. The outliers, the frustrated minority, the early signal, all the people who in my experience actually say something new, are precisely the voices a simulation smooths away.

Confident error is the fourth, in that a real respondent hesitates, contradicts herself and says she does not know, while a simulated one answers everything, immediately, in complete sentences. Fluency reads as reliability to a human audience, and the two are unrelated.

Effort research outside pharma shows how much is hiding in the friction a tidy answer skips over. Gartner found 62% of customer service channel transitions are high effort , in industries where the company can watch it happen. A simulated customer never reports being worn down, because being worn down is not something a person articulates but something a person quits over.

How should a synthetic persona be validated?

Provenance is the first of three tests, and anything that cannot pass them does not belong in a decision. It asks whether the signal can be traced to something a human did rather than something a model inferred about what a human might say. Know which of the two is in hand.

Predisposition or rationale is the second, asking whether the input captures what moved the person or the story told afterwards. A synthetic respondent can only produce the latter, which caps what it can ever be worth.

Predictive hold is the third, running the simulation against a cohort whose outcome is already known, blind, and comparing its prediction to realized script to start conversion, time to therapy and persistence. The error rate gets published, and the test repeats quarterly, because model behavior drifts.

That third test is the one the industry is skipping. A fidelity score a vendor defines, computes and reports on its own work is a marketing number, while an error rate against a company's own outcomes is evidence. Insist on the second before buying.

What rules should govern its use?

Four rules apply, and they are not onerous, starting with never letting a synthetic output become a reported number. Use it to decide what to measure, never as the measure.

The second is to label it everywhere it appears. Any chart built on simulated respondents carries that fact in the title rather than in a footnote, so that a decision made on it is made knowingly.

The third is to validate before adoption and on a schedule after it. One accuracy check at purchase describes a model that no longer exists. Models are often updated, retrained and replaced underneath a buyer, and nobody sends a memo.

The fourth is to keep real listening funded. The strongest argument for simulation is that it is cheaper than research, which is also how a company talks itself out of the research it needs.

Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied. No company will simulate its way across a 54 point perception gap.

The routes that produce real signal are set out in voice of the customer in pharma , and the cheapest real signal a company already owns is covered in voice of the frontline . Within customer intelligence in pharma the persona is the hypothesis generator in a three instrument method, never a source of truth on its own.

So should a company use them?

Yes, for the four jobs above, with the three tests applied and the four rules in place. The position is simple, in that simulation beats assumption and loses to evidence. Deploy it where the alternative is a guess, keep it away from anything that gets reported, and hold it to the same standard as any other instrument claiming to describe a customer.

That standard is the point, and the measures it should ultimately be scored against are in how to measure customer experience in pharma . The discipline that connects what an organization hears to what it realizes is Customer Excellence .

Key Takeaways

A synthetic persona is a model generated stand in for a customer, producing simulated answers from existing research and public data.
Fidelity differs enormously by audience, since physicians are checkable, patients are unverifiable, and payers run on economics a text model never saw.
They model the rationale rather than the decision, which caps their value in a market driven by predisposition.
Grounding a persona in a company's own survey history encodes its existing blind spots and reproduces them faster.
A vendor defined fidelity score is marketing, while an error rate against a company's own realized outcomes is evidence.

Diagnostic Questions to Consider

Which of the three audiences a given persona is for, and the accuracy evidence that exists for that audience specifically.
What source material grounds it, and what happens to the output if that material was biased.
Whether a blind holdout test against real outcomes exists, with the error rate published.
How often it is revalidated, and who pays for that.
Which decisions the vendor would advise against making on it.

Closing Reflection

The case for synthetic personas rests on a comparison that is often left unstated. At the design stage the realistic alternative is rarely real data but one person's unchallenged opinion, and simulation does beat that. Run the comparison the other way and the limit appears, because simulation loses to evidence wherever evidence is available.

Fidelity is the part that cannot be argued away. A physician simulation can be scored against real prescribing behavior, a patient simulation has no real voice to be scored against, and a payer simulation runs on economics the model never saw. The audience a company most wants is almost always the one it is least able to check.

What follows is a working position rather than a verdict on the technology. A persona can be a legitimate hypothesis generator, and it stops being one the moment its own fidelity score stands in for an error rate against realized outcomes. Keeping real listening funded is what preserves that difference, since the evidence a simulation has to answer to has to come from somewhere.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Voice of the customer in pharma, three ways to hear , Voice of the frontline and What is value leakage in pharma?

Voice of the Frontline: The Listening Program You Already Run

Sat, 10 Oct 2026 01:15:30 GMT

Voice of the frontline is the field force already running the best listening program a pharma company has, which the company is simply not collecting. Every day the reps, the hub agents, the medical information team and the patient support staff watch the commercial system meet real people and fail them in specific, repeated, nameable ways. Almost none of that reaches a decision. It gets told as a story in a district meeting, nods go round the room, and it dies there. In the organizations I have worked inside, that is the most expensive waste in the commercial budget, and fixing it costs less than one survey wave.

Why is a rep a better instrument than a survey?

A rep reports what happened rather than what someone says they think. A survey asks a physician how she feels about prior authorization. The rep saw the office manager stop filling in the appeal halfway through, close the file and move on. One of those is an opinion about a process, while the other is the process failing, observed, with a date on it.

Consider what is already being paid for. A field visit is the most expensive research instrument in pharma, and most companies use it exclusively to talk. A company funds a trained professional to sit in the room where its system is being used, then collects nothing about what she sees there. No commercial organization would buy an observational study and throw away the observations.

The economics have got worse, which makes the waste larger. Veeva Pulse data reported by BioSpace put HCP accessibility at 45%, down from 60% eighteen months earlier. Every visit a company still gets is worth more than it was two years ago, and most are extracting half the value from it.

What does the frontline see that nothing else catches?

Policy changes, weeks early. Four things show up here, and the dashboard carries none of them. A rep hits a new payer requirement the first week it bites, while claims data will show the same thing in a quarter, after the patients are already lost.

Where the process actually breaks. The useful fact is rarely that time to therapy is eleven days. It is that the eleven days sit between the benefit check and the prior authorization submission, because each team believed the other had it.

Workarounds. When an office invents its own process to cope with a company's, that is a diagnosis. Somebody has said exactly which step is broken, in the most expensive way available, by building a bypass.

What the patient said to the nurse. A manufacturer often cannot talk to the patient, but the nurse can, and does, and remembers. That is the closest thing to patient voice available in most markets, and it sits in a company's own staff's heads.

So why does none of it reach the brand team?

Three reasons explain it, and only the third is hard. The first is that there is nowhere to put it, because a CRM captures what the rep said rather than what she saw. There is a field for the call objective and no field for the observation, so the observation has no home and does not survive the drive back.

The second is that nothing comes back. A rep who reports something and hears nothing reports fewer things next quarter, and nothing at all by the year after. Every listening system in history has died this way, and it is entirely predictable.

The hard one is that it gets dismissed as anecdote. Somebody senior says one rep in Ohio is not data, and they are often right, which is why the fix is structural rather than cultural.

Channel preference shows the same pattern from the other side. Engagement mix in this industry is still largely set by what a company can deploy rather than by what a clinician asked for. The field has been saying that for years, in rooms where it did not count as evidence.

How does anecdote become evidence?

Anecdote becomes evidence by asking the same question every time and counting the answers. One rep saying an office gave up on an appeal is a story. Four hundred reps answering a standing question about where accounts stalled this week, captured the same way, time stamped and counted, becomes a dataset. Its coverage and latency beat anything a company can buy.

That is the whole trick, since anecdote becomes evidence through standardization rather than through volume of conviction. Give the frontline a fixed, short set of things to report, make reporting take under a minute, and the aggregate carries statistical weight that no individual story ever could.

The capture has to stay brutally small. Where did an account stall, what did the customer do about it, and was it resolved and how long did it take. Three things, every week, from everyone. A capture that takes longer than a minute will produce compliance theatre instead of signal, and compliance theatre is worse than silence because it looks like data.

Where should the signal go?

It should go to someone who can change something that week. In the organizations I have worked inside, routing may be where most of these programs fail quietly. Signal that lands in a quarterly insights report has arrived too late to matter. Signal that lands with a named owner of the specific seam, inside days, produces a fix the rep then hears about, which is what keeps her reporting.

The loop has to run in both directions, from capture to route to resolve to telling the person who reported it. That last step is not a courtesy but the mechanism that keeps the instrument alive, and it is the step everybody skips. The operating discipline for running a field organization as a sensing system rather than only a delivery channel is set out in our practice note on FieldOS .

What does this fix that surveys cannot?

It closes the gap between what executives believe and what customers experience. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives satisfied with those same strategies. A 54 point spread does not come from a measurement error. It comes from a company whose senior people have no route to what the frontline sees every day.

The burden the frontline watches is real and documented. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. Reps have been describing that to someone for years. Close the route and the spread tends to close with it, because the argument in the room stops being about whether the problem is real.

The downstream cost is documented too. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. The frontline watched a share of those happen in real time.

How does a company know it is working?

The test is not how much gets collected but what moved. Track the share of reported stalls that got an owner within a week, and the time from report to resolution. Then track whether barrier resolution speed, the one progression measure a field organization can move inside a quarter, is actually improving.

A frontline listening system that produces a rich monthly report and no change in resolution speed is the same failure as the survey program it replaced, wearing different clothes. What separates a listening program from a listening system is set out in operationalizing voice of the customer for sustainability and scale .

Hold it to the same standard as any other signal. It should be traceable to something a human did, capable of capturing what moved the person rather than the story told afterwards, and scoreable against outcomes that can be observed.

That test is set out in voice of the customer in pharma , and the measures it should move are in how to measure customer experience in pharma . Inside the wider method of customer intelligence in pharma , the frontline is the instrument that confirms whether something is actually happening.

Get this right and the result is the one listening asset a competitor cannot buy. It runs on people the company already employs, in rooms they are already in, watching a system only that company can fix. Customer Excellence runs on exactly that kind of signal.

Key Takeaways

A field force already observes the commercial system failing, daily, and almost none of it reaches a decision.
A field visit is the most expensive research instrument in pharma and most companies use it only to talk.
The frontline catches four things nothing else does, namely policy changes weeks early, where the process actually breaks, customer workarounds, and what the patient said to the nurse.
Anecdote becomes evidence through standardization, which means the same short question, every week, counted and time stamped.
Close the loop back to the person who reported, or the instrument dies within a year.

Diagnostic Questions to Consider

Where in the company's systems a rep records something she observed rather than something she said.
What came back to a rep who reported a problem last quarter, and how long it took.
How long after a payer policy changes it appears in a report the brand team reads.
The three questions every field person could answer in under a minute every week.
Whether barrier resolution speed has improved since frontline input started being collected.

Closing Reflection

The frontline problem is a design gap rather than a character gap. Reps, hub agents and nurses are already watching the commercial system meet real people, and in the organizations I have worked inside they describe what they see to whoever will listen. The structure around them has no field for the observation, no owner for the seam and no route back to the person who reported it, so the intelligence dies where it was formed.

What makes this worth the effort is the arithmetic of access. Physician accessibility has fallen and every remaining visit is worth more than it was, which means the half of each visit that goes uncollected is a larger loss every year. Standardization is what converts those observations into something a brand review can treat as evidence.

The measure of success is movement rather than volume. A system that reports richly and changes nothing has become the survey program it replaced in different clothes. Barrier resolution speed is the one progression measure a field organization can move inside a quarter, which makes it the honest scoreboard. Closing the loop may be the least visible part of the design, yet it is the part that keeps the instrument alive.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Voice of the customer in pharma, three ways to hear , Operationalizing voice of the customer and What is value leakage in pharma?

Voice of the Customer in Pharma: Three Ways to Hear, Not One

Sat, 10 Oct 2026 00:38:10 GMT

Pharma needs voice of the customer more than any industry I have worked in, and collects less of it than any of them. That is not a failure of effort. The structure of the market blocks the front door, and what most companies do about it is stop listening and call the survey a listening program. The result tends to be a dashboard nobody acts on and a patient population the company has never heard from. There is a better answer, and it starts with admitting there are three ways to hear a customer rather than one.

Why does pharma need it most?

Customers in this market meet a system the company designed and cannot see. In retail, a bad experience ends in a complaint and a refund. In pharma, a bad experience ends in a patient who never starts therapy, and nobody tells the manufacturer. The science worked and the clinician decided, yet the value evaporated somewhere between the decision and the dose, inside a process the company set up and does not watch.

The scale of that silence is documented. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. Almost none of those people filed a complaint with the manufacturer.

The gap shows in the numbers. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives satisfied with those same strategies. That 54 point spread is the sound of an industry not listening and not knowing it. Meanwhile access to the people who could say so is shrinking, with Veeva Pulse data reported by BioSpace putting HCP accessibility at 45%, down from 60% eighteen months earlier. The need goes up as the door closes.

Why does pharma collect so little of it?

Three structural blocks stand in the way, and only one of them is about budget. The first is that a manufacturer often cannot speak to the patient at all. In most markets the product may not be discussed with her, which removes the single most informative conversation available to any other industry.

The second is that the customer is three people. A physician chooses, a payer covers, a patient uses. Ask one and a company has heard a third of the decision, usually from the party least exposed to what went wrong. I have written separately on why consumer CX does not translate to pharma , and this is the clearest consequence of it.

The third is that remaining access is expensive. Outside pharma, Gartner found 62% of customer service channel transitions are high effort in industries where the company can watch the transition happen. Pharma usually cannot watch its own, and every survey sent to a physician spends a little of the 45% that is left. A listening program that burns access to produce a slide is worse than no listening program, because it costs the company the thing it cannot buy back.

What are the three ways to hear a customer?

Direct, frontline and synthetic are the three, and each carries a different fidelity, a different cost and a different job. The discipline is knowing which one a decision is standing on.

Direct voice is the customer speaking for herself, the highest fidelity signal available and the most constrained. It is best used sparingly, on questions nothing else can answer, and never for anything that could have been observed instead.

Voice of the frontline is the field force, the hub agents, the medical information line and the patient support team reporting what they witnessed. It carries lower fidelity on feelings and far higher fidelity on behavior, and it is almost entirely unused.

Synthetic is a model standing in for a customer the company cannot reach, the lowest fidelity and the highest reach of the three. It is useful in a narrower band than its vendors tend to suggest.

Most companies invest in the first, ignore the second and are being sold the third, while the order of value runs roughly the reverse. The method that puts all three to work is customer intelligence in pharma , which organizes them as context, orchestration and progression.

Why is the frontline the most undervalued signal in pharma?

The frontline reports behavior rather than opinion, and behavior is what a commercial organization is actually trying to predict. A rep does not need to ask a physician how she feels about prior authorization, because she watched the office manager give up on an appeal. A hub agent does not need a survey to know which step loses people, having said the same sentence forty times this week. That is observed evidence, collected daily, at no incremental cost, by people the company already employs.

It also arrives early, since a rep meets a new payer policy weeks before any dashboard registers it. In the organizations I have worked inside, there is often nowhere to put that signal, so it dies in a car park between calls. Treated properly it becomes an instrument. Structure what gets captured, route it somewhere a decision can be made, and close the loop back to the person who reported it, or they stop reporting. The discipline for running a field organization as a sensing system rather than only a delivery channel is set out in our practice note on FieldOS .

Where does synthetic actually help?

Synthetic voice helps upstream of research and never downstream of it. At the design stage the choice is rarely between a synthetic persona and real data, because the live alternative is one brand manager's assumption, formed in a meeting and left unchallenged. Simulation beats assumption, which is a real gain and worth having.

The limit is just as honest. A model trained on text learns how people explain decisions rather than how they make them. A physician decides on context, habit, trust and the difficult patient she saw on Tuesday, then produces a tidy rationale when asked. The model reproduces the rationale, which yields a fluent and confident account of why someone would do something they will not actually do.

That matters more in pharma than in most markets, because predisposition rather than stated preference is what moves prescribing. It matters most of all on patients, where the pitch is strongest and there is no ground truth available to check the simulation against. The audience a company most wants to simulate is the one it can least validate. So synthetic voice belongs where it can generate hypotheses, pressure test a design or reach a segment that cannot be surveyed in time, rather than inside a number that gets reported.

How can a company tell which signal to trust?

Provenance. Three tests apply, and the first asks whether an input can be traced to something a human did rather than something a human said. An abandoned appeal outranks a satisfaction score.

Predisposition or rationale. The second asks whether the input captures what moved the person or the story they told afterwards. Stated reasons are the weakest evidence in this market, and the only thing a synthetic respondent can produce.

Predictive hold. The third runs the signal against a cohort whose outcome is already known, comparing what it predicted to realized conversion, time to therapy and persistence. The error gets published, and any signal that cannot be scored this way is a focus group with better grammar. That last test is the one the industry is skipping, and it is the only one that separates a listening system from a listening theatre.

Where does this sit against measurement?

Voice of the customer sits beside measurement, doing a different job, and confusing the two is what broke the last generation of CX programs. Voice of the customer tells an organization why, while progression measurement tells it whether. Both are needed, and the error was never listening too much. The error was promoting sentiment to the scorecard, where it could not carry the weight. Voice itself runs at three levels, from score to diagnosis to foresight , and only the last two change a decision.

Keep listening rich and the scorecard behavioral, and the whole system tends to hold. The measures that belong on the scorecard are in how to measure customer experience in pharma , and the discipline that connects listening to realized value is Customer Excellence .

Key Takeaways

Pharma needs voice of the customer more than other industries and collects less of it, because the front door is closed by law and by structure.
The 54 point gap between how HCPs rate pharma's engagement and how its executives rate it is what not listening looks like from the outside.
There are three routes rather than one, namely direct voice, voice of the frontline and synthetic, in descending fidelity and ascending reach.
The frontline is the most undervalued signal a company owns, because it reports observed behavior rather than stated opinion and arrives weeks earlier.
Synthetic simulation beats assumption and loses to evidence, so it belongs upstream of research and never inside a reported number.

Diagnostic Questions to Consider

The last time a patient told the organization something that changed a decision, and the route that account travelled to reach the people deciding.
What happens to what the field force sees, between the observation and the next planning cycle.
The proportion of customer evidence in the last brand review that was observed rather than stated.
The cohort a newly bought synthetic audience would be validated against, and the person who would publish the error.
The numbers on the scorecard that are sentiment, and what would replace them.

Closing Reflection

The structural blocks on listening in pharma are real, and they deserve respect rather than exhortation. A company that cannot speak to the patient, that faces three customers rather than one, and that watches physician access narrow is not careless when its listening comes out thin. The design of the market produced that outcome.

What follows is a different question than how to collect more. The three routes carry different fidelity and different cost, and the useful discipline is knowing which one a decision is resting on before the decision gets made. Observed behavior outranks stated opinion, and a signal that cannot be scored against a known outcome has not earned a place in a reported number.

The frontline is the part of this that is already paid for and already watching. Structuring what it captures, routing it where a decision can be made, and closing the loop back to the person who reported it may be the least glamorous work in the commercial system. It is also the work most likely to turn listening into realized value.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Operationalizing voice of the customer for commercial success , Bespoke, the future of experience measurement and What is value leakage in pharma? and Pharma customer experience, why it stalls and what replaces it

LillyDirect: What Lilly Actually Changed, and What You Can Copy

Fri, 09 Oct 2026 22:51:30 GMT

Organizations tend to copy the visible half of a move and leave behind the half that produced the result. LillyDirect is usually written about as a digital platform, which is the least interesting thing about it. Strip the website away and what is left is a pricing and channel decision that changed who Lilly has to satisfy in order to get paid.

Lilly did not build a better customer experience in the ordinary sense of the phrase. It removed two of the three people from its market, which is a different kind of move entirely. That distinction matters, because most companies are about to copy the wrong half of it.

Lilly changed the route to the patient rather than the experience

What changed was the route and not the experience. When the platform launched in January 2024, David Ricks framed the move around burden. The launch release said a complex US healthcare system "adds to the burdens patients face when managing a chronic disease."

Underneath the language, three things changed at once. A self pay price means coverage stops being the gate, a telehealth route means the prescriber stops being the gate, and direct fulfillment means the pharmacy counter stops being the gate. Speaking to Axios the same week, Ricks was blunter about the model, saying "We're used to buying consumer goods directly from manufacturers all the time on online websites."

Notice what is missing from that list. There was no survey, no workshop and no experience function, only three structural changes to how the product reaches a patient, made by commercial leaders. In the organizations I have worked inside, a change of that shape rarely arrives from the direction most people expect.

The channel worked, on the company's own unaudited account

On Lilly's own account it worked, and at a scale almost nobody in this industry predicted two years ago. At the J.P. Morgan Healthcare Conference in January 2026, Ricks told the room that "basically a million people a month go online and buy GLP-1 medicine directly from a drug manufacturer."

He also said the vials sold through the channel had become roughly the second best selling obesity product after Zepbound in an autoinjector. Both figures deserve care in how they are read. The million a month figure describes the whole direct channel across manufacturers rather than Lilly alone. Both numbers are the CEO's own claims rather than audited disclosures, which may be read as directionally real and precisely unverified.

Even discounted, the signal holds. A route that did not exist in 2023 is now moving product at a volume that competes with the company's own flagship presentation. The question that matters for everyone else is what share of a brand's volume moves through a channel that did not exist three years ago.

LillyDirect solves the Path to Fulfill and little else

The platform solved one of three problems, and naming which one is what makes the case usable. We model the distance between a company's science and its patient as three sequential paths. The Path to Prescribe is where a patient is identified, diagnosed, referred and a clinician decides. The Path to Fulfill is where that decision survives coverage, prior authorization, cost and dispensing. The Path to Adhere is where the patient stays on therapy long enough to get the benefit the trial demonstrated.

LillyDirect is a Path to Fulfill solution, and an elegant one. It takes the stage where most earned value is lost in the US and shortens it from weeks to days. It does very little for the other two paths, which is a description of the design rather than a criticism of it. I read that as a reminder to check which path a brand is actually funding, since the answer is rarely the one on the slide.

The move dissolved three of the four conditions that defeat consumer models

It worked because it dissolved three of the four conditions that make consumer models fail in pharma, rather than managing around them. A pharma market has three people in it, since a physician chooses, a payer covers and a patient uses. Lilly did not solve that. It deleted the payer from the transaction by setting a cash price and routed around the access problem with telehealth, leaving one buyer, one decision and one path.

The feedback loop in pharma is partly closed by law and partly invisible by structure. A direct channel hands Lilly first party data it never had, covering who ordered, who refilled, who stopped and when. That is the loop closing, and it may be the most undervalued asset in the whole program.

The value event in pharma is sustained therapy, months after the transaction the system counts. In a refill channel persistence can be seen directly rather than inferred from claims data that arrives late and incomplete. The fourth condition is the hinge, because regulation governs claims rather than burden.

Nothing in the rules prevented Lilly from doing any of this, because none of it is a claim about efficacy or safety. The move is an attack on friction, and friction was never the regulated part. In the organizations I have worked inside, the line between a rule and a habit is often left untested.

Most companies will copy the website, the least transferable part

Most companies will copy the website, and the website is the least transferable part of the move. The portal is downstream of a pricing decision. LillyDirect works because a meaningful number of patients will pay cash for a GLP-1, which is largely true of GLP-1 medicines and almost nothing else in a pharma portfolio.

In oncology, in rare disease and in most specialty categories, the payer cannot be deleted because the therapy costs more than any patient will put on a card. For a brand where coverage is mandatory, copying the channel buys a handsome site that changes nothing. The three person market is still three people, and the gate is still the prior authorization.

The published numbers on that gate are getting worse. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024, up from 24.3% in 2018. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

The transferable lesson is the structural one. Lilly identified the specific gate between its science and its patients, then changed the structure rather than improving the experience around it. That question has a different answer for every brand in a portfolio.

Owning the whole path invites scrutiny of every conversion rate

Owning the whole path costs scrutiny, and the detail is worth studying before anyone designs their own. In July 2025, after a nine month investigation, Senators Durbin, Welch, Warren and Sanders published a report on manufacturer telehealth platforms. Three figures from their findings on LillyDirect are the ones to note. They are not a verdict on Lilly but a description of what any company inherits when it owns the whole path.

Patients routed to a telehealth visit received a prescription 74% of the time. At one partner, more than 500 of 620 LillyDirect patients were prescribed a medication, against 39% of that partner's overall patients. LillyDirect users seeing a contracted physician were six times more likely to receive a Lilly product than another brand.

Durbin said the findings "shine a light on potential conflicts of interest and inappropriate prescribing." Lilly has maintained that it does not incentivize physicians to prescribe its own medicines. Both facts hold at once, because the channel removed real burden for real patients and it also put the company in a position where every conversion rate becomes an exhibit.

That is a structural consequence of integrating the path rather than evidence of intent. Anyone building one of these can design the governance before the interface. That means deciding in advance how a prescriber is selected, what the patient sees before they meet one, and who audits the prescribing pattern quarterly. Those are answerable questions, and they are much harder to answer after a subpoena than before a launch.

Brands that cannot delete the payer work the seams instead

A brand that cannot delete the payer works the seams instead and measures the path. Most brands will never have a cash option, and for those the gate is the interval between the prescription and the patient. The work there is often unglamorous.

It starts with finding where patients stop moving and putting a name on each of those seams. Script to start conversion and time to therapy can be measured across the Path to Fulfill, and persistence and barrier resolution speed across the Path to Adhere. Realized value measured against the value a brand had already earned is its Realization Rate.

Those numbers belong on a commercial leader's scorecard rather than in a quarterly experience readout. We call the money sitting in that interval value leakage , the discipline that recovers it Customer Excellence , and the bar it is built to clear Consumer-Grade .

Lilly took the shortcut available to a company with a cash paying category. The rest of the industry has to do it the long way, and the long way is still a commercial system change rather than a CX program.

Key Takeaways

LillyDirect is a pricing and channel decision with a website attached, and it solves the Path to Fulfill rather than the whole distance to the patient.
It worked by deleting the payer from the transaction, which is available only in some categories where patients will pay cash.
The direct channel closed a feedback loop pharma has never had, giving Lilly first party data on ordering, refill and discontinuation.
Nothing in regulation prevented any of it, because regulation governs claims rather than burden.
Owning the whole path from advertisement to prescription invites scrutiny of conversion rates, so the governance deserves designing before the interface.

Diagnostic Questions to Consider

Name the single structural gate between the prescription and the patient for a lead brand, and the person who owns it.
Decide whether any meaningful share of patients would pay cash, and at what price, since a direct channel is no answer where none would.
Consider what visible refill data would reveal about persistence, and what is being inferred in its place today.
Separate the constraints that are genuinely regulatory claims rules from the operational burden that has simply never been challenged.
Identify who would audit the prescribing patterns of a direct channel, and how often that audit would run.

Closing Reflection

Lilly read its own market accurately and changed the structure that stood between its science and its patients. That deserves respect, and it also deserves precision about what was solved, because a Path to Fulfill solution does not shorten the whole distance a patient travels. The company turned weeks into days in the one stage where most earned value is lost in the US, and it left the other two paths much as it found them.

The uncomfortable part of the case lands on everyone else. Most brands have no cash option, no deletable payer and no portal that would change either fact, which leaves the slower work of naming the seams and measuring the path. The shortcut is what tends to get copied, and the structural question is what rarely gets asked.

The scorecard I would want for that work belongs to a commercial leader rather than to a quarterly experience readout. Lilly's three changes were made by commercial leaders, and that is the part of the story which transfers to any company, in any category, with or without a cash price.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Why consumer CX does not translate to pharma , Who should own customer experience in a pharma company? and How to measure customer experience in pharma

Lilly and Novo Solved One Path to the Patient. Two Are Still Open.

Fri, 09 Oct 2026 22:49:55 GMT

A move made twice in public can teach more than a move made once. Lilly and Novo Nordisk have run the same experiment for two years, and between them they have proved something the rest of the industry can use. Both identified a structural gate between their science and their patients, and both removed it the same way.

The results diverged, and the divergence may be more instructive than either company's individual performance. It separates the part of the move that transfers to another brand from the part that does not. What follows is what they solved, what they did not, and where that leaves everyone else.

Both companies built the same three changes about a year apart

Both built the same three changes, about a year apart, and nothing in either is beyond the reach of another company. LillyDirect arrived first, in January 2024. David Ricks framed it around burden, saying a complex US healthcare system "adds to the burdens patients face when managing a chronic disease."

NovoCare Pharmacy followed with the same architecture. In both cases a cash price removed coverage as the gate, a telehealth route removed the prescriber as the gate, and direct fulfillment removed the pharmacy counter. Novo added retail and telehealth partners including Ro, LifeMD, Amazon and WeightWatchers, a model STAT examined in detail last year.

Both companies decided the payer did not have to be in the transaction, which is a commercial system change made by commercial leaders, and it worked. At the J.P. Morgan Healthcare Conference in January 2026, Ricks said "basically a million people a month" now buy a GLP-1 medicine directly from a manufacturer, through a channel that did not exist three years ago.

Both platforms solve the Path to Fulfill and little beyond it

They solved one of three problems, and naming which one is the whole value of the case. We model the distance between a company's science and its patient as three sequential paths. The Path to Prescribe is where a patient is identified, diagnosed, referred and a clinician decides. The Path to Fulfill is where that decision survives coverage, prior authorization, cost and dispensing. The Path to Adhere is where the patient stays on therapy long enough to get the benefit the trial demonstrated.

LillyDirect and NovoCare are Path to Fulfill solutions, and elegant ones. They take the stage where most earned value is lost in the US and shorten it from weeks to days. Run another brand against those three paths and the same pattern often appears, with enormous investment in the first, real but partial investment in the second, and almost nothing systematic in the third. The money sitting in all three is what we call value leakage .

Product, timing and capability explain the divergence rather than experience

Three reasons explain the divergence, and in my reading the first two have little to do with experience. Tirzepatide outperformed semaglutide on weight loss in the data prescribers and patients were reading, which is a product fact that no commercial system changes. Lilly also moved first on the self pay vial and had manufacturing capacity ready behind it, while the category as a whole was absorbing supply constraints and compounded alternatives.

Experience did not create that gap and experience will not close it. That is worth saying plainly, because our field has a habit of claiming credit for outcomes it did not produce. The third reason is the one that belongs to everyone else.

Building a channel is a project with a delivery date, while operating as a consumer business is a capability with no end date. In the organizations I have worked inside, the two have looked identical in a budget line.

Novo's CEO is naming culture, DNA and focus

Maziar Mike Doustdar, Novo's chief executive, named the harder of the two problems, and more candidly than most leaders in this industry manage. At the same January 2026 conference, he said the business "acts a lot more as a consumer business than a traditional medication."

Notice what he is not reaching for. He described the work ahead as "taking the company back to the DNA we have," and added that "we are really good when we focus."

He is not reaching for a platform, because Novo has one, and he is not reaching for spend. Of the previous year he said the company had to accept that "we're no longer on our own, and we need to hurry up."

He is pointing at how the company behaves, which is the diagnosis that is rarely said out loud at that level, and the one that takes longest to act on. That is also the clearest external statement of our central argument I have found from a sitting pharma CEO. A patient does not grade a company against the pharma company down the road.

She grades it against the last excellent thing that happened to her. Meeting that bar is what we call Consumer-Grade , and Doustdar is describing it as an operating standard rather than a marketing ambition.

The 2% shows both leaders are still at the beginning

The figure shows that both leaders are still at the beginning, and that the other two paths are wide open. Doustdar put the scale of what remains as a question. Novo and Lilly together probably have ten or fifteen million patients, so "what about the other 85 million?"

Novo's own material is starker. Around 7% of the 550 million people with type 1 or type 2 diabetes receive a GLP-1, falling to roughly 2% once the 900 million people living with obesity are included. In the most commercially successful category of the decade, with extraordinary demand and awareness, 98 of every 100 eligible people are not on therapy.

Almost none of that gap sits in the path the direct channels fixed. It sits upstream, in people never identified, diagnosed or referred, and downstream, in people who start and stop. Those are the Path to Prescribe and the Path to Adhere.

Even inside the path they did fix, the US picture is unforgiving for brands without a cash option. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

What transfers to another brand is capability rather than the channel

Three conclusions follow, and none of them is to build a portal. The first is to treat the channel as table stakes rather than strategy. A channel a competitor can reproduce in twelve months is not necessarily strategy, since it is closer to a cost of entry. The planning assumption should be a market where everyone has one.

The second is to put the investment into capability, because capability is what did not transfer between these two companies. That means decision speed measured in days, pricing as a live instrument, and service recovery that can move one patient's stalled order without convening anyone. It also means a standard the company holds itself to when nobody is watching.

A competitor can hire the same platform vendor, though no competitor can buy eighteen months of changed behavior. The third conclusion is to measure all three paths rather than the one just improved.

Script to start conversion and time to therapy can be measured for the Path to Fulfill, and persistence and barrier resolution speed for the Path to Adhere. Realized value measured against the value a brand had already earned is its Realization Rate, and that holds across all of it. The full set is in how to measure customer experience in pharma , and the discipline that holds it together is Customer Excellence .

Lilly and Novo took the route available to a category where patients will pay cash. Most brands will never have that option, which means doing it the long way. The long way is still a commercial system change rather than an experience program, and it remains available to any company willing to make it.

Key Takeaways

Lilly and Novo both solved the Path to Fulfill by taking the payer out of the transaction, and both proved the move works at scale.
The channel itself transferred between them while the results did not, which suggests the channel is not where the advantage lives.
Product performance and manufacturing explain much of the divergence, and experience claims no credit for either.
Novo's CEO is describing the remaining work as culture, DNA and focus, which is the clearest statement of the Consumer-Grade standard from a sitting pharma CEO.
At roughly 2% penetration across diabetes and obesity, the Path to Prescribe and the Path to Adhere remain almost entirely unaddressed.

Diagnostic Questions to Consider

Name which of the three paths has received real investment, and which one has never been measured.
Establish what share of the people eligible for a therapy are on it today, and who owns that number.
Time how long this company takes to change a price, a message or a service rule, and compare that against a consumer business.
Decide what can be done before Monday when one patient's order stalls tonight, and by whom.
Separate what this year's investment is buying, a platform or a capability, since the two look identical in a budget and behave nothing alike.

Closing Reflection

Both companies read their own market accurately and removed the gate that stood between their science and their patients. That deserves credit, and it also deserves precision, because the Path to Fulfill was the one path they shortened. The 2% figure says the rest of the distance is still there, upstream in people never identified and downstream in people who start and stop.

The uncomfortable part of the comparison lands on everyone else. The channel transferred between two companies and the results did not, which leaves the slower work of capability rather than the faster work of procurement. A platform vendor can be hired, and eighteen months of changed behavior cannot.

The distinction I keep returning to is between a project with a delivery date and a capability with no end date. Doustdar is pointing at the second one, in a category where both leaders have already shown the first is reproducible. Most brands will never have a cash option, which leaves the long way, and the long way is still a commercial system change.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: LillyDirect, what Lilly actually changed , Why consumer CX does not translate to pharma and What is Customer Excellence in pharma?

Who Should Own Customer Experience in a Pharma Company?

Fri, 09 Oct 2026 22:19:29 GMT

Ownership questions tend to arrive once an organization has decided that something matters and has not yet decided what it is. Nobody should own customer experience inside a pharmaceutical company, and the fact that the question is being asked is itself the diagnosis. I know how that sounds from someone who did the job. The argument still deserves a hearing, because ownership is what sinks these programs, and it sinks them in a specific and avoidable way.

Why is "who owns CX" the wrong question?

The question assumes experience is a thing rather than a property of a system. Put a function in charge of it and the result is a department accountable for an outcome it cannot produce. A CX team does not control the prior authorization process, the hub vendor, the copay program, the field call plan, the medical information line or the specialty pharmacy. It can observe all of them, it can influence some of them, and it can change none of them.

So the team builds the only thing it can build on its own, which is a survey, a dashboard and a quarterly readout. Then someone senior asks what the business should do differently, and the honest answer is a list of improvements nobody outside the room is accountable for. The more useful question is not who owns experience but who owns the places where customers stop moving.

What actually breaks, and where?

The answer is almost always the seams. Here is the pattern I saw over and over inside commercial organizations. Access hits its formulary targets, the hub hits its service level, the field hits its call plan, medical answers every inquiry inside the window, and patient support closes its cases. Every function clears its bar, and a patient still waits eleven days between a benefit check and a prior authorization submission, because each group believed the other had it.

Nobody failed. The handoff failed, and handoffs have no owner on an org chart. Making customer outcomes a shared accountability is the right instinct, and it collapses into diffuse accountability unless every handoff carries a name.

The industry wide version of that pattern shows up in Deloitte's 2025 research. It found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies. That is not a gap in effort, it is what happens when every function measures its own piece and nobody measures the path through all of them.

So where should it report?

The honest answer is inside commercial, on a leader who already carries brand numbers. There are four realistic options and three of them are worse. A standalone function reporting to the CEO sounds powerful and is the easiest to cut, because it owns no revenue. Parking it under patient services makes it a support cost rather than a growth lever, and it will be managed as one.

Leaving it in marketing works only where the marketing leader actually controls access and field, which in most companies is not the case. The CMO's own position is the sharpest version of that problem, because a chief marketing officer is accountable for forming intent rather than for its survival. Put the measures on the commercial leader who owns the brand P&L, and give that leader a small team whose job is the seams rather than the surveys.

The team is the instrument, and the accountability stays with the person who already answers for the number. That is what we mean when we call Customer Excellence the fourth pillar of commercial excellence rather than a function beside the other three.

What does the owner actually own?

There are four things, and none of them is a score. The first is the progression numbers for the brand, meaning script to start conversion, time to therapy, persistence, barrier resolution speed, and realized value against earned value. The second is the named seams, each with a second name attached to it. The gap between access and patient support then belongs to a person rather than to a diagram.

The third is the escalation path, which is what happens in the hours after a stall is detected rather than in the quarter after it is reported. The fourth is the signal route from the field, because a representative often meets a new payer policy weeks before any dashboard registers it. That last one matters more as access tightens.

Veeva Pulse data reported by BioSpace found 45% of HCPs accessible to biopharma, down from 60% eighteen months earlier. Where a field organization sees something and has nowhere to put it, the scarcest input in the commercial system is being wasted.

Will legal and regulatory allow it?

Mostly yes, and the belief that they will not is doing more damage than the rules are. Regulation governs claims, meaning what may be said about efficacy and safety, to whom, through which channel and in which market. Those constraints are real, they are not negotiable, and they are rarely what is slowing patients down.

Regulation says almost nothing about operational burden. No rule requires a prior authorization to take three calls, and no rule requires a hub to ask for the same information twice. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. Almost none of that burden is a regulatory requirement.

Bringing medical, legal and regulatory colleagues in at design rather than at review makes most of this disappear. In my experience the ones who say no are usually saying no to a plan they saw for the first time on a Thursday.

What proves that the ownership is real?

It survives a bad quarter, and that is the whole test. A program with its own budget line, its own team and its own dashboard can be cut in a downturn without anything else changing, which is precisely why it gets cut. Measures that sit on a commercial leader's scorecard cannot be removed without removing part of how the brand is run.

The uncomfortable version of the test is worth asking out loud. If the CX team were dissolved on Monday, which commercial numbers would change by Friday? Where the answer is none, the problem is not ownership at all, because the program was never load bearing.

The companies moving fastest here are not resolving this with an org chart. When Eli Lilly launched LillyDirect, David Ricks framed it around how the healthcare system "adds to the burdens patients face" . Novartis launched its Cosentyx platform because, in its US president's words, the company needs "new ways to reach patients more directly by removing barriers in the system." Neither of those is a CX function. Both are commercial system changes aimed at burden and owned by commercial leaders, which is the shape of the answer.

Key Takeaways

Giving a function ownership of experience creates accountability for an outcome that function cannot produce.
The failures live in the seams between access, hub, field, medical and patient support, and seams have no owner on an org chart.
The progression measures belong on the commercial leader who already carries the brand P&L, supported by a small team that works the seams rather than the surveys.
Regulation governs claims rather than burden, so most of what gets attributed to legal and regulatory is unowned rather than forbidden.
The test of real ownership is whether the work survives a bad quarter.

Diagnostic Questions to Consider

Name the three seams where patients wait longest, and the person accountable for each.
Describe who finds out when a patient stalls, how quickly they learn of it, and what they are authorized to change.
Identify which commercial leader carries a progression measure on a scorecard this year.
Count how many of the constraints attributed to regulation have been tested with medical, legal and regulatory colleagues in the last twelve months.
State what would change by Friday if the CX team were dissolved on Monday.

Closing Reflection

The ownership question is really a question about where accountability can survive, and most organizations answer it by creating a place where accountability cannot survive at all. A function given the word experience and none of the levers will build what it can build on its own. It will then be asked why the business did not move. That outcome is structural rather than personal, because the people in those roles are often the ones who can see the breakdown most clearly.

What changes the picture is naming the seams and attaching the progression numbers to a leader who already answers for the brand. The handoffs between access, hub, field, medical and patient support are where value stops moving. They can only be managed by someone whose results depend on them. A small team working those seams may be the most useful instrument an organization has, provided the accountability never leaves the person who owns the number.

The companies moving first are not announcing a new function. They are changing the commercial system itself, aiming at burden rather than at sentiment, and they are doing it under leaders who carry revenue. Ownership that can be cut in a bad quarter was never ownership, and the work that remains after the cut is the only honest measure of what was ever real.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Why pharma CX programs fail , What is the ROI of customer experience in pharma? , How to measure customer experience in pharma and How to choose a pharma customer experience partner , and Pharma customer experience, why it stalls and what replaces it

What Is the ROI of Customer Experience in Pharma?

Fri, 09 Oct 2026 21:20:59 GMT

Nobody can calculate the return on a feeling, which is why most pharma CX business cases die in the room where they are presented. I have sat on both sides of that meeting. The deck carries a benchmark from another industry, a satisfaction number, and a claim that better experience drives growth. Someone in finance asks which line of the P&L moves, the room goes quiet, and the request gets deferred to the next cycle while everyone agrees experience is important. What follows is the version that survives the question.

Why does the usual business case fail?

The usual case asks a CFO to accept a chain of inference with four links in it. Better experience raises satisfaction, satisfaction raises advocacy, advocacy raises prescribing, and prescribing raises revenue. Each link is defensible on its own. Multiply four probabilities together and the result is something finance is trained to discount to near zero.

Cross industry proof does not rescue it either. Forrester found that customer obsessed organizations reported 41% faster revenue growth , which is a real finding about companies that sell directly to the people who use their products. A pharmaceutical CFO knows the industry does not sell that way. Bain's own range for score to growth runs from 10% to 70% , and a range that wide is not a business case, it is a shrug.

What is the actual unit of return?

Drop the chain, because there is a one link version. The unit of return is value the brand has already earned and is losing before the patient gets it. That is a different claim from experience drives growth, and a much easier one to prove, because the loss has already happened and it sits in data the company already holds. The exercise is not a forecast of lift, it is the recovery of a leak, and finance understands recovery.

Every prescription written for the brand is a clinician choosing it, so the clinical decision is already made. What happens next determines whether that decision becomes revenue, and most of what happens next is operational rather than persuasive. We call the gap value leakage , and the money sitting in it right now is Customer Value at Risk.

How can it be sized without a pilot?

Four numbers are needed, and three of them are already in the building. Start with prescriptions written for the brand in a period, which the data team holds. Then take the share that never became a patient on therapy, and the gross value of a treated patient over a defined horizon, which the forecasting team already models. The fourth is the recoverable share, which is the one that has to be estimated.

That last number is where the argument lives, so the right posture is conservative in public and rigorous in private. Not every abandoned script is recoverable. Some patients were never going to start, some were switched for good clinical reasons, and some barriers sit well outside anyone's control.

The published data says the pool is large. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024, up from 24.3% in 2018. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. IQVIA data reported by Managed Healthcare Executive puts abandonment at 61% once the patient pays more than $250. The American Medical Association's latest survey has 82% of physicians saying prior authorization at least sometimes leads patients to abandon treatment.

Those are industry figures rather than company figures, useful for justifying the exercise and no substitute for computing the brand's own. A business case built on an organization's own denominator is unarguable in a way that a borrowed benchmark never is.

What does the arithmetic look like?

The following is illustrative only, with round numbers, because every brand's figures will differ and borrowed ones should not be presented as its own. Take 100,000 prescriptions in a year. Say 35% never become a patient on therapy, which puts 35,000 scripts in the leak. Put gross value per treated patient at $12,000 over the horizon being modeled, and that is $420 million of earned value that did not convert.

Now comes the harsh assumption, which is that only 15% of the leak is operationally recoverable, writing off 85% as clinical, competitive or structural. That still leaves $63 million against a program that costs single digit millions.

Run that with the brand's own figures first. Where the recoverable share comes out at 5% the case usually still clears, and where it does not, the organization has learned something more valuable than a budget approval.

What will finance actually challenge?

Three challenges arrive, usually in this order. The first is how anyone can know the program caused it , and the honest answer is that nobody can know yet, so the claim should not be made. Propose a comparison instead, either matched territories or a staged rollout where some regions get the intervention first. Pharma runs this design constantly for field tactics, and finance teams already trust it.

The second is whether this is simply patient services doing its job , and the answer is partly yes, which is worth saying out loud. The incremental claim is about the seams between access, hub, field and medical, where nobody currently owns the handoff. Point at a specific seam and the days patients sit in it.

The third is the payback period , where barrier resolution speed moves in a quarter, which is unusual in this industry and worth leading with. Persistence takes longer. Give finance a short horizon number and a long one rather than a blended figure that is wrong at both ends.

What return should actually be promised?

A measured baseline rather than a multiple. This is the part I would do differently if I were starting over. The temptation is to promise a number, because a number gets approved. A promised multiple on an unproven chain is also how CX programs end up defunded eighteen months later when nobody can show the link.

Commit instead to three things that can be held to. The first is a baseline Realization Rate for the brand, published by the end of the first quarter. The second is a named owner for each of the top three stall points. The third is a quarterly figure for Customer Value at Risk that goes into the brand review alongside every other number.

Promise measurement first and the recovery argument becomes self funding, because the first baseline usually produces a number large enough that nobody asks for the business case again. The increment above that baseline, the realized value the same brand, product and spend would not otherwise have produced, is what I call experience alpha . The full measurement set sits in how to measure customer experience in pharma .

One caution belongs on where the money shows up. The savings rarely land in the budget that funded the work, which is a political problem rather than an analytical one. Agree in advance who books the benefit, because an unclaimed benefit becomes nobody's win and the program dies in the next planning round. The deeper version of the same problem is that a chief marketing officer measured on the formation of intent is rarely measured on its survival. That is the same reason Customer Excellence has to sit inside the commercial system rather than beside it.

Key Takeaways

The standard business case fails because it chains four inferences together, and finance discounts the product of four probabilities to nothing.
The unit of return is value the brand already earned and lost before the patient started, which is recovery rather than forecast.
Three of the four numbers needed are already inside the organization, and only the recoverable share has to be estimated.
Finance will raise causation, overlap with patient services and payback period, and causation is answered with a staged rollout rather than with a claim.
Promise a measured baseline rather than a multiple, because a promised multiple is how the program gets defunded later.

Diagnostic Questions to Consider

Name the share of last year's prescriptions that became treated patients, and the person who owns that number today.
State what a treated patient is worth to this brand over the horizon the organization forecasts.
Estimate how much of the value lost between script and start is operationally recoverable, and say what that estimate rests on.
Identify whose budget books the benefit if that value is recovered.
Describe what would have to be visible within one quarter to keep the work funded, and whether anyone measures it today.

Closing Reflection

The business case for experience in pharma has usually failed for a reason that has little to do with whether experience matters. It failed because it was presented as a forecast of lift, resting on a chain of inferences that finance is paid to distrust. The same argument, made as the recovery of value the brand has already earned, asks for nothing on faith.

That reframing changes who has to be convinced. A leak that already exists sits in data the organization already holds, so the conversation moves from belief to arithmetic, and the arithmetic can be run before anyone is asked to fund anything. The discipline is to be conservative about the recoverable share in public and rigorous about it in private, because that single number is where the case is won or lost.

What should be promised is measurement rather than a multiple. A baseline Realization Rate for the brand, named owners for the largest stall points, and a quarterly figure for Customer Value at Risk will outlast any number borrowed from another industry. Programs that promise a multiple tend to be defunded when the link cannot be shown, while programs that publish a baseline rarely have to argue the case twice.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Why pharma CX programs fail , How to measure customer experience in pharma , Why consumer CX does not translate to pharma and How to choose a pharma customer experience partner , and Pharma customer experience, why it stalls and what replaces it

Does NPS Work With Physicians?

Fri, 09 Oct 2026 20:41:18 GMT

No, and the reason is more interesting than the usual complaint about survey fatigue. The standard objection is that physicians are busy and response rates are poor, which is true and beside the point. The real problem is that the strongest evidence for using an advocacy score in pharma almost certainly has the arrow pointing the wrong way. What follows is the case for it, then why I stopped believing it.

The evidence for NPS in pharma is stronger than critics admit

The case deserves to be put at its strongest before it is taken apart. Bain's 2018 pharma work found that roughly 40% of a doctor's drug recommendations relate to overall experience rather than the product. The same work put physicians who score a company highly at somewhere between 2.3 and 2.7 times more likely to prescribe its brands. McKinsey's launch research found fully satisfied prescribers more than twice as likely to prescribe, and those are large effects that any brand team will have seen presented.

The original logic is sound too. Fred Reichheld built the case in the Harvard Business Review in 2003 on a real observation, which is that willingness to recommend tracked growth across the industries he studied. It was honest work, and pharma simply borrowed it without checking whether the conditions held.

Why the causal arrow probably points the other way

A doctor who already prescribes a brand has every reason to rate the company highly. She has met the rep more often, and the medical team answered her question about a difficult patient. Her office staff knows how to work that company's hub, and she has seen the drug work. Each of those is a consequence of prescribing rather than a cause of it.

So a finding that high scoring physicians prescribe more may simply be the discovery that prescribing produces high scores. The correlation is real and the direction is assumed. Nobody in the industry has published the study that separates the two, and until somebody does, a brand plan built on that arrow is a brand plan built on a guess.

Bain's own numbers hint at the problem. Their published range has relative score differences explaining anywhere from 10% to 70% of the variation in subsequent revenue growth. A span that wide is less a measurement than an admission of uncertainty. In a separate paper the firm put it more carefully still, calling goodwill "a necessary but insufficient condition for generating revenue growth."

Necessary but insufficient is a fair description of what the instrument buys. It can rarely be managed to, because the phrase names a condition without naming a lever. That distinction matters more in pharma than in the industries where the score was first validated.

A three person market breaks the advocacy question

The physician is not the only party in the transaction, and the score only asks her. She chooses, a payer decides whether to cover, and a patient uses the therapy and pays part of the cost. The advocacy question assumes those three are one person, because in the markets Reichheld studied they were. Asking a bank customer whether she would recommend her bank reaches the chooser, the payer and the user in a single question.

Asking a physician the same thing surveys one third of the decision, and the third least exposed to what goes wrong. She writes the script while the failure happens downstream, in an adjudication she never sees and a pharmacy counter she never visits. I have written separately about why consumer CX does not translate to pharma , and this is the clearest single example of it.

Closing the loop on a detractor is rarely possible in pharma

The discipline was never really about the number. It was about what happened after a low score, when someone called the customer, found the problem, fixed it and said so. That loop is the engine, and in pharma the engine is constrained in ways the original design did not anticipate.

A company may not be able to discuss the product with a patient, and it often cannot see which handoff failed. A rep may learn about a detractor score weeks later, in a format she cannot act on, about an issue that belongs to a function she does not control. So the signal gets collected and the circuit never closes. A diagnostic with no treatment attached is a report rather than a program.

The score is paid for in access and credibility

Access is now the scarcest asset in the commercial model, and every survey consumes a little of what remains. Veeva Pulse data reported by BioSpace found 45% of HCPs accessible to biopharma, down from 60% eighteen months earlier. The honest test is what the last wave of responses actually produced, and if the answer is a slide, then access was spent on a slide.

There is a credibility cost too. As I put it to CXM last year, doctors do not go around asking about loyalty. Asking a physician to rate her affection for a pharmaceutical company tells her something about how the relationship is seen, and it is not flattering.

Effort is the better question to put to a physician

What a physician can report accurately is what it cost her to work with a company. The useful questions are how many calls it took to start one patient, and how many times her staff supplied the same information twice. The others are how long she waited to learn a case had stalled, and whether anyone told her when it resolved. Effort is specific, attributable to a named team, and fixable inside a quarter, which is three things a score rarely manages.

Pairing that with progression data on the patients themselves produces a measurement system rather than a mood ring. I set out the full replacement set in how to measure customer experience in pharma , and the short version is that every measure needs a numerator, a denominator and an owner.

The gap this leaves open is not small. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies. Those executives have scores, and the scores did not warn them.

One narrow version of the score still earns its keep

The surviving use is narrower than most vendors will describe. Running the same question across a company's own regions, teams or reps, at the same moment, holds the confound described above roughly constant. Everyone in that comparison is measuring physicians who already prescribe, so what is left is relative. Relative differences between a company's own territories can point at a practice worth copying or a problem worth visiting.

That is an internal diagnostic and nothing larger. It is not a measure of commercial health, it does not belong in a board pack, and it cannot carry a brand plan. Kept at that size it earns its keep.

What the score cannot do is say whether the science reached the patient. That question needs different instruments, which is why we built Customer Excellence around progression rather than sentiment.

Key Takeaways

The strongest pharma evidence for advocacy scores cannot rule out reverse causation, because prescribing produces the experiences that produce the score.
Bain's own published range for score to growth runs from 10% to 70%, and the firm calls goodwill necessary but insufficient.
The chooser, the payer and the user are three different people, so a physician survey reaches the party least exposed to the failure.
Without the ability to close the loop on a detractor, the score remains a diagnostic with no treatment attached.
The score can be kept as an internal comparison across a company's own teams, where the bias is constant and the differences still mean something.

Diagnostic Questions to Consider

State what would be expected in the brand numbers, by when, and who would be accountable, if the score rose four points next quarter.
Explain how the high scoring physicians can be distinguished from the existing prescriber base.
Identify who calls a physician who gives a low score, how fast, and what that person can actually change.
Account for what the last wave of responses produced, and whether it was worth the access it cost.
Establish whether any measure in the CX pack reports whether a patient started therapy.

Closing Reflection

The case against the advocacy score in pharma is not that the research is dishonest or that physicians dislike surveys. The evidence is real, the effects are large, and the original logic held in the markets where it was first tested. What pharma borrowed was a conclusion, and the conditions underneath that conclusion were never checked.

Once the arrow is in doubt, everything built on top of it is in doubt with it. A score that may be an effect of prescribing cannot be managed as a cause of prescribing, and a span from 10% to 70% cannot carry a brand plan. The instrument also asks the one party in a three person market who is least exposed to the failure.

What remains is a narrow internal comparison and a better question. Effort can be reported accurately, assigned to a named team and fixed inside a quarter, and progression can say whether a patient actually started therapy. Those are the properties a measurement system needs, and they are the reason sentiment was set aside rather than improved.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

How to Measure Customer Experience in Pharma

Fri, 09 Oct 2026 17:50:16 GMT

Measuring customer experience in pharma means measuring whether customers moved, rather than how they felt about the company. That single swap is most of the answer, and it is harder than it sounds, because nearly every instrument a commercial organization owns was built to do the opposite. What follows is the replacement set, where the numbers come from, and the test I use to decide whether a measure has earned a place on a dashboard.

Why does the score stay flat while the business leaks?

The score holds because the person answering the survey is not the person who failed. A physician chooses the therapy, a payer decides whether to cover it, and a patient uses it and pays part of the cost. Three people, three sets of interests. The survey usually reaches the first one, and she is the least likely of the three to know what went wrong after she signed.

Meanwhile insurer rejections of brand name prescriptions reached 40.7% of initial attempts in 2024, up from 24.3% in 2018, in a JAMA study summarized by Johns Hopkins . Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. Nearly half of a rejection cohort disappears, and a relationship survey will not flinch, because nobody it asked was there.

That is the first thing a measurement system in pharma has to solve. A three person market cannot be measured with an instrument built for one buyer.

What does a progression measure actually look like?

A progression measure has a numerator, a denominator and a date, which is the whole specification. Seven of them tend to carry most of the weight in a pharma commercial system.

Script to start conversion. Of the prescriptions written for a brand last month, the share that became a patient on therapy, and the number of days it took.
Time to therapy. Median days from the clinical decision to the first dose, cut by payer and by site of care. The median hides less than it appears to once it is cut.
Stall points. Where patients stop moving, at the benefit check, the prior authorization, the appeal, the copay, the hub intake and the specialty pharmacy handoff. Count how many sit at each one and how long they sit.
Barrier resolution speed. Once a patient is known to be stalled, how long the organization takes to clear it. This is the one measure a field team can move next week.
Persistence at 90 and 180 days. Starting is not benefiting.
Realization Rate . Realized therapeutic and commercial value against the value the brand had already earned when the clinician decided. This is the headline number.
Customer Value at Risk. CVaR is the money sitting inside unresolved stalls right now. It turns a service backlog into a forecast problem, which is the only form in which a commercial leader will act on it.

Notice what every one of them has in common, which is that someone can own it and each one moves money. I call the gap they are built to expose value leakage .

How experience can be measured without talking to the patient

The move is to stop measuring the patient and to start measuring the system acting on the patient. A pharma feedback loop is partly closed by law and partly invisible by structure. In most markets the product cannot be discussed with the patient, and the pharmacy counter and the payer's adjudication often cannot be seen at all. A survey strategy that depends on reaching the patient is dead before it starts.

The loop that cannot be closed still leaves timestamps everywhere. Benefit verification requests, hub intake records, prior authorization submissions and their outcomes, appeal files, specialty pharmacy dispense data and copay program redemptions are all time stamped. None of that was designed as experience data, yet all of it shows where customers stopped and for how long, which is the only question that matters.

The field force is the other half of the instrument. Reps and MSLs often meet a new payer policy weeks before any dashboard registers it, and most companies have nowhere to put that signal, so somewhere to put it has to be built. Access is also tightening while that decision waits.

Veeva Pulse data reported by BioSpace found 45% of HCPs accessible to biopharma, down from 60% eighteen months earlier. The visits that remain are too expensive to waste on information the company already has.

What should still be asked of physicians?

The question worth asking is about effort rather than affection. A physician does not think of herself as a pharma company's customer, and asking her to rate her loyalty produces a number that is real and nearly useless. As I put it to CXM last year, doctors do not go around asking about loyalty.

The better questions ask what it cost her to work with the company. How many calls it took to get one patient started, how many times her staff supplied the same information twice, and how long she waited to learn a case had stalled.

Effort is measurable, attributable and fixable, which is three more properties than sentiment has. Outside pharma the link is established, since Gartner found 62% of customer service channel transitions are high effort in industries where the company can watch the transition happen. Pharma usually cannot watch its own, which makes asking about it more important rather than less.

Channel fit is worth asking about too, and the answer is easy to dislike. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies. Somebody in that pair is measuring the wrong thing.

Regulation limits what can be claimed, not what can be counted

Regulation does not stop any of this, though it is where most measurement programs quietly give up. Regulation governs claims, constraining what may be said about efficacy and safety, to whom, through which channel and in which market. It says almost nothing about operational burden. A company may not promise a patient an outcome, and it may absolutely count how many days she waited.

The burden numbers already show a great deal. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. IQVIA data reported by Managed Healthcare Executive puts abandonment at 61% once a prescription costs the patient more than $250.

Not one of those figures required a claim about a product. They are all counts of friction, and counting friction is legal everywhere a pharma company operates.

How a measure earns a place on the dashboard

Three tests settle it, and applying them to a current measurement pack shows how few numbers survive. A measure has an owner outside the CX team, by name. It moves money in a way that can be described in one sentence, and it can change inside a quarter, which means someone can be held to it.

An advocacy score fails all three. That is not an attack on the instrument, which was built in good faith for a different market. Bain's own published range has relative score differences explaining anywhere from 10% to 70% of the variation in subsequent revenue growth, and a measure with that much room in it cannot carry a brand plan.

The deeper reason the swap works is timing. The imported model counts the transaction, and in retail the transaction is the value event. In pharma the value event is sustained therapy, months later, handled by payers, pharmacies, hubs and office staff the company does not employ. Progression measures follow the patient into that interval, while sentiment measures stay at the door.

Getting these onto brand reviews changes the shape of the argument, because a leader stops defending a program and starts managing a system. That is what Customer Excellence is for, and the standard it reports against is Consumer-Grade .

Key Takeaways

Progression measures beat sentiment measures because each one has an owner and each one moves money.
The chooser, the payer and the user are three different people, so a single survey respondent cannot locate where value was lost.
The loop that cannot be closed still leaves timestamps, in the hub, benefit verification, appeal and dispense data a company already holds.
Physicians can be asked about effort rather than loyalty, because effort is attributable and fixable.
Regulation limits what may be claimed rather than what may be counted, so the burden data is available to measure.

Diagnostic Questions to Consider

Of last month's prescriptions, the number that became treated patients is worth establishing, along with whether that number appears anywhere in current reporting.
Median time to therapy deserves to be known, including how much it varies by payer.
The top three stall points and the named owner of each should be identifiable without commissioning a study.
The money sitting in unresolved barriers right now is a figure somebody ought to be reporting.
The numbers in a current CX pack that would pass the three tests above are worth separating from the rest, with a decision made about the remainder.

Closing Reflection

Measurement in pharma rarely fails for want of data. It fails because the question reaches the person least likely to know what went wrong, long after the moment that mattered. The chooser, the payer and the user sit in different places, the value event arrives months after the decision, and the systems in between leave a record of every delay.

The replacement is a set of numbers with a numerator, a denominator and a date, applied to the points where patients stop moving. Those numbers can be owned, they move money, and they change inside a quarter, which is what separates a managed system from a defended program. In the organizations I have worked inside, that is the change that lets experience work survive a budget cycle.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Why pharma CX programs fail , Why consumer CX does not translate to pharma , What is value leakage in pharma? , Pharma CX, why it stalls and what replaces it and Pharma's Realization Blind Spot

Why Consumer CX Does Not Translate to Pharma

Fri, 09 Oct 2026 17:46:49 GMT

Pharma is different is the most overused sentence in this industry, and it is usually an excuse. On this one question it happens to be correct. The customer experience discipline that arrived here was built somewhere else, for markets that work differently in four specific ways, and it underperformed.

The industry watched that happen and concluded that experience does not drive commercial outcomes in pharma. The right conclusion was narrower, because the imported version did not fit and nobody had yet built the version that would. That made the rejection rational, even though the lesson drawn from it was the wrong one.

I say that as someone who taught the imported version. Before pharma I led delivery at the Ritz-Carlton Leadership Center, where service is an engineered system and the Credo is a working document rather than a wall poster. That model is superb, and it also assumes four things about the pharmaceutical market that are not true.

What did pharma actually import?

Three things arrived, and none of them was adapted on the way in. The first was an instrument, built on surveys and an advocacy score, which Fred Reichheld set out in the Harvard Business Review in 2003 for industries where customers choose freely and buy repeatedly. The second was an organizational shape, the CX function, sitting beside commercial rather than inside it. The third was a logic, which says a satisfied customer buys again.

The results were visible early. Bain's pharma work noted that the industry rated among the least customer friendly in a 2011 Harris poll, down 43% from a similar poll in 1997 . That reading is old now, and the direction has not reversed. In 2025, a DHC Group survey reported by eMarketer found just 16% of respondents view the pharma industry as patient centric.

Why does a three person market break the instruments?

The reason is that the customer is not one person. A physician chooses, a payer decides whether to cover, and a patient uses the therapy and pays part of the cost. Three people, three sets of interests, and none of them holds the whole relationship with the company.

Every consumer instrument assumes those three are the same person. Loyalty assumes the chooser can come back, repeat purchase assumes the user controls the next transaction, and advocacy assumes the person recommending a brand is the person who paid for it. Take that unity away and the arithmetic stops working.

Here is what that looks like in practice. A physician who thinks highly of a company writes a prescription that a payer refuses and a patient abandons at the counter. The survey score holds steady while realized value does not, and the instrument cannot see the failure because the failure happened to someone it never asked.

Why can the loop not be closed the way retail closes it?

A retailer hears a complaint and fixes it with the customer directly, and that loop is the engine of the whole discipline. In pharma it is partly closed by law and partly invisible by structure. A company often cannot contact the patient, and in most markets it cannot discuss the product with them. Visibility is limited in the same way, at the pharmacy counter, inside the payer's adjudication, and in the thirty seconds when the office staff decided the appeal was not worth filing.

Consumer service has its own version of this problem, and it is instructive. Gartner found that 62% of customer service channel transitions are high effort for customers, in industries where the company can watch the transition happen. Pharma companies often cannot watch theirs at all, and an instrument designed around a loop that does not exist will report that things are fine right up until they are not.

Why does the value event sit outside the company's control?

In retail the value event is the purchase, and it happens in front of the seller. In pharma the value event is sustained therapy, months later, handled by payers, pharmacies, hubs, specialty distributors and office staff the manufacturer does not employ. The numbers on that interval are not subtle.

A 2026 study in JAMA, summarized by Johns Hopkins , found insurer rejections of brand name prescriptions reached 40.7% of initial attempts in 2024, up from 24.3% in 2018. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. IQVIA data reported by Managed Healthcare Executive puts abandonment at 61% once a prescription costs the patient more than $250.

The imported model counts the transaction. In pharma the transaction is a prescription, and a prescription is intent. Everything that determines whether intent becomes value happens after the point where the commercial system stops counting, and we call that difference value leakage .

Does regulation really prevent better experience?

Ask most commercial leaders why the experience is what it is and regulation comes up inside a minute. It is the industry's standing answer, and it is mostly wrong. Regulation governs claims, constraining what may be said about efficacy and safety, to whom, through which channel and in which market. Those constraints are real and they are not going away.

Regulation says almost nothing about operational burden. It does not require a prior authorization to take three calls, and it does not require a hub to ask for the same information twice. Nothing in it requires anyone to leave a physician's office guessing about whether a case stalled. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. Almost none of that delay is a regulatory requirement.

That is the most commercially useful distinction in this argument. Most of the friction customers meet is not required of anyone, which means it is unowned rather than mandated, and unowned problems are far more solvable.

What had to be rebuilt

Four substitutions followed, each replacing something that came in the imported box. Measurement moved from sentiment to progression, away from how customers feel and toward whether they advanced. The measures are script to start conversion, time to therapy, stall points, persistence, barrier resolution speed, and realized value against earned value.

Accountability moved from functions to handoffs, because access, brand, field, medical and patient support can each hit their internal standard while the patient stops moving. In the organizations I have worked inside, the failure lives between them rather than inside any one of them, so somebody has to own the seam.

The field moved from a delivery channel to a sensing system. Representatives and MSLs often meet a new payer policy weeks before any dashboard registers it, and most companies have nowhere to put that signal.

Experience moved from a downstream consequence to a design variable, sitting beside brand and product rather than inheriting whatever those two leave behind. That is the discipline we now call Customer Excellence , and the bar it is built to clear is Consumer-Grade .

Where does it have to live?

Inside the commercial system rather than beside it. A program has its own budget line, its own team and its own dashboard, which is exactly why it can be cut in a bad quarter without anything else changing. What replaced it has to be carried on commercial numbers, owned by commercial leaders, and visible in how brands are run and reviewed. Where the experience work disappears along with the CX team, the wrong thing was built.

The industry is arriving at the same place from a different direction. When Eli Lilly launched LillyDirect, David Ricks framed it around how the healthcare system "adds to the burdens patients face" . Novartis launched its Cosentyx platform because, in its US president's words, the company needs "new ways to reach patients more directly by removing barriers in the system." Neither of those is a CX program. Both are commercial system changes aimed at burden.

Meanwhile the gap the imported model left behind is still open. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies.

Key Takeaways

Consumer CX arrived in pharma with its instrument, its org shape and its logic unchanged, and all three assume a market the industry does not operate in.
The chooser, the payer and the user are three different people, which breaks loyalty, repeat purchase and advocacy as measures.
The feedback loop the discipline depends on is partly closed by law and partly invisible by structure.
The value event is sustained therapy, months after the transaction the commercial system counts.
Regulation governs claims rather than burden, so most of the friction customers meet is unowned rather than required.

Diagnostic Questions to Consider

Identify which experience measures would still mean something given that the chooser, the payer and the user are three different people.
Describe how the organization finds out when a patient stalls, and how long that takes.
Name three sources of friction customers meet that have been attributed to regulation, and establish how many are actually required.
Name the person who owns the seam between access and patient support.
State which commercial numbers would change if the CX team were dissolved tomorrow.

Closing Reflection

The industry's verdict on customer experience was reached honestly. An instrument built for free choice and repeat purchase was applied to a market with three different customers and a value event months downstream, and it reported comfort while value drained away. Rejecting that version was reasonable, and the mistake was in what the rejection was taken to prove.

What those years actually showed is that the version pharma needed had not been built yet. Measurement had to move from sentiment to progression, accountability from functions to the handoffs between them, the field from a delivery channel to a sensing system, and experience itself from a downstream consequence to a design variable. None of those substitutions comes out of a consumer playbook, and all of them can be built inside a pharmaceutical commercial system.

Most of what stands in the way can be dismantled. Regulation governs claims rather than burden, which means the friction patients and physicians meet is largely unowned rather than mandated, and unowned problems have owners available to them. The work only holds where it sits on commercial numbers and commercial leaders, because anything carried on its own budget line can be removed in a bad quarter without the rest of the system noticing.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He learned service delivery at the Ritz-Carlton Leadership Center before leading global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Why pharma CX programs fail , Pharma customer experience, why it stalls and what replaces it and What is Customer Excellence in pharma?

Why Pharma CX Programs Fail, and What I Did About Mine

Fri, 09 Oct 2026 17:14:11 GMT

I inherited a customer experience program that looked healthy on every internal measure and could not prove it mattered. It had everything the playbook asks for, including a relationship survey, a transactional survey and an advocacy score reported to leadership every quarter. Journey maps hung on the wall, and the work carried budget, headcount and executive sponsorship. By the standards of the discipline it was a success. My job was to scale it.

I retired it instead. The surveys went first, then the score. What follows is why, because the failure was not peculiar to that company and most commercial organizations are funding a version of it right now.

A failing program rarely looks like failure from the inside

That is the first difficulty, and it is the reason these programs tend to survive so long. Response rates hold, the score drifts a point one way and a point back, and the deck gets better every quarter. People are proud of the work, and they should be, because the intent behind it is genuine and the effort is real. Most of the people running a CX program care more about customers than almost anyone else in the building.

The tell is a single question in the quarterly review, when someone senior asks what the business should do differently as a result. If the honest answer is a list of improvements that nobody outside the CX team is accountable for, the organization has a reporting habit rather than a program. Asking that question in the room is often more diagnostic than the quarter of measurement that preceded it.

Why the program could prove nothing was built into the instruments

Three reasons sat underneath it, and the first two were properties of the instruments themselves. Sentiment was never the binding constraint, because the surveys measured how people felt about us rather than what they were able to do. In pharma, how a physician feels about a company is a long way from whether her patient gets the drug, and the distance between those two things is where the money goes.

Fred Reichheld made the original case for the advocacy score in the Harvard Business Review in 2003, and it was a good case for the industries he studied. Bain's own later work is more careful than the way the industry quotes it. Their published figure is that relative score differences explain anywhere from 10% to 70% of the variation in subsequent revenue growth. That range deserves rereading. In a different paper the firm put it plainly, calling goodwill "a necessary but insufficient condition for generating revenue growth."

The second reason was ownership, because a score can tell an organization that something is wrong somewhere without naming which handoff broke. It does not say who fixes the break, by when, or whether the fix held. Our program could raise an issue and it could not assign one. The third reason took me longest to see, which was that the thing actually failing was happening somewhere we were not looking.

The interval between prescription and patient went unwatched

That interval is where the program had no instrument at all, and it is where the numbers now land hardest. A 2026 study in JAMA, summarized by Johns Hopkins , found insurer rejections of brand name prescriptions rose from 24.3% of initial attempts in 2018 to 40.7% in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

The American Medical Association's latest survey has 82% of physicians saying prior authorization at least sometimes leads patients to abandon treatment, and 93% saying it delays care. IQVIA data reported by Managed Healthcare Executive puts abandonment at 61% once a prescription costs more than $250. None of that could have surfaced in our survey, because we were asking people how the relationship felt while patients were failing to start therapy. The two data sets never met, and we named that gap value leakage later, once there was something to name.

The instrument works poorly with physicians for structural reasons

The weakness is structural rather than methodological, which matters because a methodology can be improved and a structure rarely argues back. A physician seldom thinks of herself as a customer, and she did not choose a brand the way a consumer chooses a bank. She has a patient in front of her and a formulary behind her. As I put it to CXM last year, doctors do not go around asking about loyalty.

Scoring her affection for a company measures something real and almost entirely beside the point. That deserves its own treatment and it will get one, so the narrow version will do here. An instrument built to predict repeat purchase in a voluntary market will often underperform in a market where the buyer, the payer and the user are three different people.

Progression measured stage by stage replaced the score

What replaced the program was progression, measured brand by brand and stage by stage rather than sampled and scored. The measures were script to start conversion, time to therapy, and the stall points where patients wait alongside how long they wait there. Persistence at 90 days joined them, with barrier resolution rate and speed, and realized value set against the value the brand had already earned.

Those measures have two properties the old ones lacked, in that someone can own each of them and each of them moves money. The discipline that sits on top of them is what we now call Customer Excellence , and the standard it is built to meet is Consumer-Grade . Neither is a rebrand of what I shut down. The old program asked how customers felt. The new one asks whether they got what the science promised, and what it cost the business when they did not.

A discipline survives where a program can be defunded

I would not build it as a program again, and that is the part I would say differently if I were starting over. A program has a budget line, a team and an end date, which means it can be defunded without anything else changing. An operating discipline sits inside commercial, owns handoffs, and shows up in how brands are run. The first is easy to approve and easy to kill, while the second is hard to approve and hard to kill, which is the point.

The industry wide version of this gap is still open. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, while 82% of life sciences executives say they are satisfied with those same strategies. Roughly two thirds of the customer base disagrees with the companies serving it, and the instruments in use are not reporting the disagreement.

Key Takeaways

A pharma CX program can look healthy on every internal measure and still prove nothing about the business.
Sentiment instruments measure something real that is rarely the binding constraint, and Bain's own range on score to growth runs from 10% to 70%.
Scores can raise issues without being able to assign them, which is why so little tends to change after the review.
The failure that matters most happens after the prescription, where most CX programs never look.
Progression measures work because each one has a named owner and each one moves money.

Diagnostic Questions to Consider

Name who in the room is accountable for what the business should do differently after the next CX review.
State what would be expected in the brand numbers, and when, if the advocacy score rose four points next quarter.
Establish how many of last quarter's prescriptions became treated patients, and whether CX reporting carries that number anywhere.
Identify which experience measures carry a named owner outside the CX team.
Describe what would change in the commercial operating model if the program were defunded tomorrow.

Closing Reflection

Retiring a program that everyone considered successful was never a judgment on the people who built it. The instruments were doing exactly what they had been designed to do, and they were pointed at a question that mattered less than the one nobody was asking. Capable teams can run a measurement system faithfully for years without that system ever being able to tell the business what to change.

What the interval between prescription and patient taught me is that the failure often lives where no instrument is pointed. A score can describe a relationship while a patient fails to start therapy, and nothing in the reporting will connect the two. Measurement that cannot be owned tends to become reporting, and reporting tends to survive until someone asks it for a decision.

The replacement was never a better score. It was a set of measures with owners attached, each tied to a stage a patient either reaches or does not, and each one carrying consequences for realized value. That is the difference between a program that can be defunded and a discipline that shows up in how brands are run.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Field Force Effectiveness in Pharma When the Script Is Just the Beginning

Fri, 09 Oct 2026 11:40:19 GMT

Institutions tend to keep measuring the thing that used to be the constraint. Field force effectiveness in pharma is still measured the way it was measured when a rep could see most of the doctors on the list. Calls per day, reach and frequency, and message delivery made sense when access was the constraint and more activity often meant more prescriptions.

Access is no longer the constraint, and the numbers are not ambiguous about it. Veeva's Pulse data had 45% of HCPs accessible to biopharma in 2024 , down from 60% eighteen months earlier. The constraint now is what happens after the prescription, and almost no field model is built or measured for that. What follows sets out a different definition of field effectiveness, the evidence behind it, and how to rebuild the field around it without dismantling the model already in place.

The field is judged on the wrong half of its job

The arithmetic that field dashboards rarely show sits in the claims data. A 2026 JAMA study summarized by Johns Hopkins found that insurer rejections of brand name prescriptions rose from 24.3% of initial attempts in 2018 to 40.7% in 2024. Of the rejected scripts, 48.4% were never followed by a fill of that drug or any drug in its class within 90 days. IQVIA data reported by Managed Healthcare Executive found that 61% of prescriptions with a final cost above $250 are never picked up. In the American Medical Association's latest survey, 82% of physicians said prior authorization at least sometimes leads patients to abandon treatment.

Place the strongest rep in a territory inside that picture. She wins the prescribing decision, the script hits a prior authorization wall, the office staff give up after the second call, and the patient never starts. By every field metric in use, that quarter was a success, and by the only measure that matters to the physician, the patient and the revenue, it was a loss. Multiplied across a territory, the pattern describes a field force that is effective at creating intent and largely blind to whether intent becomes treatment. That gap is value leakage in the commercial sense rather than the contracting one, and the field sits closer to it than any other function.

What field effectiveness means once the script is written

A field force is effective when the physicians it serves get more of their patients onto appropriate therapy, faster, and keep them there. Read as a capital question rather than an activity question, that becomes the field multiple , which decomposes into coverage, hit rate and velocity. That definition changes three things at once, each of them inside the existing model.

It changes the rep's job. In a specialty category the physician already knows the efficacy story. What she does not know is which of her patients are stuck in the hub, which payer changed its policy last month, and who inside the company can fix it. A rep who can answer those questions is worth a meeting, and a rep who delivers the core message a fourth time rarely is. The access numbers suggest how physicians have been voting on that difference.

It changes what gets measured. Script to start conversion by territory, time to therapy, where patients stall and how long they sit there, persistence at 90 days, and barrier resolution rate and speed are progression measures. They describe whether the field is converting the intent it creates, while activity measures describe effort. Effort can be excellent while the funnel leaks, and in most organizations it is.

It changes what the field is for. Reps and MSLs encounter access barriers, pharmacy problems and support failures weeks before any dashboard registers them, and that signal often dies in a call note or a hallway complaint. Captured, classified and acted on, the same signal becomes the earliest warning system a commercial organization has. The field is one of pharma's most underused intelligence systems , and treating it as a message delivery channel wastes it.

Experience moves prescribing, and the evidence is already public

The case for this reading of effectiveness is not primarily a values argument. Bain's pharma practice found in 2018 that around 40% of a physician's drug recommendations relate to overall experience with the company rather than the product. The same work found that physicians who rate a company highly are two to three times more likely to prescribe its products. McKinsey's launch research the same year found fully satisfied prescribers more than twice as likely to prescribe. The field delivers most of that experience, and it is the human face of a company at the moment a physician decides whether to trust it with her patient.

The leaders of the industry have noticed. Lilly built LillyDirect to remove the burdens patients face in a complex system. Novartis launched a direct platform for Cosentyx because the company needs new ways to reach patients "by removing barriers in the system," as its US president put it . The obesity category "acts a lot more as a consumer business than a traditional medication," Novo Nordisk's CEO told Fierce Pharma in January 2026. When the people running the industry describe the job as removing barriers and meeting consumer expectations, a field model that still rewards call volume is out of step with its own leadership.

Rebuilding the field without breaking the model already in place

None of this requires a new CRM or a reorganization. What it asks for is four changes in how the field operates, taken in this order. The first is to start with one brand and one leak, using commercial data already in the building to find where patients stall between script and first dose for a priority brand. That gives the field a specific problem to solve rather than a general exhortation to be more customer centric.

The second is to give the field a way to report what it sees. A rep who learns that a regional payer added a step edit needs somewhere to put that information where it will be classified, assigned to an owner, acted on and measured. Build that loop, even crudely, and run it for a quarter, and it will often say more about an access problem than a market research study has. We described the operating version of that loop in our note on FieldOS, the field impact operating system .

The third is to change the scorecard before changing the incentive. Adding progression measures alongside activity measures for two quarters lets the field see the connection between what it does and whether patients start, and the incentive can move after that. Doing it in the other order tends to produce resentment and gaming.

The fourth is to make the standard explicit. Physicians compare the experience of working with a pharmaceutical company to the best service they received that week, which is the Consumer-Grade standard, and the field is where most of it is delivered. Recognition, anticipation, coherence, effort, resolution and visibility are six conditions a territory can be audited against. A physician who has to tell three people at the same company the same patient story has an effort problem that can be fixed without a single new message.

Key Takeaways

Field effectiveness in pharma is still measured through activity, at a point when access is no longer the binding constraint.
Insurer rejections of brand name prescriptions rose from 24.3% of initial attempts in 2018 to 40.7% in 2024, and 48.4% of rejected scripts were never followed by a fill within 90 days.
A field force can win every prescribing decision in a territory and may still deliver very few treated patients.
Bain's work attributed around 40% of a physician's drug recommendations to overall experience with the company rather than the product.
Progression measures such as script to start conversion, time to therapy and persistence at 90 days describe whether intent becomes treatment, while activity measures describe effort.
The field encounters access and support failures weeks before dashboards register them, which makes it an intelligence system rather than only a delivery channel.

Diagnostic Questions to Consider

Leadership should be able to say what share of prescriptions written in the strongest territories became treated patients last quarter, and how that compares with the weakest.
The organization should know where information about a new access barrier goes once a rep learns of it, and how long passes before anything changes.
A field leader should be able to say whether patient starts would hold if the most resourceful reps left tomorrow, or whether they depend on favors that no process replaces.
The scorecard should show whether progression measures sit alongside activity measures, and whether the incentive moved before the field could see the connection.
A territory review should be able to name where recognition, anticipation, coherence, effort, resolution and visibility are failing for a specific physician.

Closing Reflection

Field effectiveness once meant getting in the door. It now means getting the patient through the door the physician opened, which is a different job carrying a different scorecard. The companies that measure the second thing will tend to have the more valuable field force, whatever their call counts say.

The argument for reasserting the field rather than managing it down in the age of AI runs through winners believe in the field . In the organizations I have worked inside, the field almost always knew where progression was breaking long before the reporting layer did. What I saw missing was rarely insight and more often a route from what a rep observed to something the organization then did about it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

HCP Engagement Strategy: Why Share of Voice Stopped Working

Fri, 09 Oct 2026 11:39:38 GMT

Most HCP engagement strategies are still optimized for a world that ended around 2022. Reach and frequency, channel mix and share of voice were the right levers when 60% of physicians would see a rep. Veeva's Pulse data put that figure at 45% in 2024 and falling.

When access shrinks, the strategy that wins is rarely the one that squeezes more touches out of fewer doors. It is the one that makes each interaction worth the physician's time. What follows sets out what that strategy looks like and what the data says about the gap between pharma and its physicians. It also sets out how engagement can be rebuilt around what physicians are actually trying to get done.

The gap pharma is engaging into

Two numbers describe it. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, while in the same research 82% of life sciences executives said they were satisfied with those strategies. Most commercial leaders sit in the 82%, and the physicians they serve sit in the 72% who disagree.

A gap that wide is rarely a content problem, because it is a question of what pharma thinks engagement is for. Most engagement models exist to deliver messages, while physicians engage in order to solve problems. Those are different jobs, and only one of them earns a second meeting.

What physicians are actually trying to do when they engage

Strip away the channel conversation and a physician's interaction with a pharmaceutical company has a small number of purposes. She wants to know whether the therapy is right for a specific patient in front of her, and she wants that patient to get the drug without a fight. She wants help when the fight happens anyway, and she wants to know what to do when the patient comes back with a problem on therapy. Every one of those jobs sits in the chain from prescribing decision to treated patient, and every one is a place where engagement either helps or gets in the way.

The fight happens a lot. The American Medical Association's latest physician survey found that 93% of physicians say prior authorization delays care and 82% say it at least sometimes leads patients to abandon treatment. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections of brand name prescriptions reached 40.7% of initial attempts in 2024, with nearly half of those never filled within 90 days.

The physician wrote the script and did her part. Then the system she was engaging with on the company's behalf let her patient fall through. That is what she remembers at the next call, whatever a message recall study reports.

Why experience beats share of voice

This is not a soft argument. Bain's pharma work in 2018 found that roughly 40% of a physician's drug recommendations relate to her overall experience with the company rather than the product itself. The same work found physicians who rate a company highly are two to three times more likely to prescribe its products. McKinsey's launch research from the same year found fully satisfied prescribers more than twice as likely to prescribe.

An engagement strategy that spends 90% of its effort on the product argument and leaves the experience to default is under investing in the variable that moves two fifths of the decision. The companies that have read this evidence are changing their models. Lilly built LillyDirect to remove the roadblocks physicians and patients hit after the prescribing decision.

Novartis launched its Cosentyx direct platform in 2025 because the company needs "new ways to reach patients more directly by removing barriers in the system." Those were the words of its US president. These are engagement decisions, even though nobody filed them under engagement, and they change what a physician gets when she chooses the drug.

Rebuilding engagement around progression

The shift fits in one sentence, which is to stop managing engagement as message delivery and start managing it as whether the physician and her patient progress to the next stage. Four practical changes follow from that. The first is to give every channel a job in the chain.

The rep's job in a specialty category is rarely to deliver the efficacy story one more time. It is to know which of this physician's patients are stuck, why, and what the company can do about it this week. Medical's job is to make the clinical decision easier before it is made, and patient services' job is to make the fulfillment path visible to the office so nobody has to call to ask. When every channel has a progression job, omnichannel orchestration becomes a question of who does what for whom, rather than how many impressions can be stacked. We explain that distinction in our definition of Customer Excellence .

The second change is to measure what the physician would measure. The numbers that matter are time from script to first dose for her patients, how often her prior authorizations get resolved and how fast, and whether her patients remain on therapy at 90 days. Recall, reach and satisfaction describe the company rather than her experience. An organization that cannot see those numbers by physician or by practice cannot engage on them, and leaves the physician to find out by herself.

The third change is to turn the field into a listening system. Reps and MSLs hear about a new payer policy, a hub bottleneck or a pharmacy problem weeks before any dashboard shows it. In the organizations I have worked inside, that intelligence was present in the field long before it was visible to anyone able to act on it. Most companies have no reliable way to capture that signal, classify it, assign an owner and act on it.

Build that loop and the field becomes an intelligence asset as well as a delivery channel. We described the operating version of this in our practice note on FieldOS, the field impact operating system .

The fourth change is to make the standard explicit. Physicians judge a company against the best service they received this week, rather than against the other reps who called. That is the Consumer-Grade standard, and it has six testable conditions, namely Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Running a current engagement model against those conditions is a short exercise with uncomfortable results.

The first question is whether the physician has to reintroduce her patient's situation every time she talks to a different part of the company. The second is whether she learns that a prior authorization failed from the company or from the patient. A third is whether her office can see where a case stands without calling. Every answer in the negative is a place engagement is failing her, and a place a competitor can win.

Key Takeaways

Access has fallen from 60% of physicians to 45%, so the strategy that wins makes each interaction worth the physician's time rather than adding touches.
Only 28% of HCPs believe pharma's engagement strategies meet their needs, while 82% of life sciences executives say they are satisfied with those same strategies.
Roughly 40% of a physician's drug recommendations relate to her overall experience with the company rather than the product itself.
A physician engages in order to solve problems, and those problems sit in the chain from prescribing decision to treated patient.
Engagement measured as message delivery can rarely tell a company whether a patient progressed, which is the thing the physician is watching.

Diagnostic Questions to Consider

Establish how many of the physicians engaged most heavily last quarter had patients who never started therapy, and whether anyone knows why.
Identify which channels carry a defined job in helping a patient progress from script to first dose, and which exist only to deliver a message.
Trace where the information goes when a rep hears about a recurring access barrier, and what happens to it after that.
State the time from script to first dose for a named physician's patients, and name the function that reports it.
Test the current engagement model against Recognition, Anticipation, Coherence, Effort, Resolution and Visibility, then record every answer in the negative.

Closing Reflection

The uncomfortable part of the Deloitte numbers is not that pharma is indifferent to physicians. Engagement models were built with care, and they do the job they were designed to do, which is to deliver messages at scale. What changed is that access shrank and the physician's problems moved downstream, into fulfillment and adherence, where most engagement models carry no instruments and no owners.

In the organizations I have worked inside, the gap was rarely a failure of effort by the people in the field. It was a design gap, because nobody had given each channel a job in the chain and nobody was measuring whether the patient progressed. Capable teams were being asked to earn a second meeting with an instrument built for a first one.

The physicians in Deloitte's 72% already know the difference between engagement and promotion. An engagement strategy that cannot say what happened to a physician's stuck patients is a promotion strategy with a different name. Making the standard explicit, giving every channel a progression job and turning the field into a listening system are the ways that gap can be closed.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Pharma CX: Why It Stalls and What Replaces It

Fri, 09 Oct 2026 11:38:57 GMT

Pharma CX is the experience a patient, a caregiver or a clinician has of obtaining a medicine and staying on it, and it is the one part of the pharmaceutical value proposition the industry has never industrialized. Most pharma CX programs stall because they were borrowed from consumer markets, where a company owns the transaction from promise to fulfillment. Pharma does not own that transaction, and the steps between a prescribing decision and a dose are run by parties the manufacturer cannot manage. What replaces those programs is Customer Excellence, a commercial capability measured by whether clinical intent becomes sustained therapy and held to a Consumer-Grade standard. That is the argument I have made since leading customer excellence inside Pfizer and Bayer, and the rest of this page sets out why.

I came to see the prescribing decision as a midpoint rather than a finish line

For most of my career I worked in industries where a company controls the transaction from promise to fulfillment. A hotel that measures satisfaction is measuring a journey it owns from end to end. That ownership is what makes conventional experience measurement meaningful, and it is the condition pharma does not satisfy.

Inside global pharma at Pfizer and Bayer, I came to understand the prescribing decision differently. A prescription is an intention declared rather than a product delivered, and from the moment it is written that intention travels through a sequence the prescriber does not control and the manufacturer does not manage.

Benefit verification, prior authorization, affordability, specialty pharmacy coordination, onboarding, first fill. Each is administered by a different party with different incentives. Each is a point where a clinically justified decision can stall or quietly end. I have concluded that the distance between that decision and a patient on therapy is where the next decade of commercial advantage will be decided.

Pharma measures success at the moment its earned value becomes most vulnerable

Commercial performance in this industry has long been measured at the point of prescribing. The convention is rational and it carries a hidden cost. It locates success precisely where the value the organization has earned becomes exposed.

In work I published with TheyDo, I set the arithmetic out as a ladder. Roughly thirty percent of prescriptions are never filled, which takes a billion dollars of earned value to around seven hundred million. Early discontinuation claims a further tranche, and long term adherence erosion takes more again. What remains is close to four hundred and fifty million in realized value, and no competitor takes the difference.

The external evidence has sharpened considerably since that analysis. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. Of those rejected prescriptions, 48.4 percent were never followed by a fill of that drug or anything in its class within ninety days.

Every instrument on the commercial dashboard points upward at the moment leakage is worst. The dashboard measures the formation of intent rather than its survival, which may be why so many organizations read their own data faithfully and still reach the wrong conclusion about how well they are doing.

Experience is the third leg of the value proposition and the one pharma never built

Pharma has industrialized two of the three things it offers a customer. The product is engineered to a standard that few industries can approach. The brand is built with discipline, evidence and considerable investment.

The third leg is the experience of obtaining and staying on the medicine, and it has largely been left to assemble itself out of whatever the surrounding system happens to do. A therapy may change biology. The experience around it determines whether that biology ever reaches the person it was developed for. That distance from molecule to patient is the therapeutic value chain , and the commercial system is a link in it rather than a wrapper around it.

This matters more as clinical differentiation narrows. In crowded categories where profiles converge, the product and the brand can both be excellent and still fail to separate a company from its competitors. Experience is harder to copy than either, because it is produced by how an enterprise is built rather than by what it says or what it makes.

Customer Excellence is the discipline the commercial system is missing

The industry has built three domains of commercial excellence and named them. Launch excellence secures early momentum. Marketing excellence shapes narrative and credibility. Sales excellence sustains presence and relationship capital in the clinical community.

Those three domains are not outdated and they remain necessary. What has changed is their sufficiency. Each optimizes performance within a category that already exists, and each shares one boundary condition that four decades of refinement never removed. None of them owns whether the value the enterprise earns is actually realized.

Customer Excellence is the fourth . I define it as the enterprise capability that designs, delivers and scales coherent experiences across the three paths a customer travels, and that governs whether clinical intent becomes realized therapy. It is not a program, an initiative or a layer added to the other three. It is the discipline that makes the organization behave in alignment with what it claims to stand for.

Imported customer experience could describe this system but was never given authority over it

The industry's earlier response to this gap was sincere and insufficient. Customer experience arrived largely intact from retail, hospitality and financial services, where the organization controls the full transaction. Applied here, it measured how a journey felt while holding no authority over whether that journey progressed.

I do not think the discipline itself was wrong, only that it was imported without being redesigned for the market it entered. Here the prescribing decision is made by a physician, funded by a payer, adjudicated by a pharmacy benefit manager, dispensed by a specialty pharmacy and lived by a patient. A manufacturer directly controls none of those actors, and can rarely compel any of them. Those parties together form the ecosystem a manufacturer has to operate through rather than own, and it may be the competitive gameboard of the next decade . Measurement without governance produces awareness without change.

There is a second reason the transplant failed, and it is the one that creates the opening. Regulation in this industry governs claims rather than burden. Almost none of the friction a patient meets between a prescription and a first dose is legally required, which means it is unowned rather than mandated. I have set out that argument at length in why consumer CX does not translate to pharma .

Value is lost along three journeys that fail for entirely different reasons

The losses are rarely scattered evenly across the commercial system. They cluster in three sequential journeys between a molecule and a patient who benefits from it. Each fails differently, sits with different functions, and responds to different work.

The Path to Prescribe runs from an undiagnosed patient to a clinical decision. The Path to Fulfill runs from that decision to the medicine in a hand. The Path to Adhere runs from a first fill to the duration the trial actually demonstrated, through the unglamorous months in which an efficacy claim either becomes true for a particular person or does not.

Naming a journey is often what makes it fundable in the first place. An unnamed loss has no owner, no budget line and no place on a scorecard, which may explain why it survives in organizations that are otherwise exacting about cost. I would ask any brand team which of the three has a named owner, a budget against it, and a measure a commercial leader reviews. In most companies the honest answer is one of three.

Realization Rate makes the loss legible to the people who allocate capital

Experience work tends to lose funding arguments because it arrives without arithmetic. Someone presents a sentiment score, someone senior asks what it is worth, and the answer borrows a correlation from another industry. That conversation ends politely and it usually ends the program.

A clinical decision made in a brand's favor is value the science and the promotion have already earned. The share of that earned value which becomes sustained therapy is what I call the Realization Rate , and the distance between earned and realized is value leakage . Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk. That number tends to require no translation in a finance conversation.

Measured this way, the loss can be forecast rather than described. It also reprices every commercial investment the organization makes. If less than half of created intent survives to realization, the marginal dollar spent creating more intent competes against the marginal dollar spent protecting intent that already exists, and in most portfolios the second dollar now earns more.

Underneath the arithmetic sits a standard patients are already applying. Someone tracked a parcel to the minute this morning and changed a flight on a phone in ninety seconds, then called a manufacturer's hub and repeated a date of birth four times. She is comparing the company to the last competent transaction she had rather than to another pharmaceutical company. That bar is what I call Consumer-Grade .

An enterprise becomes predisposed to help by design rather than by heroics

Capable people usually prevent these gaps from becoming visible failures. Field colleagues make extra calls, access specialists pursue exceptions, support teams work beyond their assigned remit. Leadership sees the resolution without seeing the effort required to produce it.

Heroics are a subsidy. They allow an organization to deliver promises its routine processes cannot reliably support, and because the cost is absorbed through discretionary effort it is easily overlooked. A recurring design problem can survive for years because committed people keep rescuing the outcome.

The alternative is an enterprise that is structurally predisposed to help. Predisposition begins with customer consciousness, which I would describe as reading a customer's world deeply enough that what their life is making them need becomes visible before any market has formed around it. It becomes durable only when Customer Excellence is embedded in four layers rather than assigned to a function.

Leadership DNA determines whether the commitment survives contact with a quarterly target. Organizational DNA determines who owns the seams between functions. Operational DNA determines whether helpfulness is repeatable without an exceptional colleague. Commercial DNA determines whether the measures, incentives and investment decisions reward realized value rather than declared intent. I devote four chapters of The Customer Excellence Enterprise to those layers because no one of them holds on its own.

I entered pharma believing that experience determines how well a company fulfills its promise. Working inside the industry changed my understanding of the stakes rather than the conviction. The commercial system is part of how the value of science reaches patients, and governing that distance is the work I now do, which is the discipline I call Customer Excellence .

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

What Is Customer Excellence in Pharma? The Definition

Thu, 08 Oct 2026 21:45:00 GMT

Customer Excellence in pharma is the discipline of designing and operating the commercial system so that clinical intent reliably becomes realized therapeutic and commercial value. It is the fourth pillar of commercial excellence, alongside Launch, Marketing and Sales Excellence. It is what customer experience becomes once it is rebuilt for pharma, and it is the capability through which a company becomes Consumer-Grade. Wayne Simmons set the term out in The Customer Excellence Enterprise (Wiley, 2024), and this page is its definition for pharma and life sciences.

What is Customer Excellence?

Customer Excellence is customer experience rebuilt for pharma's economics. The customer experience that was imported into the industry measured sentiment through surveys and scores, while Customer Excellence measures whether customers progress. The discipline asks whether the clinician got the information the treatment decision needed, whether the patient obtained the therapy that was prescribed, and whether that patient got the support to continue. It is an operating discipline rather than a program, a department or a training initiative, and its unit of success is realized value rather than advocacy.

The purpose of the discipline is to raise the customer consciousness of a commercial organization, meaning the degree to which customer reality is present in decisions before they are made. That is a different ambition from caring about customers, which pharma companies already do. It is the ambition of making the state of the customer's journey as visible and as consequential in commercial decisions as the state of the brand or the pipeline.

Why does pharma need its own version?

Because the first versions of customer experience did not fit the industry, and the industry drew the wrong lesson from rejecting them. Consumer CX arrived with net promoter scores, relationship surveys and journey maps built for retail and banking. In pharma they produced dashboards that could not show whether anything mattered to the business or the patient. Commercial leaders reasonably concluded that experience was a soft discipline, so the rejection was rational even though the conclusion drawn from it was wrong.

Experience in pharma is not a sentiment variable. It is the mechanism by which prescribing intent becomes patient and commercial impact, because in pharma the commercial system is part of the therapeutic value chain . Customer Excellence is the correction, keeping the insight that a customer's experience determines outcomes and dropping the instruments that measured the wrong thing. It can be read as customer experience 3.0, fit for pharma, and it belongs inside commercial excellence rather than beside it.

How does it differ from Commercial Excellence?

Commercial Excellence as pharma practices it today improves demand creation. Launch, Marketing and Sales Excellence make an organization better at generating prescribing intent. Customer Excellence asks a question none of the three asks, which is how much of the intent already created is failing to convert into treatment, where that happens, and why.

The discipline extends the commercial system past the prescribing decision through fulfillment and adherence, and it holds commercial success accountable beyond the point where the script is written. The four pillars together are commercial excellence. Without the fourth, the funnel ends too early and the value lost after the prescription belongs to no one.

How does it differ from omnichannel and from a CX function?

Omnichannel manages the delivery of messages across channels, while Customer Excellence manages whether customers and patients progress to the next state of their journey. Omnichannel can be made to serve that objective, but it cannot own it. A CX function, where one exists, often owns listening, which means surveys, voice of customer programs and journey maps.

Customer Excellence owns what happens next, which barrier got classified, who was assigned, what intervention was made, whether progression improved and what the organization learned. Listening without reliable improvement is not Customer Excellence.

What does a Customer Excellence enterprise actually do?

It designs experience with the same seriousness it designs brand and product. Most of pharma designs brand and product with rigor and leaves experience to default, and a Customer Excellence enterprise instead treats experience as the third element of the value proposition and engineers it. It governs the whole journey rather than its parts, with explicit accountability at handoffs, defined exception handling and measurement of progression.

It runs a closed loop from frontline signal to classified barrier to assigned owner to intervention to measured progression to learning. It treats the field as one of its most underused intelligence systems rather than a message delivery channel. It makes excellence structural, so the organization is predisposed to deliver exceptional experiences rather than dependent on the heroics of a few people.

How is Customer Excellence measured?

By value realization rather than sentiment. The operating measures are script to start conversion, time to therapy, stall points, persistence, barrier resolution and realized value per unit of demand. The summary measures are Realization Rate , realized value over earned value, and Customer Value at Risk, the share of earned value exposed to loss through friction, fragmentation and failed handoffs.

A Customer Excellence enterprise can say, brand by brand, how much of the value it earned this year will be realized and what it is doing about the rest. Most of the commercial organizations I have worked inside cannot, and that gap is the case for the discipline.

Where does it sit in the architecture?

Consumer-Grade Pharma is the destination, a company whose commercial system meets the experience standard its customers already hold from the best interactions in their lives. Commercial Value Realization is the economic thesis that explains why the destination pays, and Customer Excellence is the capability that gets an organization there.

The capability is built in three phases. The first is a diagnostic that locates value leakage in existing commercial data. The second is a mobilization that engages the organization and the field around the highest value barriers. The third is an operationalization that turns the first interventions into permanent ways of working.

Key Takeaways

Customer Excellence is the discipline of running a commercial system so that intent becomes realized value.
It is the fourth pillar of commercial excellence, extending that system past the prescription.
It replaces sentiment measurement with progression and value realization measurement.
It owns the operating consequences of customer signal rather than the listening alone.
It is the capability through which a pharma company becomes Consumer-Grade.

Diagnostic Questions to Consider

Leadership should know whether the organization measures customer progression or only customer satisfaction.
Someone should be accountable for commercial value after the prescription is written.
When the field reports a barrier, the organization should know what happens to it and how fast.
Experience should be designed with the same rigor as brand and product rather than left to default.
For the priority brand, leadership should be able to state the share of earned value that will be realized this year.

Closing Reflection

Pharma did not reject customer experience out of indifference. It rejected a set of instruments that could not show what they were worth, and that rejection was rational. The lesson drawn from it, that experience is a soft discipline, may still be carrying a cost.

What I have seen is that the correction is rarely about new conviction. Pharma companies already care about clinicians and patients, so the work is largely about whether customer reality is present in commercial decisions before those decisions are made. Customer Excellence is the discipline that puts it there, and the measures of realized value are what make it consequential.

The four pillars together are commercial excellence, and the first three are the ones pharma has already built. The fourth decides how much of the value they earn ever reaches a patient.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related definitions: Consumer-Grade Pharma and value leakage in pharma . Related reading: Pharma customer experience, why it stalls and what replaces it .

What Is Value Leakage in Pharma? The Definition

Thu, 08 Oct 2026 21:40:00 GMT

Value leakage in pharma is the therapeutic and commercial value that is earned when a clinician decides to prescribe and then lost before the patient starts, continues and benefits from therapy. It happens in the interval between prescription and patient, at the handoffs between access, fulfillment, support and the field. It is measured as Customer Value at Risk, the share of earned value exposed to friction, fragmentation and failed handoffs. The Customer Excellence AGENCY uses the term throughout its work, and this page is the definition the firm works from.

What is value leakage, in plain terms?

Commercial organizations are built to create intent, and they are very good at it. Science, evidence, brand and field engagement persuade a clinician that a therapy is right for a particular patient, and the clinician writes a prescription. Most commercial systems count success at exactly that moment, so the books close before the story does. Between the script and the patient, that prescription may be rejected by a payer, abandoned at the pharmacy, delayed in a hub, started and then dropped, or never filled at all. In most organizations nobody holds a consolidated account of how often that happens or why, and the value lost in that interval is value leakage.

Precision matters about what is leaking. A written prescription is intent, not realized value, because realized value exists only when the patient accesses, starts, continues and benefits from the therapy. Every point of value leakage is therefore a return the company invested to earn and never received. On the patient side it is a clinical benefit that was decided on and never delivered. Both losses come from the same operating failure, even though they show up, when they show up at all, in different reports.

Where does value leak?

Value leaks across three paths. The Path to Prescribe runs from awareness to the prescribing decision, and it is where the commercial engine is strongest and leakage is lowest. The Path to Fulfill runs from the written script through access, authorization, dispensing and first dose, and it is where the largest and least visible leakage happens. In some therapeutic areas as many as half of written prescriptions never become initiated therapy. The Path to Adhere covers first dose through persistence and outcome, where leakage is slow and compounding, because every missed refill or unresolved barrier cuts the value of each month of therapy that follows.

Within each path the leak is rarely inside a function. Access, brand, field, medical and patient support can each meet their own internal standard while the patient does not progress. The failure often lives between the steps, at the handoffs, where ownership is fuzzy and measurement confirms that tasks got done rather than that the patient moved forward. The effort of bridging those handoffs does not disappear, and it becomes a hidden tax paid by patients, prescriber offices and the company's own colleagues.

Why does it stay invisible?

Three reasons sit behind it. The first is accounting convention, because commercial success is counted at prescribing, so whatever happens afterward is nobody's number. The second is organizational design, where the functions that touch the patient after the script are managed separately. The human cost and the financial cost land in different reports, and the operating failure lands in neither.

The third is heroics. In the organizations I have worked inside, the most resourceful people compensate for system gaps with extra calls, personal contacts and informal escalations. That keeps a flawed model running, and it hides what the model really costs. Every one of those escalations is intelligence about where the system is broken, and most organizations never collect it.

Is every stopped therapy a leak?

Not every stopped therapy is a leak. A clinical reconsideration, an informed patient decision and a legitimate coverage determination are not failures of the commercial system. The discipline is to separate those from avoidable friction in access, coordination, communication and support, and to separate what a company controls from what it can only influence. A value leakage diagnostic that cannot make that distinction overstates the problem and loses the trust of the clinical and access teams whose cooperation it needs.

How is value leakage measured?

Value leakage is measured by progression rather than activity. The core measures are script to start conversion, time to therapy, the stall points where patients wait, persistence over time, barrier resolution rates and realized value per unit of demand created. Two summary measures sit on top of those operating measures. Realization Rate is realized value divided by earned value. Customer Value at Risk, or CVaR, is earned value multiplied by one minus the Realization Rate.

CVaR captures the commercial exposure created by friction, fragmentation and failed handoffs, estimated barrier by barrier as a probability weighted revenue figure a leadership team can act on. Both measures fit inside a single statement of how value is realized in pharma. Realized Value equals Brand times Product times Experience, raised to the power of Culture, times one minus CVaR.

Brand creates belief, product creates clinical possibility, and experience moves intent toward impact. Culture decides whether that repeats, and CVaR is the share lost on the way. Value leakage is the name for everything CVaR counts.

Why is this a commercial system problem rather than a sales problem?

Because in pharma the commercial system is part of the therapeutic value chain . Its job is to put the state of the art in front of the clinical decision before it is made, and then to see that decision through to the patient. A commercial system that stops at the prescription is doing half its job and getting measured on the half it does. Pharma does not have a sales problem. It has a systemic value realization problem, and value leakage is how that problem shows up in the numbers.

This is also why digital and AI programs so rarely close the leak. They make the demand creation half of the system faster and more scalable. On their own they do not assign an owner to a handoff, define how an exception gets handled, or turn a frontline observation into a classified, assigned and resolved fix. Those are design decisions, and they are the work of Customer Excellence.

What does closing the leak look like?

Four changes, in order. The first is explicit accountability on every handoff between prescription and sustained therapy. The second is a defined path for exceptions, so a stalled patient triggers a process instead of a heroic act. The third is progression measurement, covering where barriers occur, how long they take to resolve and whether the fix held.

The fourth is a formal loop that captures frontline signal, classifies the barrier, assigns an owner, intervenes, measures progression, then learns and improves. Where competing therapies offer similar clinical benefit, the company that runs that loop reliably converts more of its earned value than the company that does not. That is the commercial advantage that begins after the prescription.

Key Takeaways

Value leakage is earned therapeutic and commercial value lost between prescription and patient.
It concentrates in the Path to Fulfill and compounds in the Path to Adhere, at handoffs rather than inside functions.
It stays invisible because commercial success is counted at prescribing, functions report separately and heroics hide the cost.
It is measured by progression, summarized as Realization Rate and Customer Value at Risk.
Closing it is a design and governance job for the whole commercial system rather than a sales or technology fix.

Diagnostic Questions to Consider

Leadership should be able to say how much appropriate prescribing in your portfolio never becomes treatment, and how much of that loss is preventable.
Someone should own progression from prescription to initiation, with the authority to act across organizational lines.
If every hub, pharmacy and field dashboard turned green tomorrow, you should still be able to show that patients started treatment faster.
Treatment initiation should hold up even if the most resourceful people in the field organization were out for a month.
When the frontline spots a recurring barrier, the organization should know how long it takes to change the process and who decides.

Closing Reflection

Value leakage is an old failure that the commercial system was never built to see. The accounting stops at the prescription, the functions report separately, and the people closest to the patient absorb what the design leaves undone. None of that reflects a shortage of capability, and all of it reflects a model that was finished before the patient's journey was.

What I have seen inside commercial organizations is that the arithmetic is rarely the hard part. Realization Rate and Customer Value at Risk can be estimated well enough to govern decisions long before they are precise. The harder part is accepting that the interval after the prescription belongs to the commercial system, and that it can be designed rather than left to the resourcefulness of whoever happens to be nearest the problem.

Where competing therapies deliver similar clinical benefit, the difference in realized value tends to come from what happens after the script is written. That is where value leakage lives, and it is where Customer Excellence does its work.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related definitions: Consumer-Grade Pharma and Customer Excellence in pharma . Related reading: Pharma CX, why it stalls and what replaces it and Pharma's Realization Blind Spot

What Is Consumer-Grade Pharma? The Definition

Thu, 08 Oct 2026 21:35:00 GMT

Consumer-Grade Pharma™ is a pharmaceutical company whose commercial system delivers experiences that meet the standard patients and physicians already hold from the best interactions in their lives. The purpose of meeting that standard is that the value of the science is realized rather than lost between prescription and patient. Wayne Simmons introduced the term in The Customer Excellence Enterprise (Wiley, 2024). A related idea sits underneath it, Experiential Commerce , the redefinition of value that puts the cumulative experience rather than the product alone at the center of the exchange. It is the category The Customer Excellence AGENCY exists to advance, and this page is the definition the firm holds itself to.

What does Consumer-Grade mean in pharma?

Consumer-Grade means a standard of experience rather than a style of marketing. Consider the physicians a field organization calls on every week. One of them got a same day fix from her airline this morning, and another watched his pharmacy app show exactly where a refill stood. A nurse on the floor had her bank flag a problem before it became one. Each of them walks into the clinic with a benchmark already set, and no pharmaceutical company set it or can opt out of it.

The physician who spends one hour a day as a prescriber and twenty three as a consumer does not leave the second benchmark at the clinic door. The standard covers the whole commercial system, which includes the field, medical, access and patient support rather than marketing alone. A company becomes Consumer-Grade when the experience it delivers is designed and run to that standard every time, rather than rescued now and then by a rep who goes above and beyond.

Why is it a burden standard rather than an aesthetic one?

The most common misreading of the term is often to hear it as polish, meaning prettier portals, friendlier emails and a more pleasant rep visit. Consumer-Grade is a burden standard instead. It measures how much administrative, informational and emotional effort a physician or patient has to spend to get what the science already promised them. A prior authorization that takes three calls, a hub enrollment that asks for the same information twice and a sample request that vanishes into a queue are all failures the standard exposes. None of them is cosmetic.

Customers now judge that burden against the everyday services in their lives rather than against other pharma companies, and that is the shift that makes the standard unavoidable. Being the least burdensome company in a therapeutic category is no longer a defense when the comparison set is every well run service a customer used this week. Much of that burden is a hidden tax , the effort a commercial system quietly transfers onto patients, prescriber offices and its own colleagues.

Who sets the standard?

The customer does, and in pharma the customer is plural. Physicians, nurses, pharmacists, office staff, caregivers and patients each bring a benchmark from outside the industry, and each of them experiences a company as one entity rather than as a set of departments. Excellence in marketing paired with inconsistency in access reads to the customer as inconsistency. That is the Symmetry Gap , world class rigor inside the lab and the plant paired with uneven and often uninspiring interactions in the marketplace. Consumer-Grade Pharma is what it looks like when a company closes that gap.

What are the six conditions of a Consumer-Grade experience?

Six conditions tell whether an experience meets the standard. Recognition means the customer is known across interactions and never has to reintroduce themselves or their situation. Anticipation means the organization sees the next need coming and prepares for it rather than discovering it after the fact.

Coherence means every function tells the same story, carries the same context and makes the same promise. Effort means the work of getting value sits with the company rather than with the customer.

Resolution means that when something fails the company closes it rather than escalating it into silence. Visibility means the customer can see where things stand without having to ask.

These conditions work as a diagnostic rather than as a description. A commercial system can be audited against each one at every stage from prescribing intent to sustained therapy, and where it fails is where value is leaking.

How does Consumer-Grade Pharma relate to Customer Excellence and value realization?

Consumer-Grade Pharma is the destination. Commercial Value Realization is the economic reason to go there, because in pharma the commercial system is part of the therapeutic value chain, and experience is how prescribing intent becomes patient and commercial impact. Customer Excellence is the capability that gets a company there, the discipline of designing and running a commercial system so that clinical intent reliably becomes realized value. The three are not competing banners. One names where the industry is going, one explains why it pays to go, and one describes how the journey is made.

The money is real, because a written prescription is intent rather than realized value. In some therapeutic areas as many as half of written scripts never become initiated therapy. The value lost between the script and the patient is Customer Value at Risk, the commercial exposure created by friction, fragmentation and failed handoffs. A Consumer-Grade commercial system is one a company has engineered to shrink that exposure, which is why the standard is a revenue question before it is a reputation question.

What Consumer-Grade Pharma is not

Consumer-Grade Pharma is not direct to consumer marketing, though the companies that built experience first commercial models are the clearest proof that experience led architecture takes share. The standard is not the consumerization of medicine, and it does not loosen the evidentiary or regulatory standards that define the industry. Regulation governs claims rather than operational burden, and most of the friction the standard exposes can be fixed without touching a claim.

The standard is also not a customer experience program measured by satisfaction scores, and not a technology layer. Digital and AI investments make whatever commercial system already exists faster and more scalable, and they do not make a fragmented system coherent.

How is progress toward Consumer-Grade measured?

Progress is measured by progression rather than activity. The measures to track are script to start conversion, time to therapy, the stall points where patients wait, persistence, barrier resolution rates and realized value per unit of demand created. Two summary measures sit on top of those. Realization Rate is realized value divided by earned value, and Customer Value at Risk is the share of earned value a company stands to lose. An organization is moving toward Consumer-Grade when realization rises and exposure falls, brand by brand and stage by stage.

Why has the standard become unavoidable now?

Five forces converged. Specialty medicines made journeys longer and more complex, so there is more distance across which value can leak. Payers and health systems started scrutinizing whether therapies are started and sustained rather than simply prescribed. Consumer-Grade expectations arrived inside the clinical workflow through the devices and services clinicians use all day.

Competitors built experience first commercial models and showed that those models take share. Artificial intelligence made it possible to deliver recognition, anticipation and visibility at scale, which means a company that designed for the standard can now operate to it. A company that did not design for it may fall behind faster than it expects.

Key Takeaways

Consumer-Grade Pharma is a standard of experience set by customers' best experiences anywhere, applied to the whole commercial system.
It is a burden standard that measures the effort a physician or patient must spend to get the value the science already promised.
Six conditions define it, namely recognition, anticipation, coherence, effort, resolution and visibility.
It sits above Commercial Value Realization, the economic thesis, and Customer Excellence, the enterprise capability.
Progress is measured by progression and realization rather than by activity or sentiment.

Diagnostic Questions to Consider

Leadership should know which companies, inside or outside pharma, physicians and patients actually benchmark the organization against.
Between prescribing intent and sustained therapy, the organization should know where the most burden falls on the customer and who owns that stage.
Leadership should be able to name which of the six conditions the commercial system would fail first in an audit today.
The share of value the brands earned this year that will be realized should be known, along with how it is known.
Experience should be designed the way brand and product are designed rather than left to default.

Closing Reflection

The benchmark that now governs pharma was not set inside the industry. It was set by airlines, banks, pharmacies and every other service that learned to carry the burden rather than hand it to the customer. Physicians and patients bring that benchmark into the clinic whether or not any company invited it.

In the organizations I have worked inside, the gap is rarely one of intent. The science is held to an extraordinary standard, the manufacturing is held to an extraordinary standard, and the interactions that surround both are left to whatever the system happens to produce. That asymmetry is what the term names, and closing it is design work rather than conviction work.

Consumer-Grade is reachable, because the six conditions say plainly what reaching it requires. What I have seen is that an organization which treats them as a specification rather than an aspiration can audit itself honestly, and the places where it fails are the places where its earned value is leaking.

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024), where the Consumer-Grade standard for pharma was first set out. He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Consumer-Grade Pharma is a trademark application of The Customer Excellence AGENCY. Related definitions: value leakage in pharma and Customer Excellence in pharma . Related reading: Pharma CX, why it stalls and what replaces it and Patient support operating models, the router nobody built

[PRACTICE NOTE] The Value Lost Between Script and Patient

Mon, 21 Sep 2026 13:15:16 GMT

Institutions tend to measure the moment they can see most clearly rather than the moment that matters most. In pharmaceutical commercial organizations that moment is the prescription, which is visible, countable and reportable within weeks. Everything that follows it is harder to see and considerably harder to own. The result is an industry that knows a great deal about how demand forms and comparatively little about whether it survives.

That distinction carries a cost, and in work I published with TheyDo we put arithmetic to it. A clinical decision that goes a brand's way already represents value the science and the promotion have earned. What happens after that decision determines how much of the value the organization ever sees.

The ladder from earned value to realized value

Begin with a billion dollars of earned value, meaning prescribing decisions that have already gone a brand's way. Roughly thirty percent of prescriptions are never filled, which takes that billion to around seven hundred million before a single patient has started therapy. Early discontinuation claims a further tranche. Long term adherence erosion takes more again, and what remains is close to four hundred and fifty million in realized value.

The striking feature of that ladder is who collects the difference. No competitor takes it. It is not lost to a rival, it is lost to the system between a decision and a dose. That makes the loss unusual, because almost every other number on a commercial review has a named beneficiary somewhere.

Dashboards measure the formation of intent rather than its survival

Commercial performance in this industry has long been measured at the point of prescribing. The convention is rational, since that is the moment the field organization influences and the moment the data arrives reliably. It also carries a hidden cost, because it locates success precisely where the value the organization has earned becomes most exposed. Every instrument on the commercial dashboard points upward at the moment leakage is worst.

A system built this way reports the formation of intent and says very little about its survival. That may be why so many organizations read their own data faithfully and still reach the wrong conclusion about how well they are doing. The numbers are accurate. The inference drawn from them is often wrong, which is a design problem in the measurement of customer experience rather than a failure of analytical rigor.

The Path to Fulfill runs through parties with different incentives

The first stretch of loss sits on the Path to Fulfill, which runs from a clinical decision to the medicine in a hand. It passes through benefit verification, prior authorization, affordability, specialty pharmacy coordination, onboarding and first fill. Each of those steps is administered by a different party with different incentives and a different definition of a good outcome. Each is a point where a clinically justified decision can stall or quietly end.

The external evidence on that stretch has become difficult to set aside. A 2026 JAMA study summarised by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. Of those rejected prescriptions, 48.4 percent were never followed by a fill of that drug or anything in its class within ninety days. Affordability compounds the pattern, since IQVIA found that 61% of prescriptions go unclaimed once the final cost passes $250.

None of this reflects a shortage of effort or care inside commercial organizations. The AMA physician survey reported that 82% of physicians say prior authorization at least sometimes leads patients to abandon treatment, which tells you how much of this sits outside any one company's walls. What capable people do in response is absorb the gap personally, calling the hub after hours and working escalations nobody records. Heroics operate as a subsidy for a design that was never built to carry the load.

The Path to Adhere extends to the duration the trial demonstrated

The second stretch is the Path to Adhere, which runs from first fill to the duration the trial actually demonstrated. This is where the distance between a label and a life becomes widest. A regimen that performed for a defined period under controlled conditions now has to survive side effects, refill logistics, benefit resets, changes in income and the ordinary fatigue of managing a condition. Most commercial systems carry no mechanism for noticing when that survival begins to fail.

The erosion is slow, which is part of why it goes unmanaged. A brand can post strong prescribing performance for several quarters while its realized value declines underneath, because the two measures are tracked by different functions on different cycles. By the time persistence data confirms the pattern, the cohort it describes has largely dispersed.

Some attrition reflects judgment that deserves respect

Some share of this attrition is appropriate and should be read that way. A clinician changes approach on clinical grounds. An informed patient weighs burden against benefit and decides against continuing. Those decisions deserve respect, and treating them as commercial losses would be both wrong and corrosive to the trust the relationship depends on.

The work is to separate them from the cases where someone could not move forward because information was unclear or responsibility was unresolved. Those two categories can look identical in claims data while being entirely different problems. One is medicine working as intended. The other is an operating model failing quietly, and organizations that never separate the two tend to overestimate how much of their attrition was actually chosen.

An unnamed loss acquires no owner and no budget line

There is a structural reason this persists in companies that are otherwise exacting about cost. An unnamed loss has no owner, no budget line and no place on a scorecard. Nobody is failing to manage it, because nothing in the management system has ever asked anyone to manage it. Naming the loss is the precondition for governing it, which is why vocabulary turns out to matter more here than it usually does.

In the organizations I have worked inside, the moment a loss acquires a name is the moment it acquires a meeting. That meeting is where ownership gets assigned and where the first honest estimate of size appears. Before the name exists, the same conversation circles between access, marketing and patient services without landing anywhere. Each function can show it met its own standard while the patient still fails to progress.

Three measures that make leakage legible in a finance conversation

Three measures carry the argument into the rooms where resources are allocated. The Realization Rate is the share of earned value that becomes sustained therapy. Value leakage is the distance between earned and realized. Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk, a number that tends to require no translation in a finance conversation.

What makes these useful is less their precision than their location. They sit downstream of the prescription, which is exactly where the existing instrumentation goes dark. An organization that can state its Realization Rate by brand and by segment holds a different conversation about commercial investment than one that can only report scripts. It also has a defensible basis for discussing the return on customer experience investment , which has rarely been available in this industry.

The marginal dollar now earns more protecting intent than creating it

If less than half of created intent survives to realization, the economics of commercial investment change. The marginal dollar spent creating more intent competes directly against the marginal dollar spent protecting intent that already exists. In most portfolios the second dollar now earns more, because it operates on value the organization has already paid to create. That is an argument about return, which is why it belongs in the planning cycle rather than in a customer experience charter.

This is the work I describe as Customer Excellence , the fourth domain of commercial excellence alongside launch, marketing and sales. It is the one the industry never built, largely because a pharmaceutical company does not control the transaction between its science and a patient. The absence shows up as the distance in the ladder. Closing that distance asks for owned and measured accountability for progression after the prescription, not for another program.

Key Takeaways

A clinical decision that goes a brand's way is earned value, and roughly half of it can be lost between that decision and sustained therapy.
Measuring commercial success at the point of prescribing locates the scorecard exactly where leakage is worst.
The Path to Fulfill and the Path to Adhere are both administered by parties with different incentives, which is why loss accumulates between steps rather than inside them.
Some attrition reflects sound clinical judgment or informed patient choice, and separating those cases from unresolved friction is the actual analytical task.
The Realization Rate, value leakage and Customer Value at Risk give the loss a name, a size and a place on a scorecard.
Where less than half of created intent survives, the dollar spent protecting existing intent often returns more than the dollar spent creating more of it.

Diagnostic Questions to Consider

State the share of prescribing decisions in your largest brand that become sustained therapy at the duration the trial demonstrated.
Name the executive accountable for a patient's progression from prescribing decision to first dose, and the authority that person holds across functions and partners.
Separate last year's attrition into clinical judgment, informed patient choice, payer decision and unresolved friction, and defend the proportions.
Estimate Customer Value at Risk for one brand by multiplying its earned value by one minus its Realization Rate.
Compare the budget allocated to creating additional prescribing intent with the budget allocated to protecting the intent already earned.

Closing Reflection

The industry has spent decades becoming precise about the formation of demand. Targeting, segmentation, messaging and field deployment are measured with a rigor that would be recognized in any consumer category. The same organizations often cannot say what proportion of the demand they created ever reached a sustained dose, which is a strange asymmetry for businesses whose products are judged on outcomes.

What makes this worth confronting is not that anyone has behaved badly. Capable people are working inside a structure that was built to earn decisions rather than to protect them, and the structure performs exactly as designed. The loss sits in the connections between steps, where no single function has ever been asked to look. That is a design question, and design questions can be answered.

The prescription marks the end of persuasion and the beginning of realization. Treating it as the finish line was a reasonable convention when the route from a decision to a dose was shorter and simpler than it is today. It has become the most expensive measurement habit in the commercial model, and the organizations that retire it first will find value that no competitor ever took from them.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[DEFINITIONS] Pharma Value Realization & Customer Excellence FAQs

Thu, 20 Aug 2026 20:02:36 GMT

Closing the Intent-to-Impact Gap, Explained

Introduction

Pharma commercial leadership has a vocabulary problem, and it is costing money.

The industry has precise, shared language for everything upstream of the prescription: reach, frequency, share of voice, NBRx, TRx, segmentation, targeting, next-best-action. It has almost no shared language for what happens after. When a written script does not become initiated therapy, or when initiated therapy does not become sustained therapy, the loss is real, financially material, and largely unnamed. What cannot be named cannot be budgeted against, measured, or owned.

This FAQ defines the terms. It is written for Chief Commercial Officers, VPs of Commercial Excellence, Brand and Franchise Leads, Heads of Field Operations, and Patient Services leaders who suspect their commercial system is leaking value between intent and impact but lack the framework to quantify it or the operating model to close it.

By the end, the reader will have working definitions for Customer Excellence, Customer Value at Risk, Journey Operations, and the three paths across which pharma value is created and lost — plus a clear view of which of these are strategy problems, which are system problems, and which are culture problems wearing a technology costume.

Market Context: The Value Leakage Economy

Pharma's commercial investment is heavily front-loaded. The overwhelming majority of commercial spend is deployed to create prescribing intent — medical education, field deployment, digital engagement, brand building, launch orchestration. That investment works. Pharma is extraordinarily good at earning the script.

The structural problem begins the moment the script is earned. Across two decades inside global pharma commercial organizations — Pfizer's Chief Marketing Office and Bayer's Customer Powerhouse — I watched brands in some therapeutic areas lose as much as half of their written prescriptions before those scripts ever became initiated therapy. That figure is not drawn from published research. It is what I observed from inside the system, repeatedly, across therapeutic areas and markets.

Patients abandon at the pharmacy counter over cost. Prior authorization stalls. Specialty pharmacy handoffs drop context. Patient support enrollment never completes. Titration confusion produces early discontinuation. Each of these is a separate functional responsibility, tracked by a separate team, against a separate definition of success.

No one owns the sum. And here is the more revealing part: in most of the organizations I have worked with since, no one could tell me what their own number was. The inability to answer is the finding. A commercial organization that cannot state what percentage of its written scripts become initiated therapy is not managing a known loss. It is carrying an unmeasured one.

That is the shift worth naming: the competitive frontier in pharma commercial has moved from demand creation to demand realization . Two organizations can generate identical prescribing intent and produce materially different revenue, because one has an experiential system that carries intent through to therapy and the other does not. The organizations that build that system first will not simply perform better — they will be difficult to catch, because experiential capability compounds and cannot be purchased in a budget cycle.

This is not a marketing observation. It is a P&L observation. Every point of value leakage is revenue already paid for and not collected.

The Questions

The questions below are the ones commercial leaders raise most often when they first encounter the value realization frame — and the ones they raise later, when they try to operationalize it.

a. Definitions

What is Customer Excellence in pharma, and how is it different from Commercial Excellence?

Customer Excellence is the discipline of designing and operating the commercial system so that clinical intent reliably becomes realized therapeutic and commercial value. Commercial Excellence, as practiced in most pharma organizations, optimizes the machinery of demand creation: targeting accuracy, call quality, channel mix, launch sequencing, resource allocation. Customer Excellence does not replace it. It integrates Marketing Excellence, Sales Excellence, and Launch Excellence into a single operating system and extends that system across the full journey — including the portion after the prescribing decision, where most organizations have no unified ownership at all.

The practical difference is where each discipline looks for growth. Commercial Excellence asks how to generate more intent from the same investment. Customer Excellence asks how much intent the organization is already generating and failing to convert. In stalled brands with strong prescribing data, the second question is usually the more productive one.

What is the value realization gap?

The value realization gap — also described as the intent-to-impact gap — is the measurable distance between the clinical intent a commercial organization successfully creates and the therapeutic and commercial value it ultimately realizes.

It is visible in a specific pattern: prescribing metrics look healthy, promotional response holds, HCP sentiment is stable, and revenue underperforms anyway. Because the leakage occurs across functional boundaries — field to access, access to specialty pharmacy, pharmacy to patient services, patient services to adherence — no single dashboard displays it. Each function reports performance within its own scope and each report is accurate. The gap lives in the handoffs, which is precisely where no function is accountable.

The gap is not evidence of a weak brand or a weak field organization. It is evidence of a commercial system designed around promotional behaviors and never redesigned around journey progression.

What is Customer Value at Risk (CVaR)?

Customer Value at Risk is the quantified commercial exposure created by friction, fragmentation, and failed handoffs across the customer and patient journey. It is the compounding drag that sits between intent and impact.

CVaR borrows deliberately from financial risk language, because that is the register in which it should be managed. Organizations do not treat credit risk or supply risk as a soft issue to be addressed when convenient; they quantify it, assign ownership, and manage it down. Journey friction deserves the same treatment. Every unresolved barrier — a prior authorization loop, an unenrolled patient, an unanswered titration question, a lost specialty pharmacy handoff — carries a probability-weighted revenue value that can be estimated, tracked, and reduced.

CVaR appears in the Value Realization formula as a discount on everything else the organization creates:

Value Realization = (Brand × Product × Experience)^Culture × (1 − CVaR)

Brand creates belief. Product creates clinical possibility. Experience progresses intent into impact. Culture determines whether progression repeats or stays episodic. CVaR determines how much of the resulting value the organization actually keeps. The formula performs when Culture amplifies the multiplier and CVaR approaches zero.

Why is "Consumer-Grade" the benchmark, and why now?

Because HCPs and patients no longer calibrate their expectations against other pharmaceutical companies. They calibrate against every other experience in their lives.

The physician navigating a fragmented prior authorization process on Tuesday afternoon booked a flight, resolved a banking dispute, and reordered a prescription for her own household that same week — each in minutes, each with continuity, each without repeating herself. Her tolerance for administrative burden is set by those experiences, not by pharma's internal benchmarks. Consumer-Grade is not an aesthetic standard. It is a burden standard.

This matters commercially because burden influences prescribing behavior. When initiating a therapy is operationally harder than initiating a competitor's, that difficulty enters the clinical decision even when the clinical evidence favors the harder option. Experience has become a variable in the prescribing equation, which means it has become a variable in the revenue equation.

b. How the system works

What is Journey Operations, and how is it different from omnichannel?

Omnichannel is a distribution discipline. It governs which message reaches which customer through which channel at which moment, and it is largely oriented toward the promotional phase of the journey.

Journey Operations is a progression discipline. It governs whether a customer or patient advances from one journey state to the next — from intent to initiation, from initiation to persistence — and it treats stalls as operational defects with owners, root causes, and resolution paths. Omnichannel asks whether the message was delivered. Journey Operations asks whether the patient started therapy.

The distinction is not academic. An organization can achieve excellent omnichannel maturity — orchestrated, personalized, well-measured — while the value realization gap widens, because more coordinated messaging does nothing about a broken specialty pharmacy handoff. Channel orchestration and journey progression are different capabilities. Most organizations have invested heavily in the first and structurally in neither.

What is FieldOS, and why does field intelligence matter more in an AI era, not less?

FieldOS is a reference architecture for embedding Journey Operations into field enablement — turning the field organization from a message delivery channel into a barrier-detection and barrier-removal engine.

The prevailing industry narrative holds that the field is expensive, hard to scale, and increasingly a supporting actor to data and AI. That narrative misreads what the field actually produces. Field organizations conduct millions of nuanced clinical conversations annually inside the real complexity of a physician's practice — formulary friction, patient mix, clinical hesitation, competitive counter-messaging, accumulated brand history. That intelligence exists nowhere else in the commercial system. No digital signal captures it. No dashboard contains it. In most organizations, it evaporates the moment the call ends.

The contrarian position is straightforward: AI's highest value in a field context is not to replace what the field does but to amplify it. Structured capture of frontline barrier intelligence, synthesized at scale and routed to the functions that can resolve it, is a capability competitors cannot license. Technology platforms can be purchased. Earned clinical trust, and the operating discipline to act on what it reveals, cannot.

Where does value actually leak — Path-to-Prescribe, Path-to-Fulfill, or Path-to-Adhere?

The three paths describe the full arc across which pharmaceutical value is created and lost.

Path-to-Prescribe is where evidence, education, and clinical confidence shape the prescribing decision. This is where pharma invests most and performs best.

Path-to-Fulfill is where the script becomes therapy in the patient's hands — access, affordability, prior authorization, specialty pharmacy coordination, patient readiness. This is where the largest and least visible leakage occurs, because it spans functions that report to different leaders and is measured by process metrics rather than progression outcomes.

Path-to-Adhere is where therapy becomes outcome — onboarding, titration support, side-effect management, refill continuity, sustained belief. Leakage here is slower, quieter, and compounds over the life of the brand.

In practice, most organizations discover their concentration of CVaR in Fulfill and their most expensive long-run leakage in Adhere. Both sit outside the traditional commercial scope, which is exactly why they persist.

c. Building the capability

How do you quantify value leakage? What should be measured?

The measurement principle is that only progression metrics count. Activity metrics — reach, frequency, impressions, calls, enrollments initiated — describe effort. Progression metrics describe whether the customer or patient moved.

The core set:

Script-to-start conversion — the percentage of written prescriptions that become initiated therapy, segmented by payer, channel, geography, and HCP cohort. This single metric surfaces most Fulfill-stage leakage.
Time-to-therapy — elapsed days from prescribing decision to first dose. Duration is a proxy for accumulated friction; it is often more diagnostic than the conversion rate itself.
Stall points by journey state — where progression halts, at what volume, with what recoverable revenue attached. This is the raw material of CVaR.
Persistence at defined intervals — 30, 90, 180 days, cohort-compared against patients who did and did not encounter a specific barrier.
Barrier resolution rate and cycle time — the operational health measure of Journey Operations. Detection without resolution is reporting, not capability.
Realized value per unit of demand created — the executive-level ratio, and the one that connects this discipline to the P&L.

The discipline test is whether a commercial leader can state, in dollars, what a specific journey barrier costs the brand annually. If not, the organization is describing friction rather than managing it.

What technology is required — and is technology the constraint?

Technology is rarely the binding constraint, and treating it as one is the most common and most expensive diagnostic error in this space.

Most large pharma organizations already own the necessary components: CRM, MCM and orchestration platforms, patient services systems, specialty pharmacy data feeds, claims and dispensing data, and increasingly a CDP or unified data layer. The barrier is not capability absence. It is that these systems were architected around functional accountability rather than journey progression, so the data required to see a single patient's or physician's path exists but is never assembled into one view.

What must be added is usually architectural and organizational rather than technological: a shared definition of journey states, a single owner for progression across functional boundaries, an instrumented barrier-capture mechanism at the field and service edge, and a governance forum with the authority to resolve issues that cross functions. Organizations that begin by procuring a platform typically discover eighteen months later that they have automated an unresolved ownership problem.

Why do digital, omnichannel, and AI transformations fail to close this gap?

Because transformation modernizes tools without challenging the mental models that define success.

A transformation program that improves targeting precision, expands channel coverage, and accelerates content production makes the organization more efficient at executing its existing pattern. If that pattern is oriented toward demand creation, the result is more efficient demand creation — and an unchanged, or wider, realization gap. Efficiency applied to the wrong half of the system produces sophistication without impact.

There is a second failure mechanism that is less discussed. Channel proliferation increases the cognitive burden on the HCP. Adding touchpoints while leaving underlying friction intact makes the brand harder to engage with, not easier. Several organizations have improved every engagement metric on their dashboard while their actual burden profile deteriorated.

The question that separates programs that work from programs that do not is simple and rarely asked: did this investment reduce the effort required of the physician or the patient, or did it multiply the number of things they must navigate?

How long does it take to build a value realization capability?

Sequencing determines outcome more than duration does.

A focused diagnostic — instrumenting one brand in one market to quantify script-to-start conversion, identify concentrated stall points, and size CVaR against the P&L — is typically a matter of weeks, not quarters, because most of the required data already exists inside the organization. This phase produces the number that makes the case.

Standing up Journey Operations for a priority brand — defined journey states, assigned progression ownership, field barrier capture in the workflow, a functioning cross-functional resolution forum — generally runs one to two quarters, and is where most of the recoverable value is first realized.

Making the capability structural across a portfolio and multiple markets — embedded in planning cycles, incentive design, launch playbooks, and leadership standards — is a multi-year cultural build. That is the exponent in the formula, and it is the part that cannot be compressed.

Organizations that attempt the enterprise build before proving the brand-level number consistently stall, because they are asking for structural change without evidence attached.

Does this work in a regulated environment, and does it scale across markets?

Regulatory constraint is frequently offered as the reason pharma cannot deliver Consumer-Grade experiences. It is rarely the actual reason.

MLR governs claims, promotional content, and communication about products. It does not govern how quickly a prior authorization is resolved, whether a patient services handoff preserves context, whether a physician has to supply the same information three times, or whether an organization notices that a patient never started therapy. The overwhelming majority of journey friction is operational rather than promotional, and therefore fully addressable within existing regulatory constraint. Organizations that have made real progress here typically found that compliance was a design input, not a ceiling.

International scaling introduces genuine variation: access architecture, payer structure, patient support models, data residency, and channel norms differ materially by market. The scaling pattern that works is a consistent global architecture — shared journey state definitions, common CVaR methodology, comparable progression metrics — with local ownership of barrier resolution, because the barriers themselves are market-specific. Standardize the diagnostic. Localize the remedy.

What Closing the Gap Delivers

The returns from value realization work differ from promotional returns in an important way: they are recovery rather than acquisition. The demand has already been paid for. Closing the gap collects revenue the organization has already earned and is currently forfeiting.

In practice, this has produced measurable movement in three places:

Brand trajectory recovery. A stalled high-priority launch restored to a 12% NBRx growth turnaround — achieved without added promotional intensity, by removing progression barriers rather than generating more intent.

Field organization leverage. A field-led revenue uplift exceeding 30%, generated by operationalizing frontline and HCP experiential intelligence into enterprise ways of working rather than expanding headcount or call volume.

Signal-driven commercial improvement at scale. Voice-of-customer signals rewired into commercial decision-making across 100+ markets, spanning digital, field, and DTC channels.

The pattern is consistent. The largest available gains in mature commercial organizations are not in creating additional demand. They are in stopping the loss of demand already created.

d. Deep-Dive Sections

Why the Gap Is Structural, Not Behavioral

The most common misdiagnosis of the value realization gap is that it is an execution or effort problem — that field teams need better training, that patient services needs more staff, that access needs stronger messaging. Each of those may be true and none of them addresses the cause.

The gap is structural because the commercial system was designed to optimize a phase, not a journey. Every function in the post-prescription chain is doing its job well, measured against a definition of success it did not choose and cannot see beyond. Field is measured on reach and quality of engagement. Access is measured on formulary position. Patient services is measured on enrollment volume. Specialty pharmacy is measured on fill rate. All four can hit target while script-to-start conversion declines, because no one is measured on the thing that connects them.

This is why exhortation fails and why reorganization alone fails. The remedy is a progression layer that runs horizontally across functions, with its own definition of success, its own instrumentation, and enough authority to resolve issues that no single function owns. That is what Journey Operations is for.

How Culture Functions as the Exponent

In the Value Realization formula, Culture is not a multiplier. It is an exponent — a deliberate structural claim rather than a rhetorical flourish.

Multipliers scale linearly. Exponents determine whether a system compounds or decays. A commercial organization can execute a well-designed journey intervention on a priority brand and generate real recovery, then watch that recovery dissipate as attention moves to the next launch. The intervention worked. The organism did not change. That is episodic progression, and it is what most transformation programs actually purchase.

Culture, in this specific sense, is not values or engagement scores. It is what the organization does by default when no one is watching: whether a field professional captures a barrier because the system makes it natural, whether a cross-functional stall gets escalated without a mandate, whether leaders ask about progression in a brand review unprompted. When those defaults hold, every subsequent intervention compounds on the last. When they do not, each initiative starts from zero and the same barriers reappear under new names.

When to Instrument Versus When to Intervene

There is a practical sequencing decision most organizations get backwards.

Instrumentation — establishing journey states, measuring script-to-start conversion, sizing CVaR — should almost always precede intervention. Not because measurement is intrinsically virtuous, but because journey barriers concentrate. In most brands, a small number of stall points account for a disproportionate share of leaked value, and they are frequently not the ones leadership assumed. Organizations that intervene first typically fix the visible barrier rather than the expensive one.

The exception is worth naming. When a barrier is already known, already quantified, and already owned, further diagnostic work is avoidance dressed as rigor. Sizing an obvious problem for another two quarters is a way of not fixing it.

The judgment: instrument when the leakage is diffuse or contested; intervene when it is concentrated and agreed. Most organizations need the first and reach for a platform instead.

Common Misconceptions

"This is a patient services issue." Patient services owns a segment of the journey, not the journey. Locating value realization inside patient services guarantees that field-stage and access-stage leakage remains unaddressed, and it caps the discipline's authority below the level required to resolve cross-functional stalls.

"Experience is soft and cannot be tied to revenue." Experience that cannot be tied to patient outcomes and realized commercial value will always lose the budget argument — correctly. The discipline is only credible when it produces a dollar figure. That is the entire purpose of CVaR: to move experience from the language of sentiment into the language of exposure.

"We already do this — it is our omnichannel program." Channel orchestration and journey progression are different capabilities with different owners, different metrics, and different failure modes. The diagnostic question: can the organization report script-to-start conversion by barrier type? If not, it has an omnichannel program.

"Regulation prevents Consumer-Grade experience." Regulation governs claims. It does not govern burden. The distinction is where the addressable opportunity lives.

"AI will close this." AI applied to demand creation widens the gap by increasing intent the system still cannot convert. AI applied to barrier detection and journey progression closes it. The technology is identical; the orientation determines the outcome.

How The Customer Excellence Agency Can Help

The Customer Excellence Agency works with pharmaceutical and life sciences commercial leaders to close the value realization gap structurally, systemically, and consistently.

The work follows the formula. Accelerate Brand Growth identifies where demand is failing to become patient progression, quantifies the leakage, removes the barriers, and recovers the growth. Strengthen Field Performance positions the field organization as a barrier-detection and removal engine, converting frontline intelligence into activation through the FieldOS architecture. Scale Customer Excellence embeds value realization mechanisms into how the commercial organization thinks, decides, and operates — making the capability structural rather than episodic.

The methodology was not assembled from the outside. It was built inside global pharma — through Pfizer's Chief Marketing Office and Bayer's Customer Powerhouse — on a foundation of experience discipline drawn from Ritz-Carlton, LG, and Mastercard, then codified with a founding faculty colleague of Michigan State University's Customer Experience Management master's program and published by Wiley as The Customer Excellence Enterprise, now adopted in graduate and enterprise capability programs.

Conclusion & Next Steps

Pharma does not have a demand problem. It has a value leakage problem, and the leakage is invisible precisely because every function reporting on it is reporting accurately.

The most useful next step for most commercial organizations is narrow rather than broad: take one priority brand in one significant market and establish a single number — what percentage of written scripts become initiated therapy, and what the shortfall is worth annually. That number does more to mobilize an organization than any framework, because it converts an abstract concern into recognized exposure. Everything else — the operating model, the field architecture, the governance, the cultural build — becomes tractable once the exposure is named.

Breakthrough science that never reaches the patient might as well not exist. Together, we can make sure more of it does.

[Schedule a Diagnostic Conversation →]

Ecosystem Strategy: The Next Competitive Gameboard in Pharma

Mon, 27 Jul 2026 20:38:00 GMT

Institutions compete where they can keep score. The gameboard that gets measured becomes the gameboard that gets managed, and the one that goes unmeasured goes unclaimed. For four decades the competitive gameboard in pharma was the prescriber's attention and the formulary's coverage. Both are still contested, and neither is where the next advantage will be decided.

The new gameboard is the set of parties standing between an approved medicine and a patient on sustained therapy. A manufacturer owns none of them and can rarely compel most of them. Each one holds a piece of the outcome the brand is eventually graded on. That arrangement is not a failure of anyone's competence, and it deserves to be described plainly before it is judged.

I have spent most of my career inside commercial organizations asked to deliver outcomes they did not control. The people were capable and the intent was real. What was missing was a structure built to carry what the organization was being asked to carry. Ecosystem strategy is the work of building that structure, and it belongs to commercial leadership rather than to an experience function.

The gameboard moved while the scoreboard stayed in place

Prescriber attention and formulary coverage were the right gameboard when the decision and the dispense sat close together. A physician decided, a pharmacy filled, a patient started, and the interval between those events was short enough to ignore. Specialty medicine, prior authorization, step therapy and benefit design have stretched that interval into a journey with many owners. The commercial system kept measuring the decision while the value increasingly turned on everything after it.

A tenet I hold says it in fewer words. The commercial funnel ends too early. Prescribe, fulfill and adhere belong in one commercial system. Most commercial organizations remain instrumented for the first of those three. That is why the second and the third can still look like somebody else's problem.

The parties standing between an approved medicine and therapy

Name them without complaint, because complaint is the least useful register available in this conversation. The physician decides and the payer funds. The pharmacy benefit manager adjudicates, the specialty pharmacy dispenses and the hub coordinates what follows. A nurse educator onboards the patient, and the patient lives with whatever the chain produces.

Each party has its own incentives, its own cycle time and its own definition of a good month. None of those definitions is wrong inside the business that holds it. The composite of their work is what the patient actually experiences, and the composite is what the brand answers for. Nobody designs the composite, which is most of the opportunity and most of the difficulty.

Deloitte reported that only 28 percent of HCPs believe pharma's customer engagement strategies meet their needs, while 82 percent of life sciences executives are satisfied with those same strategies. A gap that wide is rarely a measurement error, and it is more often the signature of a system graded from the inside by the parties who designed it.

Position in a chain is a strategy question

A manufacturer cannot acquire its way to control of that chain and cannot regulate it into alignment. What remains is to architect a position inside it, which is a different competence from running a channel. Running a channel assumes authority over the parties in it. Architecting a position assumes the opposite, and designs instead for influence, visibility and standing.

That distinction matters because it decides who the work belongs to. Channel management sits with commercial operations and performs well when authority is clear. Position architecture sits with the people who set strategy, because it trades one form of advantage for another. The decision to shorten a path, carry a cost or stand up a front door is a strategy decision with a profit and loss consequence.

It is also the point at which the Consumer-Grade standard stops being a matter of conviction and becomes a matter of design. Pharma companies are patient-centric by nature, and that was never the constraint. The constraint is that experience has been left to default while brand and product were deliberately designed. Default is survivable inside a controlled transaction and expensive inside a chain the company does not control.

The nine workstreams that build onto the existing stack

The question that follows is what actually gets built. My answer is the Consumer-Grade Architecture, nine workstreams that build onto the pharma stack rather than replacing it. The word onto matters, because nothing here asks an organization to retire the systems it already runs. Regulated systems of record stay in place and keep doing their work. The architecture adds the layers the existing stack was never designed to hold.

The first three establish contact and sight. The Existing Pharma Core stays where it is, carrying the regulated systems of record the business already depends on. A Unified Pharma Front Door gives patients and prescribers one coherent place to arrive, rather than a brand by brand collection of portals and phone lines. Interaction Observability and Listening captures what happens in those arrivals, so that friction becomes visible as data rather than as anecdote.

The next three turn contact into context and action. Customer Context and Enterprise Memory holds what the organization already knows about a person, so nobody has to explain themselves twice. Journey Intelligence and Orchestration reads where someone sits on the Path to Prescribe, the Path to Fulfill or the Path to Adhere, then moves the next step toward them. Experience Delivery and Resolution closes the issue that was found, which is the workstream most programs quietly skip.

The last three decide whether any of it survives contact with the enterprise. Value Realization and Learning ties interventions to progression, so the architecture earns its budget on evidence. Leadership Governance and Operating Model assigns ownership across functions that have never shared a number before. Trust Privacy Compliance and Human Oversight keeps all of it inside the obligations the industry rightly carries.

Components are tailored per organization, and the sequence that fits one portfolio may be wrong for another. What does not vary is the dependency between the layers, because an organization cannot orchestrate a journey it cannot observe, and cannot observe one it has given customers no place to enter.

What the structural moves already visible actually reveal

Several companies have read the chain correctly and changed its structure rather than improving the experience around it. Setting a cash price and routing around benefit adjudication removes steps from the Path to Fulfill rather than smoothing them. The same logic runs through what Lilly changed with its direct channel , through how Novo Nordisk came to describe its own market , and through the direct to patient pricing move at Bristol Myers Squibb .

Each of those was a pricing and channel decision taken by commercial leadership rather than by an experience function. Each company identified the specific structural gate standing between its science and its patients. Then it changed the structure instead of improving the experience around the gate. That sequence is the lesson, and it is available to organizations that will never run a storefront.

David Ricks, Lilly's chair and chief executive, named the problem this way: "A complex U.S. healthcare system adds to the burdens patients face when managing a chronic disease" . Mike Doustdar, chief executive of Novo Nordisk, told investors at JPM26 that the obesity market behaves "a lot more as a consumer business than a traditional medication" . Both statements describe a category learning that the chain can be rearranged. Both also imply that somebody will rearrange it.

For most brands the gate is not price

The honest qualification belongs here, because the cash price move fits a narrow set of circumstances. For most brands the gate is not price at all. It is the interval between the written prescription and the first dose, and the quiet attrition in the months that follow. That interval rarely appears on a commercial dashboard, because no single function is accountable for the time inside it.

Rejections of initial brand name prescriptions rose from 24.3 percent in 2018 to 40.7 percent in 2024, according to a JAMA study summarized by Johns Hopkins . Almost half of those rejected prescriptions, 48.4 percent, were not followed by any fill within 90 days. The science did its work in those cases. The chain around it did not carry the result.

Some of that attrition reflects sound clinical judgment, and some of it reflects an informed patient choosing differently. Those decisions deserve respect and should never be counted as leakage. What remains once they are set aside is the part the commercial system can address, and it is usually larger than leadership believes. Value leakage names that remainder, and much of it is recoverable without a single new indication.

Progression proves an ecosystem position, not announcements

An ecosystem position is proved by progression rather than by partnership announcements. A press release names an intention. A stage ladder names a result, and the two correlate far less often than leadership teams expect. The measure that settles it is the Realization Rate , which is realized value divided by earned value.

Customer Value at Risk follows from it directly, as earned value multiplied by one minus the Realization Rate. That figure is the share of value a brand has already earned and has not yet collected. No competitor takes the difference, which is what makes it the most available growth on the page. It sits in the chain, between the parties nobody designs across.

Read that way, ecosystem strategy stops being an innovation agenda and becomes a value realization agenda. The share of earned value that becomes sustained therapy is the number that tells leadership whether the position is real. Customer Excellence is the discipline that holds the three paths in one system, and it is the fourth domain of commercial excellence alongside launch, marketing and sales. Brand, product and experience multiply rather than add, which means a weak third leg discounts the other two.

Key Takeaways

The competitive gameboard has moved from the prescriber's attention and the formulary's coverage to the chain of parties standing between an approved medicine and a patient on sustained therapy.
A manufacturer owns none of those parties and can rarely compel most of them, which makes position architecture a strategy question rather than a channel management question.
The Consumer-Grade Architecture names the nine workstreams that build onto the existing pharma stack, running from observability through orchestration to governance and oversight.
Several companies changed the structure of the chain rather than the experience around it, and each of those was a pricing and channel decision taken by commercial leadership.
For most brands the gate is the interval between the prescription and the first dose rather than the price, and some attrition inside that interval reflects sound clinical judgment.
An ecosystem position is proved by the Realization Rate and by Customer Value at Risk rather than by the number of partnerships announced.

Diagnostic Questions to Consider

Name every party standing between your approved medicine and a patient on sustained therapy, and state which of them your organization can actually influence.
Identify the specific structural gate between your science and your patients, and say whether it is price, interval or coordination.
State your current Realization Rate by brand, and the Customer Value at Risk that follows from it.
Describe which of the nine Consumer-Grade Architecture workstreams your organization already runs, and which it has never stood up.
Assign one accountable owner for the interval between the written prescription and the first dose.

Closing Reflection

The gameboard metaphor can be misleading in one respect, because a gameboard implies a contest with fixed rules. The parties between an approved medicine and a patient on therapy are not opponents. Most of them are doing what their own incentives were built to reward. The advantage goes to the organization that sees the whole board and designs its position on it deliberately.

That work is slower than a campaign and more durable than a quarter. It asks commercial leadership to own an interval it has historically treated as somebody else's. The organizations that take it on will not look dramatically different from the outside at first. The difference shows up in the share of their earned value that reaches a patient still on therapy a year later.

Exceptional science deserves an exceptional commercial system. The gameboard has moved, and the scoreboard will follow it eventually. The organizations that move first will have spent the intervening years building the architecture that everyone else will later have to buy.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Customer Consciousness and the GLP-1 Phenomenon

Tue, 23 Jun 2026 14:16:19 GMT

Ask most people in pharma about GLP-1 and you get the same debate, which is some version of how we get into this market. That is a fair question and it is not the more interesting one.

The more interesting question is what comes after GLP-1, and it is not which mechanism follows semaglutide or tirzepatide in the obesity pipeline. It is which human conditions may be accumulating the same forces that made this category inevitable. That question is worth more than any single category entry, and customer consciousness is the discipline built to answer it.

The category looked inevitable only in hindsight

Category formation in this industry tends to get treated as weather. Something arrives, the science aligns with the moment, and a market appears where none existed. The account is comfortable and it is wrong.

None of the underlying evidence was hidden, and some of it had been in plain view for a decade. The prevalence was documented, the failed interventions were catalogued, the workaround spending was visible on every retail shelf, and the cultural reframing of obesity from moral failure to metabolic condition had been underway in public for years.

The reading was available to anyone looking, and two companies looked. Massive markets in pharma do not have to be bolts of lightning. Forces that produce a category are usually present, legible and countable years before the unlock, which means the gap between inevitability and surprise is a strategic problem rather than a matter of luck.

The need was never weight loss

The need was agency over a life condition that had felt intractable, and customers seeking agency behave as consumers. They self recognized, they self funded, they formed communities, and they bypassed clinical infrastructure that had not served them. Each of those behaviors was observable long before the category declared itself.

That behavior is often the signal worth studying. High agency conditions tend to become consumer grade markets, and consumer grade markets demand commercial architecture to match, which is a different proposition from a therapeutic launch into a category that already exists.

A company that read the condition as weight loss built a product strategy, and a company that read it as agency built a market. The difference was rarely ambition or capability, and more often what each organization believed it was looking at.

Two companies read the same context and both were right

Novo Nordisk and Lilly each read the human context of obesity correctly, and each built the clinical credibility, prescribing confidence and commercial architecture that turned an intervention into a category. Their own language has caught up with that reading.

At JPM26, Novo Nordisk chief executive Mike Doustdar told the room the business "acts a lot more as a consumer business than a traditional medication." STAT reported the telehealth partnerships that followed. David Ricks at Lilly had made the same point earlier and more plainly, telling Axios that "we're used to buying consumer goods directly from manufacturers all the time on online websites."

The patient had already moved ahead of both of them. PMLive put it as the end of an assumption, arguing that the patient "is no longer a passive endpoint in a clinical pathway." Both companies acted on a reading the industry could have made collectively and did not.

Customer consciousness is a discipline rather than an instinct

I define customer consciousness as the practice of reading a customer's world deeply enough that what their life is making them need becomes visible before any market has formed around it. The definition matters because it places the work upstream of research rather than inside it. Research can tell you what people say about a category that exists, and this is the capability that tells you a category is forming.

Reading one condition correctly proves the reading is possible, though it does not by itself make the reading repeatable. In the commercial organizations I have worked inside and audited, no function has carried the remit of reading customer context ahead of category formation. There is no standing brief to detect human conditions accumulating toward a market, no cadence on which that detection runs, and no instrument carrying its output into portfolio strategy.

That absence is the strategic problem, and it is larger than any individual category decision. Reading one condition well produces a franchise. Reading any condition well produces a capability, and those are different assets with different half lives.

The Convergence Readiness Model names seven conditions

The instrument I use to make the reading systematic assesses seven conditions: persistent need, normalized burden, identity intensity, cultural readiness, self recognition, scientific unlock and ecosystem potential. Each is observable in public behavior rather than in proprietary data, which is what makes the reading available to any organization willing to run it.

The model applies to any therapeutic adjacency or investment opportunity under consideration, and it is scored rather than debated. Its purpose is not prediction in the forecasting sense. It is locating where a human condition sits on the path to category formation, and how far along that path it has already travelled.

Capital markets call GLP-1 a supercycle. That reading is accurate and almost entirely uninteresting, because it measures the wave without explaining the water. A supercycle is a demand release event rather than a demand creation event, and what releases is customer context that has been accumulating, unread, for decades.

Context debt is the liability of what you encountered and never internalized

Where value leakage measures what an enterprise loses inside a category it already competes in, context debt measures what it never collects because it never read the context that would have created the category. The two are the same discipline applied at opposite ends of the commercial system. One recovers value already earned, and the other locates value never approached.

The proof of context debt is behavioral rather than financial. Customers in a high agency condition will route around an industry that has not met them, and their workarounds are visible long before any analyst records a market. Every one of those workarounds is a receipt for interest the customer has already paid.

An organization carrying context debt can be commercially excellent inside its existing categories and structurally absent from the next one. Those two facts tend to coexist quietly for years, because nothing in a standard commercial review is designed to surface the second.

Customer consciousness sits upstream of everything else in the platform

Pharma reasons from first principles in the laboratory and has largely reasoned by analogy in the marketplace, taking the last launch as the template for the next. The obesity category was won by an approach closer to the first habit than the second. Read the condition people were actually living with, then build the system that would let a credible answer land.

That sequence is repeatable, and repeating it deliberately is worth considerably more than entering the category it produced. It is also the upstream end of the same argument that runs through value leakage and the Realization Rate at the downstream end.

GLP-1 is the masterclass. Customer consciousness is the discipline. The Convergence Readiness Model is the instrument. Customer Excellence is the institution that holds all three, and the companies that build it will not be chasing the next GLP-1.

Key Takeaways

The forces that made GLP-1 inevitable were documented, visible and countable for years before the category formed. Two companies read them and the rest of the industry treated the result as weather.
The need was never weight loss. It was agency over an intractable condition, and customers seeking agency behave as consumers and demand consumer grade commercial architecture.
Customer consciousness is the practice of reading a customer's world deeply enough that what their life is making them need becomes visible before a market forms around it.
The Convergence Readiness Model assesses seven conditions: persistent need, normalized burden, identity intensity, cultural readiness, self recognition, scientific unlock and ecosystem potential.
Context debt is what an enterprise never collects because it never read the context that would have created the category, and its proof is behavioral rather than financial.

Diagnostic Questions to Consider

Which function in our organization carries a standing remit to read human conditions accumulating toward a market, and on what cadence does it run.
Where are customers in our adjacent conditions already self funding, self organizing or routing around us.
If we scored three adjacent conditions against the seven convergence conditions today, where would each one sit.
When we explain a category we missed, do we describe forces we failed to read or circumstances that failed to cooperate.
What would change in portfolio strategy if customer context were treated as a first principle rather than an input to execution.

Closing Reflection

The industry explains its largest events in language that removes its own agency. A market appeared. The science aligned. Conditions were favorable. That account protects everyone in the room and teaches nobody anything.

Categories have an anatomy. The forces that produced obesity were present and legible years before the unlock, and equivalent forces are present and legible in other conditions today. Reading them is a discipline that can be built, which means the next convergence will be found by whoever happens to be looking closely at the right condition, unless the looking is made systematic.

The full argument, the scored instrument and a worked example are set out in The GLP-1 Masterclass in Customer Consciousness , the third CEA practice paper. It runs the protocol end to end so the technique is demonstrated rather than described.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Winners Believe in the Field

Thu, 23 Apr 2026 00:32:25 GMT

Organizations rarely abandon an asset outright. They reclassify it, and the reclassification quietly does the work nobody wanted to argue for in the open. In pharma that reclassification is happening now to the field organization, with a plausible rationale attached.

The conclusion many companies are drawing is that the field is a legacy asset to be managed down. I have come to the opposite conclusion, and the title of this note is a claim I am prepared to defend. The field is pharma's most expensive channel and also its most brand-defining one, and the companies that win will reassert it rather than reduce it.

The case for managing the field down is rational

That case deserves respect, because most of its premises are true. Access to prescribers has tightened, and Veeva Pulse found that 45% of HCPs are accessible to biopharma, down from 60% eighteen months earlier. Digital and AI channels reach more prescribers at a fraction of the cost of a human conversation. On a cost per interaction basis the comparison rarely flatters the field.

Where the reasoning breaks is in the question it answers. It ranks channels on the cost of moving a message, and any system that only talks can be replaced by a cheaper system that talks. The chosen dimension is the error, not the verdict it produces.

What the field collects cannot be bought

Brand teams nominally own the brand end to end, yet their instruments sit almost entirely in the Path to Prescribe. Prescribing data, market research, message testing, share tracking and promotional response are powerful instruments, and they are also indirect, sampled and lagged. None of them explains why a practice stopped starting new patients three weeks ago.

Field intelligence has a different character altogether. It is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke. That makes it the most unimpeachable and actionable intelligence a commercial organization has, and the one asset a competitor cannot acquire, because platforms and models can be licensed while earned clinical trust cannot.

The commercial consequence of that trust is measurable. Bain found that about 40% of a doctor's drug recommendations relate to overall experience with a company, and that doctors who rate a company highly are 2.3 to 2.7 times more likely to prescribe its products. Deloitte found that 82% of life sciences executives are satisfied with their customer engagement strategies while only 28% of HCPs say those strategies meet their needs, and that distance is where field force effectiveness is actually decided.

Belief begins with what leaders put on the agenda

Belief in the field is tested by allocation rather than by language, and leaders are read by what they schedule. In my book I argued that nothing signals leadership priority more plainly than making the customer agenda part of business reviews and board meetings. Translated into pharma, the experience of the customer and of the customer-facing colleague belongs in the monthly business review beside share and volume, rather than in an annual engagement survey.

An engagement survey asks colleagues how they feel about the company. A business review asks the organization what it intends to do about what those colleagues have seen. The second builds customer consciousness, the degree to which customer reality is present in decisions before they are made. Leadership DNA is the layer where that difference is either settled or left to drift.

Permission is the difference between seeing and acting

The second condition is institutional permission, granted so colleagues can uphold a brand promise rather than apologize for it. Field colleagues often see what is failing a patient long before any dashboard registers it. They see the prior authorization that will not clear, and the American Medical Association reports that 82% of physicians say prior authorization at least sometimes leads patients to abandon treatment.

Seeing it changes nothing when no sanctioned route exists to act on it. A colleague who raises a barrier and watches it vanish into a mailbox learns, correctly, that raising barriers is not part of the job. Permission is not a cultural gesture, and it is a policy position about what a colleague may decide without looking over a shoulder.

Signal needs somewhere to go

Permission without a route produces frustration rather than progress. The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them, which is why voice of the frontline listening belongs in the operating model rather than in a research plan. Most commercial models carry no closed loop that moves an observation from a conversation into a decision and back out as a measured effect.

FieldOS is the operating blueprint that closes that loop, and the loop runs through six stages. Those stages are Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, Learn and Improve. AI sits at the center supporting every stage rather than occupying one of its own. The diagnostic inside it is the Transfer Coefficient, the proportion of meaningful frontline intelligence that survives the journey from customer observation to consequential organizational action and measured effect.

Progression is the measure of what the field changed

A loop nobody measures becomes an initiative, and initiatives are abandoned in the second budget cycle. Activity measures tell an organization that the field was busy last quarter. Progression measures tell it whether a patient moved, which is the only question the science ever asked.

The stage ladder is deliberately plain. It runs Scripts Written, Filled, Therapy Started, 90-Day, Persistence, organized under the Path to Prescribe, the Path to Fulfill and the Path to Adhere. Measured that way a field organization can show where earned value stops becoming realized value, and the Realization Rate holds the commercial system accountable for the difference.

AI made the field more valuable than ever

The contrarian turn in this argument is that AI strengthens the case for the field rather than dissolving it. AI did not replace the field organization, it made it more valuable than ever. The tenet underneath that claim is uncomfortable for anyone selling a platform as a strategy, because AI will not make a fragmented commercial model customer-centric, it makes whatever operating system exists faster and more scalable.

Most field AI in pharma today is a talking tool. Next best action, message refinement, call preparation and targeting make an organization better at speaking, and a field organization given better talking tools simply talks better. A field organization given a listening system changes outcomes instead. Years ago I told CXM , while building a field experience measure, that "Doctors don't go around asking about loyalty." The listening has to be designed, which is the whole difference between better listening and better pre-call planning.

Heroics are a subsidy worth refusing

There is a cost in all of this that rarely appears in a commercial plan. Field colleagues absorb the failures of a system that was never designed to carry what it promises, working around a missing handoff, chasing a benefits investigation, holding a relationship together across a gap nobody above them can see. Leadership sees the resolution and largely never sees the effort that produced it.

Heroics are a subsidy. The organization books the outcome while the colleague pays for it in discretionary effort, and the subsidy stays invisible precisely because it works. Predisposition means a company is structurally and systematically predisposed to deliver exceptional experiences, which is the opposite of excellence manufactured through frontline heroics.

Believing in the field means declining to keep collecting that subsidy. In practice that means prioritization in the forums where resources move, permission a colleague can act on, a route for what they see, and a measure of what they changed. Those four conditions turn the most expensive channel into the most defensible one.

Key Takeaways

The field is pharma's most expensive channel and its most brand-defining one, which argues for reassertion rather than reduction.
Field intelligence is observed rather than recalled, account specific rather than sampled, current rather than lagged, and attached to the moment progression broke.
Belief in the field means prioritization, permission, a route for signal and a measure of progression rather than language about how much the field matters.
AI applied to talking makes a field organization a better talker, while AI applied to listening changes where value leaks.
Heroics are a subsidy that leadership collects without seeing it, and refusing it is what structural belief in the field looks like.

Diagnostic Questions to Consider

Name the forum where field intelligence changed a resource decision last quarter, and name who owned the outcome.
Describe what a colleague may decide on a patient's behalf without approval from two levels above them.
Trace the last ten barriers raised by field colleagues through to an owner, an intervention and a measured effect.
Separate the AI investments in the commercial plan that help the field speak from those that help the organization listen.
State the proportion of field performance reported as activity rather than as progression along the stage ladder.

Closing Reflection

The field has been judged for years on a question it was never the right instrument to answer. Asked how cheaply a message can be delivered, it compares poorly against a channel that costs almost nothing to run. Asked what is stopping a patient from starting therapy in a specific practice this week, it has no rival in the commercial system.

That reframe is less about conviction than about instrumentation. A field organization without a loop is an expense that leaders will eventually rationalize. A field organization inside a loop is an intelligence capability that compounds, and no competitor can buy its way into one.

Exceptional science deserves an exceptional commercial system, and the field is where that system keeps its promises or quietly fails to. Winners believe in the field because they have done the arithmetic, not because they are sentimental about it. The belief shows up in agendas, permissions, loops and measures, which is the only form of belief an organization can act on.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] The Next Chapter of Commercial Excellence in Pharma

Sun, 15 Mar 2026 19:54:30 GMT

Disciplines rarely arrive because someone invented them. They arrive because the condition that used to limit performance stopped being the condition that limits it. Commercial organizations tend to name a new capability only after the previous one has quietly run out of room. Pharma has done this three times, and the pattern is legible enough to anticipate the fourth.

The history of commercial excellence in this industry reads as a sequence of constraints relieved. Each discipline was a correct answer to the binding constraint of its own period, and each one remains necessary. The useful question is which constraint binds now, because the next chapter is always an answer to that.

Sales excellence answered the problem of access

When the modern commercial model took shape, access to the prescriber was the scarce resource. Physicians were reachable in person, their time was the gate, and the companies that organized best around that gate won. The answer was reach, frequency, territory design and relationship capital inside the clinical community. Sales excellence became a real discipline, with its own analytics, its own career path and its own vocabulary of coverage and share of voice.

Field deployment remains the most mature measurement system in most commercial organizations. That maturity was earned rather than inherited, built over decades of deciding whom to see, how often and with what. The constraint it was designed for has largely loosened, which is a different claim from saying the discipline stopped mattering.

Marketing excellence answered the problem of attention

Access eventually stopped being the hardest part of the job. As categories filled and evidence multiplied, the scarce resource became attention and credibility rather than minutes in a waiting room. A physician could be reached and still remain unpersuaded, and persuasion turned out to need different machinery than presence.

Marketing excellence answered that constraint with narrative, evidence generation, segmentation and message discipline. It built the capability to say one coherent thing across many markets and to support it with data a clinician would accept. Publication planning, medical education and brand strategy all matured inside this chapter. The craft involved is considerable and often underestimated by people who have never attempted it.

Launch excellence answered the problem of the first window

Analysis of brand histories then revealed something uncomfortable about timing. Much of a product's lifetime trajectory tends to be set in its first window, and launches that miss that window rarely recover the ground later. The constraint had moved again, this time to orchestration under time pressure.

Launch excellence answered it with readiness, orchestration and speed to peak. It brought disciplined sequencing to a moment that organizations used to manage with goodwill and heroics. Readiness reviews, milestone governance and cross functional launch teams all came out of this chapter. Of the three, it is the one that most resembles an operating discipline rather than a functional specialty.

What the three share and never resolved

Three disciplines, three correct answers, three bodies of practice that deserve respect. Each of them optimizes the creation of clinical intent, and not one of them owns whether that intent survives. The variable missing from all three accounts is experience, and it went missing causally rather than through neglect. Experience gets left to default while brand and product are designed with intent, which is a design gap rather than a failure of conviction.

Intent is the shared output. Survival of that intent belongs to nobody in particular. A therapy can be chosen by a convinced physician and still stall at an authorization queue, a copay desk or a third refill that never happens. Each of those failures sits outside the boundary of the discipline that produced the decision. I have watched capable teams run into that boundary and conclude the fault was their own.

The gap shows up in how differently the two sides describe the same engagement. Deloitte 2025 research found only 28 percent of HCPs believe pharma's engagement strategies meet their needs , against 82 percent of life sciences executives who say they are satisfied with those same strategies. A spread that wide rarely comes from a measurement error. Executives tend to measure what was delivered, while clinicians live with what was useful.

The fourth chapter has a name

The fourth chapter is Customer Excellence . Its full name carries the argument in four words, which is CX 3.0, Fit-for-Pharma, The Fourth Pillar. It is a pharma-specific interpretation of customer experience rather than an import, and that distinction is the reason it can hold where earlier forms could not. I define it as the enterprise capability that designs, delivers and scales coherent experiences across the three paths a customer travels, and that governs whether clinical intent becomes realized therapy.

The thesis underneath it is short enough to state in one line. In pharma, the commercial system is part of the therapeutic value chain, and experience is the mechanism by which that value is realized as patient and commercial impact. Written prescriptions are intent rather than realized value. The three paths are where that distinction becomes operational.

The paths are concrete rather than conceptual. The Path to Prescribe carries evidence into a clinical decision. The Path to Fulfill carries that decision through access, adjudication and dispensing. The Path to Adhere carries the therapy through the months in which benefit either accumulates or quietly disappears.

Positioned properly, Customer Excellence sits beside the other three rather than beneath them, which is the argument for treating it as the fourth pillar of commercial excellence . A capability filed inside marketing inherits marketing's boundary. The boundary is precisely the thing the new discipline exists to cross. Naming matters more here than it may appear, because institutions design what they have named and leave the rest to default.

Why the chapter is opening now

A discipline arrives when its constraint binds, not when it becomes fashionable. Five forces have tightened at the same time, and none of them substitutes for another. The first is specialty and journey complexity, which has lengthened the distance between a clinical decision and a patient on sustained therapy. The second is realization economics, which puts a number on how much of that distance gets lost.

The third is Consumer-Grade expectations arriving inside the clinical workflow rather than outside it. People who move through effortless systems all day rarely suspend that standard when they open an authorization portal. The Consumer-Grade Specification exists for that reason, as a closed set of structural conditions rather than an aspiration, covering Recognition, Anticipation, Coherence, Effort, Resolution and Visibility.

The fourth is competitors that built experience first, and it is the only force carrying proof rather than inference. Where an experience led architecture has taken share, the argument stops being theoretical for everyone else in the category. The fifth is AI, which is the decisive one on timing. AI will not make a fragmented commercial model customer-centric, it makes whatever operating system already exists faster and more scalable.

Realization economics deserves its own arithmetic. The Realization Rate is realized value divided by earned value. Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk, a figure that needs no translation in a finance review. The distance between earned and realized value is value leakage , and it has a shape worth seeing.

Work published with TheyDo set out an illustrative compounded scenario rather than a benchmark. A billion dollars of earned value becomes roughly seven hundred million once prescriptions that are never filled are subtracted. Early discontinuation takes a further share of what remains. Long term adherence erosion leaves close to four hundred and fifty million realized, and no competitor takes the difference.

What separates a chapter from a management trend

Skepticism about customer experience in pharma is rational, and it has a documented origin. The first iterations were imported from industries where one organization controls the whole transaction. They did not fit a system where a physician decides, a payer funds, a benefit manager adjudicates and a pharmacy dispenses. Those iterations were rejected for good reason. The wrong lesson drawn from the rejection was that experience does not apply here, when the fitted lesson was that the imported form did not.

Being this kind of enterprise means resisting the temptation to chase fleeting management trends or quick fixes, because enduring value comes from structural change. That belief yields a workable test. A new chapter of commercial excellence arrives with five markers, which are a named discipline, an owner, a measure, a body of practice and a budget line. Launch, marketing and sales excellence each carry all five, which is why they outlasted the executives who introduced them.

Anything carrying fewer markers is an initiative, however well intentioned, and initiatives get outlasted rather than adopted. The test is uncomfortable to apply honestly. Inside the commercial organizations I have worked with, four markers missing out of five is the common finding. That pattern explains the mortality rate of customer programs better than any shortage of talent.

Sequence rather than replacement

The fourth chapter does not displace the other three, and any version of this argument that suggests otherwise deserves suspicion. Sales excellence still decides whether the right clinician meets the right evidence. Marketing excellence still decides whether that evidence arrives credible and coherent. Launch excellence still decides whether the first window gets used rather than spent.

What the fourth chapter adds is the thing the other three have never had, which is a measure of whether what they created survived. That changes how their own results read. A launch can produce strong early demand and poor realization, succeeding by its own measures while failing by the enterprise's. Until the fourth discipline exists, nobody in the commercial system is positioned to say so out loud.

Durability comes from four layers rather than from a mandate. Leadership DNA determines whether the commitment survives a quarterly miss. Organizational DNA determines who owns the seams between functions, and Operational DNA determines whether helpfulness repeats without an exceptional colleague in the room. Commercial DNA determines whether measures and incentives reward realized value or declared intent.

Key Takeaways

Each discipline arrived when the previous constraint stopped binding. Sales excellence answered access, marketing excellence answered attention and credibility, and launch excellence answered the first window.
All three optimize the creation of clinical intent. Not one of them owns whether that intent survives access, adjudication, dispensing and the long middle of therapy.
Customer Excellence is CX 3.0, Fit-for-Pharma, The Fourth Pillar. It completes launch, marketing and sales excellence rather than replacing them, by measuring whether what they created actually survived.
The earlier rejection of imported customer experience was rational. The first iterations did not fit the industry, and the wrong lesson drawn was that experience does not apply here.
Five forces are opening the chapter at the same time. Specialty and journey complexity, realization economics, Consumer-Grade expectations inside the clinical workflow, competitors that built experience first, and AI as the decisive one on timing.
A chapter carries five markers and an initiative carries fewer. A named discipline, an owner, a measure, a body of practice and a budget line separate structural change from a passing trend.

Diagnostic Questions to Consider

Name which of the five forces binds hardest for the lead brand, then test whether the three existing disciplines can relieve it.
State the Realization Rate as realized value divided by earned value for the lead brand, without estimating the figure in the room.
Identify the single executive accountable for whether created intent becomes realized therapy, and confirm that the accountability is written down.
Apply the five markers to the current customer experience work and count how many are genuinely present.
Set Customer Value at Risk for one brand beside next year's promotional investment for the same brand.

Closing Reflection

Industries design what they have named. Pharma named three disciplines of commercial excellence, built genuine capability inside each and produced four decades of improvement within those boundaries. Experience was never the fourth name on that list, so it was left to default while brand and product were designed with intent. The distance between a prescribing decision and a patient still on therapy two years later is where that default now shows.

Opening a chapter is not an announcement. It assigns ownership to a stretch of the therapeutic value chain where ownership has been ambiguous, and ambiguity in that position carries a price the enterprise pays whether or not it measures it. Companies that move first will often look slower for a while, because governance work rarely photographs as well as campaign work.

The three chapters already written carried the industry to extraordinary science delivered at scale. The fourth decides how much of that science reaches the person it was made for. That measure has never existed, and the companies that build it will be the ones describing what commercial excellence means in the next decade.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Your Call Plan Isn’t the Problem. Your Customer Context Is.

Sun, 15 Mar 2026 19:48:03 GMT

Why healthcare professionals now judge pharmaceutical engagement against the best experiences in their lives, and what that means for the future of commercial leadership.

When commercial performance falters, the reflex inside many pharmaceutical organizations is to adjust the machinery of field execution. Leaders revisit call plans, recalibrate targeting models, and increase the volume of activity in the hope that more precision or more frequency will restore momentum. For decades this system has been treated as the central instrument of commercial performance, determining which physicians are prioritized, how frequently representatives engage, and how resources are deployed across territories.

Yet the growing gap between commercial effort and commercial impact suggests a deeper issue. T he problem is rarely the design of the call plan itself. It is the context in which healthcare professionals now operate. Physicians are navigating increasingly complex clinical, administrative, and informational environments, and that evolving reality now shapes prescribing behavior far more than the cadence of promotional interactions.

What many organizations are experiencing is a widening Customer Context Gap. Commercial systems were designed for a time when prescribing decisions could be influenced primarily through promotional interaction and product information. Today physicians operate inside a far more complex reality shaped by administrative burden, reimbursement constraints, digital information overload, and growing expectations for seamless support across the entire care journey. In this environment the physician’s decision is influenced not only by clinical evidence but also by how easily a therapy fits into the practical realities of care delivery. When commercial models remain anchored in promotional activity while the customer’s context has fundamentally changed, even the most disciplined call plan struggles to deliver the outcomes it was designed to produce.

Closing this gap requires a different way of thinking about commercial performance. The question is no longer how to optimize promotional activity but how to align the organization around the real journeys through which physicians help patients receive therapy. Prescribing decisions unfold within complex sequences of clinical evaluation, reimbursement navigation, patient readiness, and ongoing support. When commercial strategy is designed around these journeys rather than isolated interactions, the role of the field force begins to evolve. Representatives are no longer positioned primarily as messengers of information but as partners in removing barriers that slow care. Organizations that recognize this shift begin redesigning their commercial systems accordingly, aligning field engagement, digital support, access programs, and patient services around the same goal: helping healthcare professionals help patients move from clinical intent to successful treatment.

From Promotional Activity to Customer Journeys

The pharmaceutical industry has historically organized commercial activity around the moment of promotion. Call plans, targeting models, and message sequencing were designed to influence prescribing behavior primarily through informational engagement with healthcare professionals. While this model brought structure and scale to commercial operations, it reflects an earlier era in which the path from clinical awareness to prescribing action was comparatively linear.

Today the journey is far more complex. Physicians must navigate an intricate landscape of clinical evidence, treatment guidelines, payer requirements, prior authorization processes, patient affordability concerns, and adherence challenges. Prescribing a therapy is no longer a single decision point. It is the beginning of a chain of events that determines whether a patient ultimately receives and remains on treatment.

This is why the commercial conversation must expand beyond the traditional moment of prescription to encompass three interconnected journeys. The first is the Path-to-Prescribe , where scientific evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. The second is the Path-to-Fulfill, where access, affordability, patient readiness, and operational support determine whether that recommendation ultimately becomes therapy in the patient’s hands. The third is the Path-to-Adhere , where ongoing patient support, monitoring, and engagement determine whether patients remain on therapy long enough to realize the intended clinical benefit.

Science drives the Path to Prescribe, where evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. Experience shapes the Path to Fulfill, where access, affordability, and patient readiness determine whether that recommendation becomes therapy in the patient’s hands. Sustained outcomes depend on the Path to Adhere, where ongoing support, monitoring, and engagement ensure patients remain on therapy long enough to realize its intended clinical benefit. When commercial organizations focus almost exclusively on the first while leaving the latter journeys fragmented and burdened, a significant portion of therapeutic value is lost between intention and impact. In many therapeutic areas, the result appears in the persistent gap between prescriptions written, prescriptions filled, and therapies sustained—gaps that reflect not a failure of science but a failure of system design.

Recognizing these three journeys shifts the unit of focus from promotional activity to the real-world pathways through which care is delivered. It reframes the role of the field force, the purpose of digital engagement, and the design of patient support programs around a single objective: reducing the friction that stands between clinical intent, treatment initiation, and sustained patient outcomes.

Customer Context Is the New Commercial Variable

For much of the pharmaceutical industry’s history, commercial performance was largely explained by a familiar set of variables. Product efficacy, clinical differentiation, promotional reach, and sales force execution determined the trajectory of most brands. When performance lagged, leaders adjusted those levers by refining segmentation, optimizing targeting, and recalibrating call plans.

Today those traditional levers still matter, but they no longer explain commercial outcomes on their own. A far more powerful variable has entered the equation: customer context.

HCPs now operate within an environment defined not only by clinical complexity and administrative burden but also by rising expectations shaped by their experiences outside healthcare. Physicians are also consumers. In their personal lives they interact daily with companies such as Apple, Amazon, Tesla, and Netflix that anticipate their needs, remove friction, and simplify complex processes through thoughtful design. These experiences quietly reset the benchmark for competence, responsiveness, and respect for their time.

When those same physicians step into their clinical roles, they do not shed those expectations. They carry them with them. The contrast between the seamless orchestration of their consumer experiences and the fragmented systems surrounding many healthcare interactions becomes difficult to ignore. What once felt acceptable now feels unnecessarily burdensome.

This dynamic represents the Consumer-Grade Imperative. Healthcare professionals increasingly evaluate pharmaceutical engagement not against other pharmaceutical companies but against the best experiences they encounter anywhere in their lives. In this environment even a clinically superior therapy can struggle if the surrounding system makes it difficult to initiate treatment, navigate reimbursement, or support patient adherence.

Customer context therefore becomes the new commercial variable. It determines whether scientific differentiation translates into practical adoption. It shapes whether prescribing intent becomes therapy initiation and whether therapy initiation becomes sustained patient outcomes.

Call plans were designed to manage activity. Customer context requires organizations to manage journeys.

The Field Force in the Era of Customer Context

Recognizing customer context as the defining commercial variable inevitably reshapes how the role of the field force is understood. For decades the pharmaceutical sales representative has been positioned primarily as the carrier of scientific information. Call plans optimized the frequency and sequencing of these interactions to ensure that physicians received consistent messaging.

That role does not disappear, but the environment surrounding it has changed profoundly. Physicians today are navigating administrative burden, payer complexity, digital information overload, and increasing time pressure. In this environment they are not simply seeking more information. They are seeking clarity, simplicity, and support that helps them navigate the complexity surrounding treatment decisions.

This shift transforms the representative from a messenger of information into something far more valuable: a partner in removing friction from the care journey. Conversations move beyond repeating clinical claims toward understanding the practical barriers that physicians and their teams face as they attempt to initiate and sustain therapy for patients.

The most effective field forces are therefore supported by commercial systems designed around journeys rather than activities. Representatives are equipped not only with scientific messaging but with the insight and coordination required to address obstacles across prescribing, reimbursement, and patient support. Field engagement becomes a catalyst for problem solving rather than simply a vehicle for promotion.

From Call Plans to Customer-Aligned Commercial Systems

If customer context has become the defining commercial variable, then the systems designed to support the field must evolve accordingly.

The traditional call plan was built to manage activity. It provided structure for how frequently physicians were engaged, how territories were covered, and how resources were deployed. Yet activity alone does not determine whether therapies ultimately reach patients. What determines impact is whether the commercial system surrounding the physician reduces or increases the burden of delivering care.

A customer-aligned commercial system begins with the journeys through which physicians help patients move from diagnosis to treatment and beyond. Marketing clarifies the scientific story. Sales provides trusted relationships and real-time understanding of physician needs. Access teams simplify reimbursement pathways. Patient support programs reduce administrative burden. Digital engagement reinforces and extends human interaction.

The result is a commercial system that operates less like disconnected functions and more like an integrated network designed to help physicians help patients. This is the essence of Customer Excellence. It aligns the entire commercial enterprise around the real-world context in which care is delivered. The problem was never the call plan. The problem was the context.

Key Takeaways

Commercial performance in pharma organizations has traditionally been managed through field execution mechanics, yet the effectiveness of those mechanics increasingly depends on how well they reflect the real-world context in which physicians operate.
Customer context has become the most pivotal commercial variable as administrative burden, payer complexity, and consumer-grade expectations reshape how prescribing decisions are made.
HCPs now evaluate pharmaceutical engagement against the best experiences they encounter anywhere in their lives, raising the standard for clarity, responsiveness, and ease.
Optimizing promotional activity alone is no longer sufficient. Commercial success depends on reducing friction across the journeys physicians navigate as they move patients from diagnosis to treatment.
Customer Excellence represents the structural response, aligning marketing, sales, access, digital engagement, and patient support around the real journeys of care delivery .

Diagnostic Questions to Consider

Are we optimizing the activity of our field force, or designing commercial systems that support the real journeys physicians navigate to help patients receive therapy?
How well do we understand the administrative, reimbursement, and operational barriers physicians encounter after they decide to prescribe a therapy?
Do our commercial systems reduce the burden placed on physicians and their staff , or unintentionally add to the complexity of care delivery?
Are we benchmarking our engagement against other pharma companies , or against the best experiences physicians encounter in their lives as consumers?
Have our investments in digital platforms simplified the physician’s experience, or multiplied the number of disconnected interactions they must manage?
Are we still managing performance through activity metrics alone , or beginning to understand the context that ultimately determines whether therapies reach patients?

Closing Reflection

The pharma and life sciences industry has spent decades refining the mechanics of field execution. Call plans, segmentation models, and targeting systems brought structure and discipline to commercial organizations. Yet the environment surrounding physicians has evolved far more rapidly than the systems built to support them.

Healthcare professionals now operate in a world defined by consumer-grade expectations for clarity, responsiveness, and ease. When the experience of engaging with a pharmaceutical company fails to reflect those expectations, the contrast becomes impossible to ignore.

Organizations that recognize this shift will redesign their commercial systems around the realities of modern care delivery. They will move beyond managing activity and toward understanding the context in which physicians help patients receive treatment. In doing so they will close the gap between scientific innovation and real-world impact.

Your breakthrough science deserves experiences worthy of it. Together, we turn customer excellence into real-world impact.

About the Author

Wayne Simmons is a hands-on commercial excellence architect and founder of The Customer Excellence Agency, where he partners with pharmaceutical and life sciences leaders to turn customer-centric ambition into durable commercial advantage. He previously served as Global Customer Excellence Lead within Pfizer’s Chief Marketing Organization and has held leadership roles with Bayer Pharmaceuticals and The Ritz-Carlton Leadership Center. Wayne writes The Customer-Centric Marketer newsletter and is the author of The Customer Excellence Enterprise: A Playbook for Creating Customers for Life.

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] FieldOS: The Field Impact Operating System

Mon, 23 Feb 2026 20:31:09 GMT

Organizations tend to measure what they already know how to improve. The measures that endure are the ones their systems were built to collect, so instrumentation often describes a company's past rather than its present. Pharma commercial organizations make the point plainly, because four decades of field force effectiveness work have produced measurement sophistication that describes almost nothing a field colleague can actually change.

Reach, frequency, call plan adherence and share of voice all answer the same question. They ask whether the activity happened at the planned volume in the planned place. They say very little about whether anything moved. FieldOS is my name for the operating blueprint that would ask the second question.

Field effectiveness became an efficiency discipline

Efficiency disciplines are not mistakes, and they were the right answer to a commercial model whose binding constraint was coverage. Putting the right message in front of the right prescriber at the right interval was hard to engineer. The measurement system that governs field force effectiveness deserves respect for the problem it solved.

What has changed is the location of the constraint, because the science now reaches a prescriber who often agrees with it and still cannot act on it. Administrative burden, disconnected handoffs, lack of visibility, fragmented support, poor escalation and process complexity sit between clinical conviction and a patient on therapy. Coverage is largely solved, and continuity is not.

Those hurdles accumulate into commercial drag, and the available figures describe the new constraint rather than the old one. Payers rejected 40.7% of initial brand name prescription attempts in 2024, up from 24.3% in 2018, according to a JAMA study summarized by Johns Hopkins . Nearly half of those rejections, 48.4%, were never followed by a fill of any drug in the class within 90 days. The field organization was not idle through any of that.

The design gap sits between what she sees and what the system receives

A field colleague is often the only person in the enterprise who sees the whole of a customer's situation. She sees which practices cannot get a prior authorization through. She sees which patients stall at a specialty pharmacy, and where a nurse has invented a workaround for a form that does not work. She carries a picture of the market that no dashboard in the building contains.

The scale of what she sees is rarely anecdotal. The AMA's 2024 physician survey found 93% of physicians say prior authorization delays care, and 82% say it at least sometimes leads patients to abandon treatment. She visits those practices every month, and their experience of the therapy forms in the places her reporting template does not ask about.

Almost none of that reaches a system able to act on it. The field is instrumented to report activity rather than to report context, so some of the richest intelligence in the commercial organization has nowhere to go. The colleague is not failing. The operating model she works inside was never designed to receive what she knows.

This is a design gap rather than a character gap. Field teams are capable, trained and motivated, and most of them have tried the informal routes already. The information gets heard and then it stops, because hearing is not the same as receiving.

Why field intelligence is the superior signal

Frontline Intelligence behaves differently, being observed rather than recalled, account specific rather than sampled, and current rather than lagged. It also arrives already attached to the moment progression broke, which makes it the most unimpeachable and actionable intelligence in the commercial system.

The frontline remains one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. In my practice that reads as a tenet rather than an observation, because the pattern repeats across therapeutic areas. Dropout points are experiential rather than clinical or promotional, which is why promotional instruments cannot see them.

Why an operating blueprint rather than a program

Operating systems work behind the scenes, orchestrating components so a connected device stays usable. Companies can be read the same way, since leaders, functional systems, accountability structures and ways of working combine into something that behaves much the same. Just as operating systems for phones and laptops need patches and periodic major upgrades, a corporate operating system requires the same.

An operating system encoded with helpfulness encapsulates the leadership, organizational, operational and commercial DNA of the enterprise. Those differences prove durable because they are structural rather than superficial. A program eventually ends, and the operating model it tried to change carries on without it.

FieldOS is an operating blueprint for field intelligence and activation. It describes the direction an organization aspires to take its field operating model, away from ad hoc and reactive process. The direction runs toward a model more empathetic to customer facing colleagues, more customer-centric and more AI enabled. Components are tailored per organization, which is what separates a blueprint from a template.

The closed loop is locked at six stages

The loop that makes field intelligence consequential has six stages. Capture Signal brings the observation in, and Classify Barrier decides what kind of obstruction it is, because an access barrier and a workflow barrier need different owners. Assign Owner gives it a name and a date.

Intervene does the work, whether through a process change, an enablement change or a design change. Measure Progression asks whether the intervention moved anything that matters. Learn and Improve feeds the result back into the next cycle, which is the stage most organizations drop. AI sits at the centre of the loop supporting every stage, never as a stage of its own.

Its role inside the loop is named as context, orchestration and progression. Context means the loop knows what else is true about the account, orchestration means the right people see the right item without a meeting, and progression means the loop can tell movement from motion. The loop ultimately serves a wider method of customer intelligence in pharma , which runs on those same three terms.

Better listening rather than better pre-call planning

Most field AI in the market is a talking tool. Next best action, message refinement, call prep, targeting and territory optimisation all make the field better at speaking. Each is useful, and none of them improves what the enterprise hears.

FieldOS is about better listening rather than better pre-call planning. Intelligence is the sensing half and activation is the mobilization half, with journey progression governance as the payoff. The tenet underneath is blunt, because AI will not make a fragmented commercial model customer-centric, it makes whatever operating system exists faster and more scalable. The conviction underneath the blueprint is that winners believe in the field and reassert it rather than manage it down.

Heroics as a subsidy nobody books

Organizations rarely notice the effort that holds them together. Field colleagues make extra calls, access specialists pursue exceptions, and support teams work beyond their remit to get a single patient started. Leadership sees the resolution without seeing the effort required to produce it. That discretionary effort lets the organization deliver promises its routine processes cannot reliably support.

Because nobody books the cost, it is easily overlooked. In my experience inside large commercial organizations the subsidy almost never appears in a budget line. Heroics as a subsidy names that accounting failure, and the subsidy tends to be paid by the people least able to refuse it. Predisposition is the alternative, meaning a company that delivers structurally and systematically rather than through frontline heroics.

Alongside the subsidy sits context debt, the liability of everything the organization encountered through its field and never internalized. Each unreported situation is a small borrowing against future performance. The interest shows up as repeated discovery, where the same barrier is found again by another team next quarter.

Progression replaces presence as the measure

Measurement is the operational language of a commercial organization, and changing it changes behavior faster than any amount of exhortation. A field organization measured on presence will produce presence reliably and at scale, while one measured on progression has to care whether the patient started.

The stage ladder gives progression something to count. Scripts Written, Filled, Therapy Started, 90-Day and Persistence sit under the Path to Prescribe, the Path to Fulfill and the Path to Adhere. Movement between those stages is the unit of field performance, and presence between them is merely a cost.

The Transfer Coefficient measures the loop itself rather than the market. It is the proportion of meaningful frontline intelligence that survives the journey from customer observation to consequential organizational action and measured effect. A low coefficient explains a great deal that gets blamed on execution, and raising it is the work.

The economics follow from there, since value leakage is the cumulative cost of movement that never happened. Customer Value at Risk expresses the same thing as a figure, equalling earned value multiplied by one minus the Realization Rate . When the final cost of a prescription exceeds $250, IQVIA found 61% are never picked up. A field organization that reports context gives the enterprise its earliest warning of where leakage forms.

What changes when the field is instrumented for context

The first change is in what the field talks about, since cycle meetings stop being a recitation of coverage and start being a review of signals, owners and movement. The second change is in what the enterprise learns, because context arrives early enough to be designed around rather than escalated against.

The third change may be the most valuable and is the hardest to forecast. A field organization that is believed becomes a field organization that reports, and one that reports becomes the most reliable sensing capability the enterprise owns. The voice of the frontline stops being a sentiment exercise and becomes an operating input.

None of this is a technology program, since it needs only a route, a classification, an owner, a cadence, a measure and the institutional permission to use all six. Pharma has spent four decades making the field efficient. The work ahead is making the field legible to the enterprise it serves, which is the territory of rewiring operational DNA .

Key Takeaways

Field force effectiveness measures activity with precision and says almost nothing about whether a customer's situation moved.
The field colleague often sees the whole of a customer's situation, and the operating model was never designed to receive it.
FieldOS is an operating blueprint for field intelligence and activation, carrying a closed loop locked at six stages.
The Transfer Coefficient measures how much frontline intelligence survives the journey from observation to consequential action and measured effect.
Field AI that improves what the field says leaves unchanged what the enterprise is able to hear.
Progression along the stage ladder connects a field organization to the Realization Rate, which no activity measure does.

Diagnostic Questions to Consider

Describe the sanctioned route a field colleague uses to report a customer situation rather than a completed activity.
Name the owner a classified barrier gets assigned to once it leaves the field, and the cadence on which it gets reviewed.
Estimate the share of meaningful frontline intelligence that reaches consequential action, which is the Transfer Coefficient in practice.
Identify which of the commercial drag hurdles the organization has escalated repeatedly without ever changing a process.
State which current field measures would change if a patient never moved past Scripts Written.

Closing Reflection

The uncomfortable part of this argument is that the field has been telling the enterprise what it needs to know for years. The signal was present all along, and the receiver was missing, an absence that amounts to a design decision nobody remembers making.

I have sat in enough cycle meetings to know how much intelligence passes through a room and leaves no trace. The colleagues in those rooms were withholding nothing at all. They were answering the questions their system asked, and their system asked about volume.

FieldOS is a claim about where the next decade of field investment should go. It should go into a loop capable of receiving what the field already holds rather than into tools that help the field speak more fluently. The measure moves from activity to progression, and that is the only move that connects a field organization to realized value.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] The Hidden Tax on Pharma Commercial Performance

Wed, 14 Jan 2026 17:00:31 GMT

A pharmaceutical commercial system transfers effort onto the patients it serves, the offices that prescribe and the colleagues it employs. That effort never reaches the accounts, and the Consumer-Grade Specification is what finally makes it visible.

Organizations are precise about the costs they carry and vague about the costs they create. Every operating model pushes some share of its work outward, onto customers, onto partners, onto the people standing at the edge of the system. Conventional accounting captures the first kind of cost with real discipline and rarely captures the second at all. That asymmetry is where a hidden tax begins to collect.

In pharmaceuticals the asymmetry carries a sharper edge, because a manufacturer does not control the transaction between its science and the person who needs it. Earned clinical value travels through prescribers, payers, pharmacies, hubs and specialty channels that the company influences without owning. Work falls into the spaces between those parties, and somebody has to absorb it. That somebody is rarely the organization whose design created the work.

Where the hidden tax is actually paid

The hidden tax is the effort a pharmaceutical system transfers onto the people it intends to serve and onto the people it employs. A patient pays it in repeated phone calls, in the same information given to three different parties, in forms completed more than once. She pays it in days spent waiting for an answer that nobody owes her. A prescriber's office pays it in administrative labor that no payer reimburses and no manufacturer ever books.

A field colleague pays it too, in work that was never in the job description. Reimbursement puzzles, portal failures and hub escalations often arrive at the person holding the relationship, because that is the only door a customer can find. None of this breaches a policy or triggers an escalation. Gartner's work on service channels found that 62% of channel transitions are high effort for customers , and every handoff between pharma functions is one of those transitions.

Commercial drag accumulates in a sequence I have learned to look for in order. Administrative burden lands first on the Path to Prescribe, followed by disconnected handoffs as the therapy moves toward fulfillment. Lack of visibility arrives next, when no party can say where the case actually sits. Fragmented support and poor escalation then compound along the Path to Adhere, each one returning the patient to a beginning she has already reached. Process complexity is what the whole sequence feels like from the outside, and it is the hurdle most often mistaken for the cause.

Three names for one systemic deviation

In the chapter of my book on rewiring Operational DNA I borrowed three Japanese manufacturing distinctions to describe what I came to call systemic deviations. Lean practice separates waste from unevenness and both from overburden, because the three respond to different interventions. Pharma already runs this discipline at industrial grade inside its plants and its quality systems. The gap sits elsewhere, where experience has been left to default while brand and product were deliberately designed.

Muda, the work that adds nothing

Muda is waste, any activity that consumes resources without adding proportional value. In a commercial system it can show up as unnecessary interactions, stages, steps and touchpoints that create delay rather than progress. A prior authorization resubmitted because one field was blank on the first pass is Muda, and so is an enrollment that collects what the specialty pharmacy already holds.

Mura, the unevenness clinicians read as unreliability

Mura is unevenness, the irregularity that makes an outcome unpredictable rather than simply wrong. One hub call resolves a benefit question in minutes, and the next takes days. Manufacturing sites measure variance in micrograms, while commercial variability of that size is often tolerated as the price of scale.

Clinicians work in a profession built on reliability, so they tend to read variability as unreliability. This is the point where operational friction becomes experiential friction, since a clinician grades what she can feel rather than a process she cannot see. What she feels is whether a therapy can be relied upon inside a crowded week. Unevenness at that scale rarely points to weak messaging, and it points instead to a join that no owner has been asked to govern.

Muri, the overburden nobody planned

Muri is overburden or excessive strain, and it may be the most surreptitious of the three. It shows up when customers and internal operations are subjected to unplanned demand and undue effort, producing inefficiency, errors and suboptimal outcomes. Among the systemic deviations it has a particularly detrimental effect on the wellbeing of employees. That last point deserves more weight in pharma than most commercial leaders give it.

Consider a specialty launch that routes benefit verification, copay enrollment and nurse education through a hub built for a fraction of the volume. Wait times stretch, errors multiply, and rework becomes standing work rather than an exception. Nobody forecast the demand, so the strain settles on whoever stands closest to the patient.

Why the tax stays off the ledger

No line on a profit and loss statement carries this tax, because it is paid in somebody else's time. The organization measures its own cost to serve with real rigor and does not measure the customer's cost to be served. Those two numbers move in opposite directions more often than commercial leaders expect, because taking cost out of a service model can mean putting effort into a patient's week.

Deloitte's work on engagement makes the asymmetry visible from both sides at once. Only 28% of healthcare professionals believe pharma's customer engagement strategies meet their needs, while 82% of life sciences executives are satisfied with those same strategies . The internal view measures the organization's own effort and finds it adequate. The external view measures the customer's effort and reaches a different verdict.

My own position has hardened into a plain statement. Friction is an economic variable, and accumulated friction becomes commercial drag. A commercial system that declines to price friction has chosen to let somebody else carry it.

Nobody designed it, which is the problem

Nobody sat in a room and designed this tax, which is precisely why it persists. It accumulated at the joins, between marketing and medical, between access and patient services, between a manufacturer and the outside parties that touch the therapy. Each function performs its own work capably and is measured against its own objectives, while very little rigor is applied to how those functions combine inside a single person's month.

Joins are where ownership was never appointed. A touchpoint can rate well on its own and still sit inside an experience that fails end to end, which is why the question of who owns the experience rarely has a satisfying answer. This is a design gap rather than a character gap. The people in these roles are capable, and the structure was never built to carry what it is being asked to deliver.

None of it reflects a shortage of patient commitment. Patient centricity is native to this industry. What arrived a decade ago was a consumer customer experience playbook whose first iterations did not fit a regulated, multi-party commercial model, so the industry set it aside. The rejection was rational, and the wrong lesson was drawn from it, because the discipline was discarded along with the misfit.

Heroics operate as a subsidy

I have come to read heroics as a subsidy rather than a virtue. Capable people absorb the tax instead of letting it surface as a visible failure, and the system records a success. A nurse educator stays late to untangle a benefit denial, and a hub agent works around a portal that will not accept a date. Each act is admirable, and each one conceals the defect that made it necessary.

Because the cost is paid in discretionary effort, nobody books it, and the organization only ever sees the cases that broke through into a complaint. A subsidy funded by goodwill is a fragile way to run an operating model, and strain of this kind wears down exactly the people a commercial system can least afford to lose.

The tax is also a loss

Burden and loss are largely the same phenomenon measured in two directions. Every interaction either compounds value or creates drag, which is the plainest way I know to state the economics. Effort is where a clinically justified decision quietly ends, because a prescriber facing a multi step access process usually has a simpler option available. Gartner has found that low effort customers are 61% more likely to stay with a company.

In pharma the equivalent of leaving is an abandoned prescription, a skipped refill or a therapy never started. Those dropout points are experiential rather than clinical or promotional, which is why they survive sharper messaging and better targeting. The share of earned value that becomes sustained therapy is the Realization Rate , and the distance between earned and realized value is value leakage . Customer Value at Risk puts a figure on the exposure, calculated as earned value multiplied by one minus the Realization Rate.

Work published with TheyDo traced that ladder as an illustrative compounded scenario rather than a benchmark. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled. It falls again after early discontinuation, reaching close to four hundred and fifty million in realized value once long term adherence erosion is counted. No competitor takes the difference.

Effort is one of six Consumer-Grade conditions

Consumer-Grade is a specification rather than an aspiration, and the Specification is a closed structural set of six conditions. They are Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Felt attributes such as easy, simple, fast and transparent are reported outcomes that decompose into those six conditions. Thresholds are set per organization, which is the discipline that turns a mood into a measurable standard.

Effort is the condition this argument sits inside. The hidden tax is what Effort measures once somebody has set a threshold for it, and in most commercial organizations no threshold has ever been set. Without one, effort is governed by whatever the system happens to produce and whatever its people are willing to absorb. Setting it means asking how many steps, how many days and how much repeated information a therapy demands of the person taking it.

The standard the patient already applies

At this point the matter stops being a service question and becomes a competitive one. The patient is not comparing a manufacturer to another pharmaceutical company. She is comparing it to the last competent transaction she had, which may have been a same day delivery or a rebooked flight settled in one message. That comparison is the threshold she carries into every interaction, whether or not the organization has written it down.

Meeting it is the practical work of rewiring Operational DNA, and it begins by treating effort as a quality defect rather than a cost of doing business. The capability can be designed in, which is a more useful conclusion than it may first appear.

Key Takeaways

The hidden tax is the effort a commercial system transfers onto patients, prescriber offices and its own colleagues, paid in time rather than money.
Commercial drag accumulates in a recognisable order, from administrative burden and disconnected handoffs through lack of visibility, fragmented support, poor escalation and process complexity.
Muda, Mura and Muri give leaders three distinct diagnoses, and overburden is the one that most often goes unnamed.
The tax stays invisible because organizations measure their cost to serve and never measure the customer's cost to be served.
Heroics act as a subsidy, concealing structural defects and funding the operating model out of discretionary goodwill.
Effort is one of six Consumer-Grade conditions, and the hidden tax is what it measures once a threshold exists.

Diagnostic Questions to Consider

Name the steps, days and repeated disclosures a patient must complete between a prescribing decision and a first dose on your lead therapy.
Locate where administrative burden, disconnected handoffs and lack of visibility first appear in that sequence, and name who owns each one.
Identify which of your service economies were achieved by moving work onto a patient, an office or a field colleague.
List the recurring heroics your organization relies on, and treat each one as evidence of an unnamed structural defect.
State the threshold your organization has set for Effort as a Consumer-Grade condition, and what follows when a journey breaches it.

Closing Reflection

The science in this industry is extraordinary and the experience surrounding it is frequently ordinary. That contradiction reflects a gap in design rather than a gap in commitment, because the people inside these organizations are among the most committed I have worked with anywhere. Design gaps are fixable in ways that gaps of conviction rarely are.

What makes the hidden tax worth a leadership agenda is that it compounds in silence. No complaint arrives, no alarm sounds, and the quarterly review shows activity holding steady while realized value drifts downward. Leaders who want to see it will have to go looking deliberately, in the joins, in the rework and in the discretionary effort their best people spend to keep a design intact.

Every commercial system imposes some measure of effort, so the useful question lies elsewhere. It asks whether the organization has chosen to measure that effort, assign it an owner and set a threshold it is willing to defend. Answering that question is what separates a brand that is trusted from one that is merely tolerated.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Overcoming Pharma's Cultural Blindspot

Wed, 14 Jan 2026 16:40:41 GMT

Pharma's culture was built to be careful, and that carefulness is why its science is extraordinary. The same instinct, carried into the experience around the medicine, can produce caution where boldness is needed.

Institutions rarely behave the way their strategy documents describe, and they behave instead the way their beliefs allow. Those beliefs were formed long before the current strategy was written, and they tend to outlast the people who formed them. In pharma they surface most visibly around the experience surrounding a therapy rather than the therapy itself.

Culture here is not mood or morale, and an engagement survey will not find it. I define it as the institutional mindsets, beliefs, mental models and behaviors that make up the collective consciousness of a company. These are the underlying factors that drive how a company thinks and functions. They also decide how customers are to be viewed, valued and treated.

Pharma companies are patient-centric by nature. The change they now face is entering the consumer arena, where people have choice and compare freely. Consumer-Grade is a capability to be designed in rather than a conviction to be held, which makes this a design gap rather than a character gap. Treating it as a character gap is how most culture work loses the room.

Mental models work behind the scenes

Mental models are cognitive frameworks formed by the collective experience and points of view of leaders and employees. They carry core beliefs, perceptions and assumptions, and they work behind the scenes, guiding decision making, problem solving and how resources are allocated. They also decide which opportunities are judged worthy of pursuit.

In a commercial organization that does not control the transaction between its science and a patient, those models carry unusual weight. A company releases a prescription into a system it does not own, and what happens next is governed by beliefs about whose job that part is, which are rarely written down. They are the reason organizational DNA is the hardest of the four layers to move.

Three beliefs that shape how customers are treated

The three beliefs below are not failings, and none of them is held cynically. Each was accurate once, each was earned through experience, and each still produces sensible decisions inside the function that holds it. What they share is a quiet effect on where experience work is allowed to happen.

Regulation prevents it

Regulation governs claims rather than burden. Almost none of the friction a patient meets between a prescription and a first dose is legally required, which makes most of it unowned rather than mandated. The belief survives because it tends to be cheaper to assume a constraint than to test one.

The customer is the prescriber

This was true for forty years, and it built a commercial model of real sophistication. It is incomplete now that adjudication, affordability and persistence sit along the Path to Fulfill and the Path to Adhere. Teams working to a prescriber-only definition of the customer can be excellent and still never see where value is lost.

We benchmark against pharma

Imported customer experience was rejected in this industry because the first iterations did not fit it. That rejection was rational. The wrong lesson drawn from it was that the standard should therefore be set inside the sector, and peer benchmarking confirms that a company performs adequately against others carrying the same blind spot. Deloitte found that only 28% of HCPs believe pharma's customer engagement strategies meet their needs , while 82% of life sciences executives are satisfied with those same strategies. A gap of that size is what an internal standard looks like.

Reimagine the art of the possible, then ask why not us

The first counter move is to reimagine the art of the possible, which in practice means decoding what customer experience outliers actually do rather than admiring them from a distance. Expectations are now set by companies that transcend industry and geographic boundaries, and patients and clinicians carry them into every clinical encounter. Decoding at that level has little to do with copying a retailer or a hotel. It is about walking in a customer's shoes closely enough to surface the practices underneath.

Decoding is also where regulated industries find most of their room. In healthcare, financial services and government, real or assumed constraints place unnecessary limits on what is considered possible. Close study of what outliers do can reveal ways to navigate those constraints without compromising compliance. The compliance function is often a better partner in that work than it is given credit for.

Embedded in that first move is a question a company can ask of itself. Why not us. Asked seriously, it is the counterpunch to the "that won't work here" mental block that ends most experience conversations early. Bain's work on commercial productivity found that about 40% of a doctor's drug recommendations relate to overall experience with the company rather than the product alone, which is the commercial case for asking.

Codify the obligation to customers

A new belief does not hold because leadership announced it. It holds when the obligation to customers is codified into company-specific Customer Excellence principles the whole organization can read. Codification turns the good intentions of customer centricity into a form that can be understood, trained, implemented and sustained. What it raises is customer consciousness, which is the degree to which customer reality is present in decisions before they are made rather than sentiment about customers.

Principles do work that values statements cannot, acting as a compass for the decisions nobody wrote a policy for. They also carry the experiential factors a company chooses as its basis of competition, which is why two companies using the same word can mean different things by it. Personalization at one company may mean an algorithm surfacing relevant options, and at another a customer's name written on a cup.

Predisposition is the point of all of it. The term means the company being predisposed to deliver exceptional experiences structurally and systematically. It does not mean the customer being predisposed toward the brand, and it does not mean excellence produced through frontline heroics.

Co-design from inside, document, then cascade

Customer-centric cultures and the principles that embody them have to be created and owned from inside the organization. Outsiders can facilitate the design process, and I have facilitated many of them. The culture itself must flow from the collective consciousness of the company. The practical mechanism is a multidisciplinary design team of culture carriers and respected corporate citizens who build the principles in the company's own language.

Co-design is an activation strategy rather than a drafting exercise. Employees who help shape the principles tend to become their advocates and defenders, which is how adoption gets de-risked before any rollout. Documentation then removes whatever ambiguity remains, which is why the outliers commit theirs to writing. Zappos does it with its annual Culture Book, HubSpot with its Culture Code and the Ritz-Carlton with its Gold Standards.

Cascading is the step most often skipped. In many companies accountability for customer outcomes sits with a relatively small group in customer care, customer experience or customer success, who carry the weight of customer centricity for everyone else. Narrow delegation tends to produce chronic experience gaps and an untenable burden on the people holding it. Knowledge diffusion, formal learning pathways and a tiered capability structure equip a critical mass of employees instead. A field team with the language and the permission behaves differently from a field team with a dashboard.

Culture change fails where measurement stays the same

The hardest honest point here is that culture change in pharma fails most often not because people disagree with it. It fails because nothing in the measurement system changes alongside it. A company can run the co-design, publish the principles and train the organization, then watch the new belief evaporate in the first tight quarter. Two other layers decide whether that happens.

Leadership DNA determines whether the commitment survives contact with a quarterly target, because leaders reveal their priorities in what they fund, escalate and stop. Commercial DNA determines whether measures and incentives reward realized value rather than declared intent. Without those two layers moving, culture work becomes a communications exercise with a design team attached. The tenet I keep returning to is that Customer Excellence must become an enterprise capability, not another program, department or training initiative.

Heroics are a subsidy the organization keeps paying

Most companies have a small team that keeps rescuing the joins. They know which hub to call, which form releases a stalled authorization and which colleague will answer on a Friday afternoon. Their work is real, and it is often the only reason a patient reaches a first dose on time.

That team is also the clearest available evidence that the culture has not yet changed. Heroics as a subsidy means the organization is paying for an outcome it has not learned to produce by design. It pays out of the discretionary effort of people who were never resourced for it, and the cost stays invisible because nothing in the system was built to see it. When the heroics stop being necessary, the belief has moved.

Key Takeaways

Culture in this context means the institutional mindsets, beliefs, mental models and behaviors that make up a company's collective consciousness.
Pharma companies are patient-centric by nature, and the change they face is entering the consumer arena where people have choice.
Three beliefs do most of the quiet work, and each one was accurate before it quietly became incomplete.
Reimagining the art of the possible and asking why not us reopen what a company believes is available to it.
Codified principles, co-designed and cascaded into ways of working, raise customer consciousness and build Predisposition.
Customer Excellence must become an enterprise capability, not another program, department or training initiative.

Diagnostic Questions to Consider

Name the specific regulation behind the three largest sources of friction between a prescription and a first dose in your lead brand.
Identify who holds the authority to remove a step in the access pathway, and whether that person has ever been asked to use it.
Describe the standard your experience performance is measured against, and whether any customer applies that same standard.
Locate the small group of employees who rescue the joins each week, and estimate what their effort is quietly substituting for.
State which incentive in the current commercial plan rewards realized value rather than declared intent.

Closing Reflection

Culture is the slowest layer to move, and it decides what the other three are permitted to do. Pharma has the harder version of the problem, because its carefulness is load bearing and nobody should want a company that discovers medicines to become casual. The work is to keep that carefulness where it protects patients and retire it where it only protects a process.

A company that becomes predisposed to serve customers structurally does not get there by believing harder. It gets there by codifying what it owes customers, designing that obligation from inside, documenting it, cascading it, then changing what it measures so the new belief has somewhere to land. That sequence is unglamorous, and it is the only one I have seen hold under pressure.

The test is simple enough to apply this quarter. Find the people who are quietly making the system work, and ask what would have to change for their heroics to become unnecessary. Their answer is the culture agenda, stated more precisely than any survey will state it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[MANIFESTO] Advancing Human Health Through The Pursuit of Excellence in Service of Science™

Fri, 09 Jan 2026 19:46:29 GMT

The Founding Philosophy of The Customer Excellence Agency

Founded on the conviction that scientific brilliance only becomes human impact when excellence is engineered into leadership, culture, and experience delivery. This is a philosophy of rigor, responsibility, and reverence for the people science exists to serve.

Breakthrough science only matters when it reaches the patients who need it.

That is not a positioning statement. It is the conviction that has organized my entire professional life, from the discipline I learned in uniform, to the standards I studied at The Ritz-Carlton, to the years I spent inside Pfizer and Bayer watching science of extraordinary quality move through commercial systems that were never built to honor it. It is the reason I built this firm. It is the standard I hold every piece of this work to. And it is the challenge I am asking the pharma and life sciences industry to finally take seriously.

Forged Before the Industry

My path to this conviction was not linear, but it has always been anchored in the same truth: outcomes are determined by discipline, systems, and how people operate under pressure.

Eight years in U.S. Army Intelligence instilled a mission-first mindset, rigorous execution, and an intolerance for ambiguity. In environments where stakes were high and the margin for error was nonexistent, I learned that excellence is not optional and not theoretical. It is structural. It is procedural. It is how work gets done when it matters most. That was not philosophy. It was performance under consequence. It was the early formation of a belief that systems, not slogans, determine outcomes.

That conviction was sharpened through work at The Ritz-Carlton Leadership Center, where I saw that excellence is not only philosophical and not only competitive. It can be designed, taught, operationalized, and scaled. Ritz-Carlton does not rely on heroic individuals or exceptional moments. The Gold Standards are not posters on a wall. They are a governing system. The Green Book is not a symbol. It is infrastructure that embeds excellence into culture, governance, training, and frontline behavior so that excellence becomes the default, not the exception. If hospitality could operationalize excellence at global scale, regulated, mission-driven industries had no excuse for treating experience as soft, secondary, or discretionary.

Two thinkers gave me the philosophical framework for why this works. Aristotle insisted that excellence is not an act but a habit, that it must be practiced and embedded until it becomes the default way of operating. Lombardi proved the same truth in competitive reality: greatness is not created in moments of intensity but in the accumulation of disciplined behaviors over time. Together they represent the two sides of the same discipline: thoughtful provocation and competitive execution. These were not abstract influences. They became my mental model for everything that followed.

Where the Language Was Forged

That lens came into sharp focus inside Pfizer, where The Science Will Win™ resonated because of its gravity and its clarity.

It expressed a belief in rigor, evidence, persistence, and purpose applied at scale. For me, it was not the creation of a belief. It was confirmation of one I had been building for years across every organization I had worked inside. It was a living example of what it looks like when excellence is treated as infrastructure, not aspiration. When rigor is cultural, not episodic. When discipline is systemic, not symbolic.

I wanted to follow it with something of equal weight. Something that carried the same seriousness, responsibility, and moral gravity, but spoke to the layer that determines whether science ever truly reaches the people it is meant to serve. That is where The Pursuit of Excellence in Service of Science™ was born. A declaration that if science is pursued with rigor and discipline, then everything that carries that science into the world must be held to the same standard. Leadership. Culture. Operating models. Experiences. Systems. Behaviors.

What I Witnessed Inside the System

I have seen how much rigor, investment, courage, and human brilliance it takes to bring a therapy from discovery to approval .

That process is one of the most demanding and consequential things human organizations do. I believe that same standard of excellence must accompany the science all the way to the patient.

The work is not finished when the clinical data is strong. The work is not finished when the brand is launched. The work is not finished when the prescription is written. The work is finished when patients can access, start, stay on, and benefit from the therapy that was created for them.

Inside both Pfizer and Bayer, I saw what happens when science of extraordinary quality moves through a commercial system that was never designed to honor it. The intent engine, the architecture of segmentation, targeting, messaging, CRM, incentives, and access strategy, was built with extraordinary precision to do one thing: generate prescribing intent. It does that job remarkably well. What it was never built to do is govern what happens next. After the script is written, the system fragments. Patient services, hub operations, specialty pharmacy, market access, adherence programs, and field reimbursement operate in parallel, each with its own data, its own metrics, its own definition of success, and no shared architecture for determining whether the value the front end earned is actually being realized. The prescribing moment was instrumented with extraordinary care. The journey that follows it was not.

This is not a failure of effort or intelligence. It is a failure of design. And it creates a gap that in certain therapeutic categories results in up to fifty percent of clinically appropriate prescriptions never converting into initiated therapy. That number is not a commercial inefficiency. It is a measure of how much of what the science earned never reached the people it was meant to help.

To me, Customer Excellence is not a softer layer around science. It is the commercial, operational, and human discipline required to honor the science by ensuring it becomes real-world clinical impact. The rigor that creates breakthrough medicine deserves equally rigorous experiences that help patients receive the benefit, dignity, and hope that science made possible.

The Experiential Standard the Industry Has Not Yet Claimed

Pharma and life sciences operate under some of the most demanding standards in the world: the evidentiary standard of science, the regulatory compliance standard that governs safety and ethics, the precision standard of manufacturing, the trust standard of global brands.

Each of these standards exists for a reason. Each protects human life. Each reflects the seriousness of the work. Each demands discipline, rigor, and accountability. Yet one standard remains conspicuously underdeveloped. The experiential standard.

The standard that governs how people are treated. How easily they can engage. How clearly they are guided. How respectfully their time is handled. How compassionately their realities are acknowledged. How consistently the organization shows up when it matters most.

This is not a soft dimension. It is a human one. It is where science meets life. It is where protocols meet people. It is where discovery meets diagnosis. It is where brands are tested in moments of vulnerability.

Healthcare professionals and patients do not benchmark their experiences against other pharma companies. They benchmark against Amazon, Apple, Emirates, Ritz-Carlton, and the brands that shape their everyday lives. They carry those expectations into the clinic, the hospital, the pharmacy, and the patient journey. Consumer-grade is not a marketing idea. In an era shaped by Experiential Commerce, it is a moral obligation. The standard was set by the customer's last best experience, and it applies here whether the industry accepts it or not.

The same standards applied to molecules must be applied to moments. The same rigor applied to trials must be applied to touchpoints. The same discipline applied to manufacturing must be applied to experiences. Not as an aspiration. As an obligation.

The Customer's Right to Reverence

At the foundation of this work sits a principle I developed and articulated in The Customer Excellence Enterprise: The Customer's Right to Reverence.

People do not engage with organizations as transactions. They engage as human beings, with lives, pressures, fears, hopes, and responsibilities. In healthcare, those realities are amplified. Behind every prescription, every protocol, every diagnosis is a human story. A patient. A family. A clinician carrying weight.

The Customer's Right to Reverence holds that customers deserve to be treated with dignity, empathy, and respect, not because it is good for business, but because it is right. It demands that organizations honor the humanity of the people they serve in how they design journeys, orchestrate interactions, resolve problems, and make decisions. It raises the standard. It requires organizations to earn trust through behavior, not messaging. To demonstrate care through systems, not slogans. To design experiences that respect time, context, emotion, and consequence.

This is not soft. It is exacting. It is where Customer Excellence becomes more than a commercial discipline. It becomes a moral obligation. It is about stewardship. About honoring the trust placed in science by the people whose lives depend on it. About recognizing that advancing human health is not only a scientific pursuit. It is a human one.

Predisposition: Excellence as Habit, Not Event

Organizations do not create value. People create value. Organizations shape the conditions that make value more or less likely to occur.

This is what I mean by predisposition. Not a framework. Not a technology strategy. A philosophy of organizational craft. The belief that exceptional outcomes emerge when organizations intentionally create the conditions that make those outcomes natural rather than heroic. Aristotle called excellence a habit. Lombardi built systems around that truth. Both understood that greatness is not created in moments of intensity but in the accumulation of disciplined behaviors over time. Predisposition is the organizational expression of that same principle.

Most transformation efforts fail not because the aspiration was wrong but because the organization was never architecturally equipped to operationalize it. The leadership believed in the right things. The brand promised the right things. But the system was never redesigned to deliver them consistently. Customer Excellence is not an initiative. It is a predisposition. And predisposition is designed, not declared.

Teaching as founding faculty for North America's first Master of Science in Customer Experience Management at Michigan State University's Eli Broad College of Business stress-tested that thinking in practice. It forced the discipline of explanation, exposed the gaps between theory and reality, and reinforced the obligation to move beyond language and into architecture. Beyond intent and into design.

The Provocateurs

This work is not for everyone in pharma. It is for the leaders who already feel the weight of the gap between what the science earned and what patients are actually experiencing.

The leaders who are not satisfied with incremental improvement. The leaders who recognize that the customer is changing faster than the organization. The leaders who understand that scientific advantage alone is no longer enough. The leaders who are willing to build what does not yet exist.

I call them Pharma Provocateurs. Not because they are disruptive for its own sake. But because they refuse to accept that the current system is the best this industry can do for the patients it exists to serve. They are leaders willing to challenge inherited models, question why experience has remained secondary, and reframe what excellence must mean in a human health context.

The Customer Excellence Agency exists to serve those provocateurs. To be the partner they deserve. To bring the same rigor to the commercial system that science brought to the molecule.

Breakthrough science that never reaches a patient might as well not exist.

Together, we'll make sure it does.

What's your move?

The Customer Excellence Agency is a pharma and life sciences Commercial Systems Architecture firm founded on The Pursuit of Excellence in Service of Science™. We exist to help pharma organizations close the gap between the brilliance of their science and the experiences that determine whether it reaches the patients who need it.

cxedna.com

[PRACTICE NOTE] Unlocking the Field: Sales Force Effectiveness Reconsidered

Fri, 09 Jan 2026 17:57:56 GMT

Organizations measure what they can control long before they measure what they need to know. In pharma commercial operations that habit has produced one of the best instrumented functions in the industry and one of the least understood. Sales force effectiveness is a mature discipline with a settled measurement set, refined over decades and defended with real rigor.

Reach, frequency, call plan adherence, share of voice, territory optimisation and next best action all describe something real. Each one measures the field's activity. None of them measures what the field changed. That difference is not a measurement oversight, and the discipline deserves respect as the product of an era that has now closed.

Sales force effectiveness measures activity rather than consequence

The familiar critique of field force effectiveness blames the people in the territory, and that critique is almost always wrong. Field teams are capable, often more capable than the systems asking them for weekly compliance. The design gap sits in the instrumentation, which was built to confirm that a plan happened rather than to learn what a decision ran into.

Activity measures can answer whether the intended coverage occurred. They cannot answer whether the therapy occurred. A discipline that reports the first with precision and the second not at all will tend to produce confident organizations that are structurally unable to explain their own results.

The constraint moved and the measurement set stayed behind

Those measures were designed for a field whose job was access to the prescriber, at a time when access was genuinely the scarce resource. Veeva's analysis of engagement data found that 45% of HCPs are accessible to biopharma companies, down from 60% eighteen months earlier . Narrowing access raises the value of the time the field holds, which is a different claim from saying the count of that time is what matters.

Access is no longer the binding constraint on commercial outcomes. A clinically justified decision now has to survive adjudication, affordability and persistence before it becomes therapy, and any one of those can quietly undo the decision weeks after the call that produced it. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value.

The commercial funnel, in other words, ends too early. Prescribe, fulfill and adhere belong in one commercial system, and the measures that govern the field were drawn before that system was recognized. The field is the only part of the enterprise standing close enough to see where a decision stops surviving. Most organizations have no sanctioned way to collect what it sees.

Why field intelligence is the superior commercial signal

The brand team ostensibly owns the brand end to end. Its instruments, though, sit almost entirely in the Path to Prescribe, namely prescribing data, market research, message testing, share tracking and promotional response. Each of those is useful, and each is retrospective, sampled or self reported. The brand often learns that progression broke long after the moment, and without knowing which account it broke in.

The resulting confidence gap is measurable. Deloitte found that only 28% of HCPs believe pharma's customer engagement strategies meet their needs , while 82% of life sciences executives are satisfied with those same strategies. A gap of that size is rarely a matter of judgment. It is more often a matter of which instruments the organization chose to trust.

Field intelligence has four properties that no brand instrument can match. It is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke. Those properties together make it the most unimpeachable and actionable intelligence in the commercial system, which is why the voice of the frontline belongs in the same tier of credibility as prescribing data.

The frontline remains one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. The commercial consequence is not abstract. Bain's work on commercial productivity found that about 40% of a doctor's drug recommendations relate to overall experience with the company. Doctors who rate a company highly are 2.3 to 2.7 times more likely to prescribe its products. What the field observes about experience is therefore an input to prescribing itself, not a soft adjacency to it.

Empowerment is the condition that makes intelligence usable

Collecting a signal and acting on a signal are governed by different parts of the organization. The second is a leadership question, and in the book it belongs to Leadership DNA rather than to operations. Two of the empowerment principles carry most of the weight here, and both can be observed from outside without a survey.

Prioritisation means visibly putting the customer and the employee on business review and board agendas, and then allocating resources in a way that matches the stated agenda. Nothing in a company signals priority more plainly than where money and leadership attention land. When neither lands near what the field is reporting, colleagues read the signal accurately and stop reporting.

Permission means granting the institutional permission employees need to uphold brand promises. In the field that question is sharpest, because colleagues routinely see what is failing a patient and have no sanctioned route to act on it. The Ritz-Carlton practice is the clearest expression of it, where employees are pre-authorized to spend up to two thousand dollars for a guest each day to resolve an issue without seeking approval. The point of that rule was never the money so much as a standing institutional answer to the question of whether someone close to the customer is trusted to act.

FieldOS gives field intelligence an operating loop

Intelligence without a loop becomes anecdote, and anecdote loses every argument it has with a dashboard. FieldOS is the operating blueprint for field intelligence and activation, and it exists to make the loop explicit rather than ad hoc. Its closed loop runs in six stages: Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, Learn and Improve.

Each stage answers a failure that practitioners will recognize. Capture without classification produces noise. Classification without an owner produces reports. Intervention without progression measurement produces activity, which returns the organization to the problem it started with. AI sits at the centre of that loop supporting every stage, and it is deliberately not a stage of its own.

The loop has a diagnostic measure attached to it, and I have found it to be the single most clarifying number a commercial leader can ask for. The Transfer Coefficient is the proportion of meaningful frontline intelligence that survives the journey from customer observation to consequential organizational action and measured effect. Many organizations are surprised by how little survives, and the surprise itself is useful, because it moves the conversation from field capability to system design. A fuller description of the loop sits in the FieldOS field impact operating system .

Progression replaces activity as the measure of field impact

Measure Progression is the stage that most often gets softened in practice, so the ladder it runs on has to be concrete. The stages are Scripts Written, Filled, Therapy Started, 90-Day and Persistence, organised under the Path to Prescribe, the Path to Fulfill and the Path to Adhere. A field organization that can show movement on those stages is making a different argument from one that can show coverage.

This ladder also connects the field to the enterprise measure that senior leadership already recognizes. The Realization Rate is realized value divided by earned value, and every stage where progression stalls is a place where that ratio falls. Friction is an economic variable, and accumulated friction becomes commercial drag. The hurdles that accumulate across a journey are familiar enough to name: administrative burden, disconnected handoffs, lack of visibility, fragmented support, poor escalation and process complexity.

Effort is the common thread running through all six. Gartner's research on service effort reported that low effort customers are 61% more likely to stay with a company. In a therapy context, staying is persistence, and persistence is where earned value is either realized or quietly lost.

This is about better listening rather than better pre-call planning

Most field AI on the market today is a talking tool. Next best action, message refinement, call prep, targeting and territory optimisation all improve what the field says and when it says it. Those capabilities have genuine value, and they leave the underlying question untouched, because a better formulated message delivered into an unchanged system still produces an unchanged journey.

The tenet that governs this is uncomfortable and worth quoting rather than paraphrasing. AI will not make a fragmented commercial model customer-centric. It makes whatever operating system exists faster and more scalable, which means a fragmented model gets faster at fragmenting. The sequence matters more than the tooling, and the operating system comes first.

There is a more encouraging reading of the same evidence. AI did not replace the field organization, it made it more valuable than ever, because the one input that automated systems cannot generate is direct observation of what happened in an account. Experiential Commerce, the concept I developed in the book to describe commerce where the experience carries the value exchange, puts a premium on exactly that kind of observation. The field is the sensing layer, and sensing is the half of the problem that models cannot solve on their own.

What this asks of commercial leadership now

Pharma does not have a sales problem. It has a systemic value realization problem, and the field is both the most exposed part of that system and the best positioned to report on it. The move I would put in front of commercial leadership this planning cycle is to reassert the field as an intelligence function rather than defend it as a cost line.

That move sits inside a larger one. Launch excellence, marketing excellence and sales excellence are mature domains in pharma, and the fourth, Customer Excellence, is the one most organizations have not built. In my experience the field is where that fourth capability either becomes real or stays on a slide, because it is where the enterprise learns whether its promises survived a patient's week.

Key Takeaways

Sales force effectiveness measures the field's activity with precision and says almost nothing about what the field changed.
Access was the scarce resource that justified the legacy measurement set, and it is no longer the binding constraint on commercial outcomes.
Field intelligence is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke.
Prioritisation and permission are the organizational conditions that decide whether a captured signal ever becomes consequential action.
The FieldOS closed loop runs through Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression and Learn and Improve, with AI supporting every stage.
Progression measured across Scripts Written, Filled, Therapy Started, 90-Day and Persistence connects field work to the Realization Rate.

Diagnostic Questions to Consider

Whether a field colleague who observes a barrier today has a sanctioned route to escalate it, and how long that route takes to produce a decision.
What proportion of meaningful frontline intelligence survives from observation to consequential action and measured effect in the current operating model.
Which instruments the brand team actually relies on, and whether any of them can locate a stalled patient journey in a named account.
Whether field performance conversations reference progression stages at all, or terminate at coverage, frequency and share of voice.
How visibly the customer and the employee appear on business review and board agendas, and whether resource allocation follows that appearance.

Closing Reflection

The settled measures of field effectiveness were honest answers to a question the industry no longer faces. They were built for access, and access has stopped being the thing that determines whether science reaches a patient. Keeping those measures while the constraint moves is how capable organizations end up puzzled by their own performance.

What replaces them is not a new dashboard so much as a different premise about where commercial truth lives. It lives with the colleagues standing closest to the moment a decision either becomes therapy or quietly does not. Their observations are the most current and least mediated signal the enterprise holds, and in most companies that signal still has nowhere to go.

Building the route is ordinary work. Capture the signal, classify the barrier, assign an owner, intervene, measure progression, then learn from what the intervention did. Done consistently, that loop turns the most expensive channel in pharma into the most informative one. That may be the most durable advantage available to a company which does not control the transaction between its science and a patient.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[FAQs] The Customer Excellence Agency

Mon, 29 Dec 2025 17:03:21 GMT

The questions below address what this work really is, why it matters now, and how it creates durable commercial impact rather than episodic improvement.

The Customer Excellence AGENCY helps pharma and life sciences companies institutionalize customer and experience-led growth through a proven commercial model grounded in The Customer Excellence Enterprise, published by Wiley. The model was developed, tested, and refined through work with customer-centered organizations including LG Electronics, Mastercard, Chick-fil-A, and The Ritz-Carlton, and subsequently applied and proven within the pharmaceutical industry at Pfizer and Bayer.

Pharma has built formidable capabilities to develop breakthrough science, secure regulatory approval, and generate prescribing intent through promotional activity. Yet many organizations remain less equipped to ensure that the value created by those investments is fully realized across the experiences of healthcare professionals, patients, and the colleagues who serve them. Customer consciousness and experience are still too often treated as supporting capabilities rather than as disciplines of strategy, commercial execution, and organizational design.

That distinction matters. In increasingly crowded and competitive markets, the ability to understand customers deeply, adapt rapidly to their changing needs, and remove the barriers between prescribing intent and patient impact has become a critical battleground for growth. Eighty percent of CEOs acknowledge that their organizations must reimagine customer experience to remain relevant. The challenge is no longer recognizing the imperative. It is building the organizational and operational capability to act on it consistently.

The Customer Excellence AGENCY brings a practical, experience-led approach to that challenge. Through an activation approach, the agency helps pharma organizations build the customer consciousness, operating models, leadership disciplines, and frontline capabilities required to deliver exceptional experiences at scale and maximize the value realized from their science. The result is not another customer experience program, but an institutional capability for converting customer understanding into differentiated execution—and breakthrough science into repeatable clinical and commercial impact.

What is Customer Excellence Activation?

Customer Excellence Activation is the formal name for the commercial methodology CEA uses to move pharma organizations from value leakage visibility through acute intervention to a permanent state of continuous intelligence and activation. The working shorthand is The System.

It is not a CX initiative. It is not a training program. It is not a technology implementation. It is a structured, three-phase engagement that produces a commercial organization permanently predisposed to delivering experiences worthy of the science it carries, with the capability to detect and close value leakage before it compounds.

Customer Excellence Activation embeds Customer Excellence as the fourth pillar of commercial excellence, alongside Sales, Marketing, and Launch Excellence. The objective is not episodic improvement. It is durable, structural change that ensures brand promise, product value, and experience delivery move together as one system, and that when they drift, the organization sees it and acts.

What is value leakage, and why does it matter?

Value leakage is what happens between the written prescription and the patient beginning therapy. In certain therapeutic categories, up to fifty percent of clinically appropriate scripts never convert into initiated therapy, not because the field team failed to persuade, but because the commercial system was engineered to generate prescribing intent and was never built to govern what happens after that intent is earned.

Patient services, hub operations, specialty pharmacy, market access, adherence programs, and field reimbursement operate in parallel, each with its own data, its own metrics, and no shared architecture for determining whether the value the front end earned is actually being realized. The leakage accumulates quietly, at the handoffs, the unmeasured moments, the points of friction, and the loops that never close.

This is pharma's multi-billion dollar clinical and financial blindspot. The leakage was always happening. Nobody built the system to see it. Customer Excellence Activation is designed to close it.

What is the Value Leakage Workbench?

The Value Leakage Workbench is CEA's purpose-built diagnostic and anlytics toolkit for quantifying and visualizing value leakage across the commercial system. It is the instrument that makes REFRAME possible.

Most pharma organizations have a sense that value is leaking somewhere. What they lack is a structured way to see where it is leaking, how much it is costing, and which zones represent the highest-priority opportunity. The Workbench closes that gap. It runs the organization's own commercial data, CRM exports, Rx trend, payer access and formulary position, market share, and patient services touchpoint data, through a structured diagnostic framework that maps leakage across the three journey paths: Path to Prescribe, Path to Fulfill, and Path to Adhere.

The output is not a general findings report. It is a leakage heatmap, value leakage ladder and other unique visualizations that attributes exposure to specific zones in the commercial system, a dollar quantification by zone rigorous enough to put in front of a leadership team, and a Priority Zone Brief that becomes the direct input into MOBILIZE. CEA owns and deploys the Workbench on the client's behalf. It is not licensed, not installed, and not left behind as a tool the client runs independently. It is how CEA does the diagnostic work of REFRAME, and it is what makes the leadership conviction REFRAME is designed to produce based on evidence rather than assertion.

What are the three phases, and what does each one do?

Customer Excellence Activation moves through three sequential phases, each with a defined entry condition, a behavioral exit condition, and a specific output that feeds directly into the next phase.

REFRAME makes value leakage visible and quantified through a data-driven diagnostic, and builds leadership conviction through evidence. The Value Leakage Workbench, CEA's proprietary diagnostic instrument, runs the organization's own commercial data through a structured analysis that scopes and quantifies leakage before a single conversation happens in the field. The phase closes when leadership has seen the leakage that was always happening and cannot unsee it. The question in the room shifts from whether this is real to which brands go first.

MOBILIZE engages the organization to design and deploy acute interventions, with a baseline field survey generating the nuanced ground-level insight that shapes them. Multi-disciplinary teams, field force, medical affairs, market access, patient services, and analytics, ideate against the priority zones REFRAME surfaced and deploy targeted interventions fast enough to produce visible, felt impact. The phase closes when interventions are actively deployed and live field signal is being generated against the survey baseline.

OPERATIONALIZE converts the baseline survey into a permanent signal collection system and embeds barrier identification and mitigation workflows into the organization's permanent ways of working. FieldXOS, the CEA reference architecture for field intelligence and activation, is instantiated inside the client's existing technology stack during this phase. The phase is complete not when the design is delivered, but when the system is live, internally owned, and running without CEA.

What is FieldXOS?

FieldXOS is the CEA reference architecture for field intelligence and activation. It is a proven design specification, not a monolithic platform, that gets instantiated inside OPERATIONALIZE and conforms to the client's existing technology stack, CRM, and data environment while the design logic remains constant across every implementation.

FieldXOS carries the signal collection system and barrier identification workflows that MOBILIZE proved into permanent commercial infrastructure. It is designed to keep leakage from reopening once CEA is gone. The client owns the live FieldXOS implementation when the engagement is complete. CEA builds the capability. The client runs the system.

When a Reframe Trigger fires inside FieldXOS, a threshold crossed or a drift pattern detected, it surfaces a signal that The System needs to re-engage. CEA re-enters at REFRAME, faster and more targeted, informed by everything FieldXOS has been watching. The cycle runs again.

Why does this work require a different kind of partner?

Customer Excellence Activation cannot be done credibly from a distance. It requires proximity to leadership decisions, frontline realities, and execution constraints. It requires a partner who has stood inside the commercial system, not just studied it from outside.

The CEA model is deliberately structured around direct senior partnership rather than staffed engagement teams. This enables close collaboration with the leaders who have portfolio authority, clear accountability for outcomes rather than activity, and the ability to work across the broader ecosystem, agencies, consultancies, and solution providers, without adding complexity or diluting accountability.

The goal is not dependency. It is internal capability, momentum, and ownership. Every phase of Customer Excellence Activation is designed to transfer knowledge and decision-making into the organization, so that OPERATIONALIZE ends with a client that owns a system, not a client that needs CEA to run it.

How is this different from traditional CX consulting?

Traditional CX work optimizes touchpoints and pain points. Customer Excellence Activation designs the commercial system that connects brand promise to brand delivery at scale.

The difference is not between caring and not caring. It is between organizations that rely on heroic individuals and exceptional effort to deliver well, and organizations that are structurally predisposed to deliver well by design. Predisposition means that doing the right thing for customers is the natural outcome of how the organization is put together and how work gets done, not the exception that requires escalation.

CEA is not a marketing agency. It is not a customer experience consultancy. It is a commercial systems architecture firm. That distinction is everything: we are not interested in helping organizations create more compelling promises. We are interested in helping organizations become capable of keeping them.

How is this different from consumerization?

This work does not import consumer practices wholesale into pharma. It adapts consumer-grade standards deliberately to pharma's scientific rigor, regulatory realities, access complexity, and diverse business models.

Consumer-grade is not a benchmark borrowed from retail or technology. It is the standard set by the customer's last best experience, wherever that experience happened. Healthcare professionals are also high-expectation consumers in their other life. They bring those expectations into the clinic, the hospital, and the patient journey, because expectations do not change at the clinic door. Ignoring that reality does not make it less true. It makes value leakage more likely.

The goal is not consumerization. It is commercial modernization worthy of the science itself.

Who does CEA partner with?

CEA partners directly with pharma and life sciences organizations, specifically with the commercial leaders who have portfolio authority and the conviction that the current system was not built to deliver on what the science earned. These are not the organizations looking for incremental improvement. They are the ones willing to build what does not yet exist.

CEA also works alongside agencies, consulting firms, and technology and data solution providers as a complementary partner that anchors work in Customer Excellence as a commercial discipline and ensures coherence across initiatives.

Across the ecosystem, the value is consistent: clarity, coherence, and credibility at the point where intent meets delivery.

Why now?

Scientific excellence is assumed. Promotional activity no longer differentiates. What has become scarce is the ability to deliver consistently on what the science earned, across the full journey from prescribing intent to patient outcome.

At the same time, the AI investment concentrating at the front end of the commercial system is making the post-script gap wider, not narrower. The intent engine is becoming more sophisticated by the quarter. The infrastructure that carries that intent into realized patient and commercial impact has not kept pace. Waiting compounds Customer Value at Risk.

Now is the moment to move from intent to capability.

What question does Customer Excellence Activation ultimately force leaders to answer?

Are we showing up as the best version of ourselves for customers as they actually live, decide, and compare, or only as our internal assumptions suggest we do?

Customer Excellence Activation exists to help organizations answer that question honestly, and then build the commercial infras

[ABOUT] A Founder's Story: An Outsider’s Perspective, Earned from the Inside

Fri, 26 Dec 2025 17:15:42 GMT

[PRACTICE NOTE] An Outsider’s Perspective, Earned from the Inside

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”

When Competence Is No Longer Enough

There is a moment in most careers when competence becomes comfortable. When the work is still good but the friction that made it meaningful has been replaced by fluency. I had reached that moment.

I had built a career that moved deliberately across industries, retail, hospitality, financial services, entertainment, technology. The Ritz-Carlton taught me that culture is not a value statement. It is an operating system. Army Intelligence taught me that clarity under pressure is a discipline that can be designed. Building an Inc. 500 company taught me that the distance between a commercial idea and a commercial result is almost always an experience problem in disguise.

By the time I had accumulated all of that, I was good at what I did. Genuinely good. And that was precisely the problem. Competence without challenge is a comfortable place to stop growing. I was not ready to stop.

The Redirection

The redirection came from a series of conversations with people I trusted who kept arriving at the same conclusion independently. If you want to find the place where customer experience is most consequential, most structurally complex, and most genuinely unsolved, go to pharma and life sciences. They said it with reverence, the way you describe a problem that deserves more serious attention than it has received. They called it the last frontier of customer experience. I have repeated that phrase in virtually every significant conversation I have had in this industry since, because it remains the most accurate description I have encountered. A place where the stakes were as high as stakes get and where the model for how experience should work at commercial scale had never been fully resolved.

I stepped into the industry not to disrupt from a distance, but to learn from the inside. To bring an outsider's lens while deeply respecting the expertise, commitment, and scientific rigor of the people already there. That combination became essential. Novel ideas only become viable when they are co-created with those who understand the terrain.

I heard that and felt something I had not felt in years. I wanted in.

What Pharma Gave Me

Pharma gave me a gift. Not an easy welcome. The industry is demanding, regulated, and complex in ways that take years to genuinely appreciate. The gift was something else. Pharma gave me back my creative energy and the specific kind of passion that only genuinely unsolved problems at scale can generate.

Inside Bayer and Pfizer, I experienced a creative renaissance. I was designing things that had never been designed in those organizations before. Enterprise-wide customer experience strategies that translated brand intent into consistent field delivery. Omnichannel listening systems that treated HCP sentiment as a leading indicator of commercial performance rather than a post-campaign metric. Journey-based thinking and tools applied to stalled and underperforming brands to diagnose and resolve the points where value was quietly leaking away. Large-scale field force programs built around the colleague experience as the upstream driver of customer impact. Bespoke measurement systems that elevated field signal into boardroom-relevant leading indicators. At Pfizer, the role itself evolved from Global Customer Experience Lead to Global Customer Excellence Lead as the work moved into the company's first Global Chief Marketing Organization, intentionally positioning customer excellence closer to commercial leadership and performance accountability.

None of it would have been possible without the scientific, regulatory, and commercial expertise of the colleagues who built it alongside me. But the fact that it needed to be built at all was the signal.

The journey was not easy. Pharma rightly holds new ideas to a high standard of evidence. Bringing customer excellence into organizations that had not treated experience as a designed commercial discipline required sustained advocacy. I wrote a book, The Customer Excellence Enterprise, published by Wiley, because the discipline needed a framework leaders could examine and debate. I spoke at more than fifty conferences, roundtables, and executive dinners, and sat across from countless commercial leaders making the case. I helped stand up Michigan State University's Master of Science in Customer Experience Management program as founding faculty. The resistance I encountered made the thinking sharper. I respected it then and respect it now.

The Observation That Could Not Be Set Aside

Every year, lists are published ranking the world's best customer experience companies. The same names appear consistently: Amazon, Apple, Chewy, Ritz-Carlton, Nordstrom, USAA, Trader Joe's. The character of those lists holds year after year. Pharma is not on them. Not occasionally. Consistently and structurally absent.

This is not an indictment. Pharma demonstrates extraordinary organizational commitment to scientific rigor, regulatory accountability, and manufacturing precision. The absence is not a character failure. It is a design gap. Experience as a commercial discipline has not been given the same structural home that science, manufacturing, and brand have occupied for decades. The evidentiary standards of science are nonnegotiable. The precision standards of manufacturing are engineered into the system. The trust standards of brands are carefully governed and protected. Yet there was no equivalent experiential standard guiding commercial engagement. Experience was left to chance, interpretation, and fragmented ownership. The missing link in the equation has always been the experiential dimension. The pandemic made that gap harder to set aside. But it predated the pandemic. It was structural, not situational.

The Consumer-Grade Imperative

The physicians, nurses, and pharmacists at the center of pharma's commercial system are, in the rest of their lives, customers of Amazon and Apple. I call this their Other Life, and it matters commercially in ways the industry has been slow to fully reckon with. In their Other Life, they live inside a consumer ecosystem engineered around clarity, respect, and the removal of unnecessary effort. Those expectations do not reset when a white coat goes on. They follow healthcare professionals into every commercial interaction, every field engagement, every digital touchpoint.

This is what I call the Consumer-Grade Imperative. Not an aspiration for pharma to become Apple or Amazon. A threshold. One that asks the commercial system to meet HCPs and patients where they already are in their other lives, designed with the same rigor as the science, the same precision as the manufacturing, the same seriousness as the brand. That gap registers quietly and consistently, in engagement, in trust, and in the decisions that determine whether science reaches the patients it was designed for.

That realization shaped a deliberate personal decision. Through my book, my academic work at Michigan State, and years of cross-industry speaking, I made a conscious choice to keep one foot permanently in the consumer experience world and one foot permanently in pharma. Not as a transitional posture but as an intentional practice. I began describing it simply as my superpower: the ability to move fluently between those two worlds, to bring the standards, models, and expectations of consumer-grade experience into contact with the complexity and rigor of pharma. It became the mechanism through which I created the most distinctive value, and it remains the lens through which all of this work is done.

Why I Could Not Look Away

In most industries, the commercial system and the value chain run on parallel tracks. In pharma, they are intertwined. The commercial system is the value chain. How science reaches patients is inseparable from how the organization generates return on its scientific investment.

That is why the stakes of getting the commercial system wrong are different in kind. When it fails to complete the journey from scientific potential to patient outcome, the cost is not a lost transaction. It is a patient who does not start therapy. A physician who disengages before the treatment conversation fully happens. A therapy that performed in a clinical trial and underperforms in the world, not because the science was insufficient, but because the system designed to carry it was never built to go the full distance.

I could not look away from that. Not because I arrived with answers. Because I had spent a career developing the tools and perspective to work on exactly this kind of problem.

The Capability That Changed the Timing

I had been working on this problem for years before I founded the agency. The insight was not new. The conviction that pharma's commercial system needed architectural redesign, not more programs, had been building through every conference, every executive conversation, every chapter of the book. What changed was the capability to act on it at scale.

For most of the time I spent inside this industry, designing truly integrated commercial systems in service of customers required a level of coordination, data synthesis, and real-time responsiveness that was operationally out of reach for most organizations. The vision was clear. The execution ceiling was real. Artificial intelligence removed that ceiling. Not by replacing the human judgment, empathy, and accountability that sit at the center of every meaningful customer relationship, but by providing the underlying capability to design, deploy, and sustain systems in service of customers at the scale pharma actually operates. For the first time, the ambition and the capability are in the same room.

That alignment is not incidental to the timing of this firm's founding. It is the reason for it.

Why This Firm and Not Another

When I left the industry, the obvious paths were available. I had the background and relationships to build a marketing agency that would have found clients. I did not build a marketing agency. Marketing shapes the promise. It does not architect the system that keeps it.

I had also built a genuine reputation as a customer experience leader in pharma, one of a small number of practitioners who had actually done this work inside major global organizations. I could have built a CX consultancy on that reputation. I did not. Understanding the experience is not the same as redesigning the system that produces it.

I built something different. Something that did not have a clean category name when I started it. The Customer Excellence Agency is a commercial systems architecture firm, built at the intersection of marketing, sales, and experience. Not as a synthesis of those three things, but as the discipline that governs how they work together as a system. When they operate in fragmentation, the commercial system leaks value at every handoff. When they are architecturally integrated around a shared definition of what the customer needs to experience, value is realized rather than lost.

The problem pharma gave me was the most important one I had ever been handed.

I intend to spend the next chapter of my career making sure it gets the architectural answer it deserves.

A Note of Gratitude

I remain deeply grateful to the pharma and life sciences community for the openness, intellectual rigor, and spirited debate that continue to shape this work. The challenges are real. The stakes are high. The thinking is demanding. But the shared purpose is clear. Advancing human health requires not only scientific excellence, but excellence in how that science is delivered, experienced, and trusted. Contributing to that effort, alongside leaders committed to raising the standard, is work I am proud to do.

Wayne Simmons is the Founder and Commercial Systems Architect of The Customer Excellence Agency. He is the author of The Customer Excellence Enterprise (Wiley), founding faculty of the MS in Customer Experience Management program at Michigan State University's Eli Broad College of Business, a Certified Customer Experience Professional, and a former customer excellence and customer experience executive at Pfizer and Bayer. He is based in New York City.

cxedna.com

[PRACTICE NOTE] Pharma's Consumer-Grade Imperative: Closing the Symmetry Gap

Mon, 01 Dec 2025 23:15:07 GMT

Most organizations hold themselves to more than one standard without ever deciding to. One standard governs the thing they sell, written down, measured, audited and defended in front of regulators. The other governs everything that happens around the thing they sell, and it tends to be inherited rather than designed.

In pharmaceuticals the distance between those two standards is unusually wide. The product is engineered to a tolerance almost no other industry can approach. The brand that carries it is designed with similar deliberation, while the experience surrounding both is largely left to default. I have come to call that distance the symmetry gap, and closing it is commercial work rather than service work.

Two standards inside one company

The gap rarely comes from indifference. An organization that can hold a molecule to microgram tolerances is not a careless organization. The engineered standard simply stops at the edge of the plant, where ownership becomes shared and no single function answers for the whole. What follows is variation, and variation is what a customer reads as the real standard.

Deloitte's work on engagement in pharma puts numbers against that asymmetry. It reports that only 28% of HCPs believe pharma's customer engagement strategies meet their needs , while 82% of life sciences executives say they are satisfied with those same strategies. Those two figures describe two different companies. Internal confidence tends to track intent, while customer judgment tracks delivery.

Field teams, medical teams and hub staff deserve respect in this argument. They are often producing acceptable outcomes by absorbing the defects of a process that was never built to carry what it is asked to carry. Heroics of that kind can hold a system together for years. They also hide the design problem from the people who could fund the repair.

What Consumer-Grade actually means

Consumer-Grade is a standard rather than an aspiration. It does not ask a manufacturer to become Amazon or Apple, and it does not ask science to behave like retail. It means the bar a patient applies has already been set somewhere else. She does not reset that bar when she becomes a patient.

Consider an ordinary Tuesday in her life. She tracked a parcel to the minute this morning. She changed a flight on a phone in ninety seconds. She then called a manufacturer's hub and repeated a date of birth four times. She is comparing the company to the last competent transaction she had rather than to another pharmaceutical company.

None of this concerns conviction. Pharmaceutical companies are patient-centric by nature, and the people inside them have rarely needed persuading to care about patients. What has changed is the arena. These companies are now operating in a consumer arena where people have choice, and Consumer-Grade is a capability to be designed in rather than a conviction to be held.

The specification behind the standard

A standard that cannot be specified is a mood, and a mood cannot be governed. The Consumer-Grade Specification is a closed structural set of six conditions: Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Each one can be observed in an interaction and each one can carry a threshold. Thresholds are set per organization, because what counts as acceptable effort in a rare disease journey differs from what counts in primary care.

Consider a single hub interaction read against those conditions. Recognition means the patient is known on the second call, and Anticipation means the prior authorization is raised before she thinks to ask. Coherence holds context across handoffs, Effort removes the repeated data capture, and Resolution closes the matter without a second attempt. Visibility means she can see where things stand without calling to find out.

Felt attributes are where most conversations about experience stall. Easy, simple, fast and transparent are reported outcomes rather than design inputs, which is why instructing an organization to be easier rarely changes anything. Those attributes decompose into the six conditions, and the conditions are what a company can actually build, measure and govern. Specified this way, experience becomes auditable in the way manufacturing variance is auditable.

Positivity bias quietly flattens a differentiated portfolio

Customers often find it difficult to separate their perceptions of one company from the next. They are left with the impression that all the companies involved in a decision are generally positive and generally the same. In my book I described that cognitive effect as the thing that marginalizes, homogenizes and commoditizes value propositions. It works behind expensive brand investment, and it rarely announces itself in a tracking study.

In a therapeutic category where clinical profiles converge, that effect becomes a strategic problem rather than a branding one. Two agents with comparable data and comparable labels can collapse into one impression of general adequacy. What survives that collapse is usually experiential. Bain's work on commercial productivity found that about 40% of a doctor's drug recommendations relate to their overall experience with the company rather than the product alone.

Experiential factors have become the basis of competition

Customers now carry the same expectation into every interaction regardless of category. Whether they are applying for a mortgage, grocery shopping or working through any of the other jobs of daily life, they anticipate a similar level of convenience and care. The outlier companies that set that expectation rarely sit inside the industry being judged against it. Experiential factors such as helpfulness, consistency, simplicity, personalization and transparency have become the live terrain of competition.

My book describes this shift as Experiential Commerce, and it changes where exchanged value actually sits. Value moves from the functional utility of the offering toward the intangible factors that surround it. For a commercial organization that does not control the transaction between its science and a patient, the implication can be uncomfortable. Much of what determines perceived value happens in places the commercial model does not currently instrument.

The window for getting this right is also narrowing. Veeva's research shows that 45% of HCPs are accessible to biopharma companies, down from 60% eighteen months earlier . Fewer chances to be seen means each remaining interaction carries more weight than it did, so variability stops being a service irritation and becomes a risk to preference.

Regulation governs claims rather than burden

The industry's reflex when a Consumer-Grade standard is raised is to point at regulation. That reflex deserves to be taken seriously, because the constraints are real and the penalties are not theoretical. Regulation here governs claims. It does not govern burden.

Almost none of the friction a patient meets between a prescription and a first dose is legally required. The repeated data capture, the unexplained wait and the handoff that drops context are artifacts of how work was divided internally. That friction is unowned rather than mandated, which is what makes the gap available to close. In regulated industries the assumed constraint and the actual constraint are often treated as the same thing.

Importing consumer practice wholesale will not close it either. The first iterations of customer experience brought into pharma did not fit the industry. The clinical workflow, the payer, the pharmacy and the hub all sit between a company and the outcome it needs. The rejection that followed was rational, and the wrong lesson was drawn from it. Consumer experience models rarely transfer into pharma intact , which argues for a pharma-specific interpretation rather than for abandoning the standard.

The arithmetic of leaving the gap open

Experience is the third leg of the value proposition alongside product and brand, and it is the leg most often left to default. A company can engineer a molecule and build a brand with equal discipline and still watch earned value decay in the space between them. That decay has a name and a measure. The share of earned value that becomes sustained therapy is the Realization Rate , and the distance between earned and realized value is value leakage .

In work published with TheyDo I traced an illustrative compounded scenario through that distance. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled. It falls again after early discontinuation, and settles near four hundred and fifty million in realized value once long term adherence erosion is counted. The ladder is an illustration rather than a benchmark, and no competitor takes the difference.

Value that leaks in this way looks like nothing on a scorecard. There is no lost bid, no competitive switch and no line item that names the cause. The friction is distributed across thousands of small interactions, each one too minor to escalate on its own. Nothing in the reporting line is built to add them up. That is the accounting signature of an experience left to default .

Where the work begins

Closing the gap starts with naming the system that owns it. The commercial model ends at the written prescription, while value realization runs across the Path to Prescribe, the Path to Fulfill and the Path to Adhere. Very little in the current operating model answers for progression across all three. Ownership of the whole is what has been missing, not effort.

That ownership is the fourth domain of commercial excellence, sitting alongside launch excellence, marketing excellence and sales excellence. Customer Excellence is the missing domain, and it behaves like a quality system rather than a sentiment program. Defining the six conditions as a specification, measuring variation against them and governing the result with the seriousness given to manufacturing variance is the practical path. The symmetry gap closes when the standard outside the plant is written down as carefully as the one inside it.

Key Takeaways

The symmetry gap is the distance between the standard a company applies to its product and the standard it applies to everything around the product.
Consumer-Grade is a standard rather than an aspiration, because the bar a patient applies was set by the last competent transaction she had in any category.
The Consumer-Grade Specification is a closed structural set of six conditions, Recognition, Anticipation, Coherence, Effort, Resolution and Visibility, with thresholds set per organization.
Felt attributes such as easy, simple, fast and transparent are reported outcomes that decompose into those six conditions rather than things a company can build directly.
Regulation governs claims rather than burden, so most of the friction between a prescription and a first dose is unowned rather than mandated.
Leaving the gap open shows up as value leakage and a depressed Realization Rate rather than as a competitive loss anyone can point to.

Diagnostic Questions to Consider

Name the experiential standard the commercial organization is held to, and say where it is written down.
Score one high volume interaction against Recognition, Anticipation, Coherence, Effort, Resolution and Visibility, and state the threshold for each.
Separate the friction between prescription and first dose into what regulation actually requires and what the operating model merely inherited.
State who answers for progression across the Path to Prescribe, the Path to Fulfill and the Path to Adhere as one system.
Estimate the share of earned value that becomes sustained therapy, and say what that Realization Rate would need to be for the gap to stop mattering.

Closing Reflection

The companies that close this gap will not do it by caring more, because the caring was never in short supply. They will do it by extending an engineering instinct they already have into territory where it was never applied. Pharma knows how to specify a standard, observe deviation from it and govern the result, because that discipline built the product in the first place. The work is to point that same instinct at the experience surrounding the molecule.

What makes the symmetry gap worth leadership attention is that no one else can take the value it destroys. A competitor cannot capture a prescription abandoned at a prior authorization or a therapy discontinued in week three. That value simply leaves the system, and it leaves quietly enough that the commercial organization may never see it go. Science earns the right to be considered, while experience largely decides whether that right is realized.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Dr. Roswell and Her Other Life: Resetting Pharma's Experiential Benchmark

Mon, 01 Dec 2025 22:30:50 GMT

Institutions rarely choose their own benchmark. They inherit it from whoever sits closest to them, which is usually a competitor who shares the same constraints, the same vocabulary and the same explanations for why certain things take as long as they do. In pharma that habit produces an internal standard that can look respectable from the inside and unremarkable from the outside. The customer, meanwhile, has been running an entirely different comparison.

Institutions tend to measure themselves against their nearest neighbours

Pharma benchmarks its customer experience against pharma. The physician does not. The standard she applies when a manufacturer's portal asks her to re-enter a patient's insurance details for the third time was set by an industry that has never heard of her therapeutic area. Most of the surprise in this work lives in the distance between those two benchmarks.

The internal comparison is honest, and it is the only one an organization can easily instrument. A company can improve on share of voice, reach, recall and portal adoption while losing ground against the standard the physician is actually holding.

Dr. Roswell is a composite rather than a real physician

Dr. Roswell is a composite. She is not a client, not a research subject and not a disguised version of anyone in particular. She carries patterns I have seen repeat across field debriefs, access escalations and customer research inside large commercial organizations, and she carries none of the identifying detail of any one of them. Building her as a composite is deliberate, because the argument here is structural rather than anecdotal.

A single physician's frustration can be set aside as an outlier, and often is. A pattern assembled from many of them behaves differently, because it points at the system that produced it. Her specialty matters less than her situation, which is a chronic condition with a converging clinical landscape and four manufacturers competing for the same patient. What matters most about her is the second life she returns to when the clinic closes.

The twenty three hours when she is not a prescriber

She spends a fraction of her day acting as a prescriber. The remaining twenty three hours she spends as a consumer, and in those hours she is indistinguishable from anyone else buying groceries, applying for a mortgage or working through one of the many other jobs that daily life requires. Companies in that part of her world have spent years removing effort from her path, often without her noticing the removal. None of them asked her to be patient with them while they worked it out.

Those companies set her reference point without intending to. Customer experience outliers of that kind reset the standards of business regardless of industry, and they do it continuously rather than in campaigns. She is not consciously weighing a manufacturer against a retailer, which is precisely why the comparison is so difficult to argue with.

Expectations do not reset at the clinic door

In the book I argued that elevated standards travel with the customer rather than with the category. Whether the task is applying for a mortgage, grocery shopping or any of the myriad other jobs that must be accomplished in daily life, people now expect and anticipate a similar level of convenience across all of their interactions. Expectations are largely not category specific, because the person carrying them is one person. She keeps no separate and lower standard in reserve for regulated industries.

The regulated nature of her professional interactions may explain why certain steps take time, and it deserves respect as a real constraint. It rarely explains why the same information must be supplied three times, or why nobody can tell her where a request currently sits. Regulation governs what can be said and what must be recorded. Design governs how much of the resulting burden lands on her desk.

Positivity bias turns four manufacturers into one impression

Positivity bias is the tendency for people to lump competing options together into a generic and overly optimistic category of sameness. Under its influence customers often cannot meaningfully separate their perceptions and sentiments about one company from the next. They are left with the impression that all the companies involved in a decision must be generally positive and generally the same. That effect marginalizes, homogenizes and commoditizes value propositions.

For a commercial organization the sting is practical rather than academic. In a category where clinical profiles converge, Dr. Roswell's inability to tell four manufacturers apart is a competitive outcome rather than a perception problem. The experiential layer is often the only remaining place where that impression can be broken, which is why experience as the third leg of the value proposition stops being a philosophical point and becomes a commercial one.

What her other life has taught her to expect

What her other life has taught her to expect can be written down with some precision. The Consumer-Grade Specification holds six structural conditions, namely Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Felt attributes such as easy, simple and fast are reported outcomes that decompose into those six conditions. Thresholds belong to each organization, so the specification describes the shape of the standard rather than the number attached to it.

Recognition means the system knows who she is and what has already passed between them. In her other life a retailer remembers her address, her last order and the fact that the previous delivery went wrong. In her working day she introduces herself again to each function she touches, because her history sits in systems that were never built to speak to one another. Each reintroduction is small on its own and expensive in aggregate.

Anticipation means the next step arrives before she has to ask for it. A benefit verification that predictably requires three documents still asks her for one, waits, then asks for the second. The pattern is known to everyone inside the process and visible to nobody at the point where she stands.

Coherence means the answer holds across channels and across people. She may hear one thing from a field colleague, another from a support line and a third from a status page, each of them accurate within its own frame. Coherence tends to break where accountability divides rather than where competence fails.

Effort means the volume of work the system transfers to her in order to complete its own process. Her other life has taught her that low effort signals respect rather than mere convenience. Every form, every call back and every re-keyed field is effort she absorbs on behalf of a patient who is waiting. Accumulated effort of that kind becomes experiential friction, and accumulated friction becomes commercial drag.

Resolution means something actually ends. A request that is acknowledged, routed and then quietly left open consumes more of her trust than an outright refusal would, because a refusal at least closes the loop. In her consumer life a case number implies an owner and a conclusion. In her working day it may imply only that the request has been recorded somewhere.

Visibility means she can see where things stand without asking anyone. Without that view she manufactures visibility herself through follow up calls, chased messages and staff time she does not have. Lack of visibility is one of the quieter hurdles inside the commercial drag she carries through the week.

Nobody designed the composite of her working day

Everyone she deals with is competent. The field colleague knows the therapeutic area, the support agent knows the benefit design, the medical information specialist knows the data and the brand team knows the market. Nobody designed the composite of their work, which is the only thing Dr. Roswell ever actually experiences.

The gap is a design gap rather than a character gap, and that distinction carries most of the diagnostic weight here. Her working day is assembled from parts that were each optimized in isolation, by functions that were measured in isolation, against targets that were set in isolation. Experience was left to default while brand and product were deliberately designed. The default is what she meets, which makes customer experience in pharma a question of composition rather than of attitude.

The asymmetry between her account and the industry's confidence

The most useful reading of this gap comes from the distance between what customers report and what their suppliers believe. Deloitte found that only 28 percent of HCPs believe pharma's engagement strategies meet their needs, while 82 percent of life sciences executives say they are satisfied with those same strategies . Both groups may be answering honestly about genuinely different things. Executives are describing the strategy as designed, and physicians are describing the composite as delivered.

An asymmetry of that size is rarely a measurement artifact. It tends to indicate that the instruments inside the commercial system report on activity rather than on progression. What an organization chooses to measure about customer experience governs most of what it is able to see.

Where the work sits inside the commercial system

Work of this kind rarely belongs to a campaign or to a single function. It sits with Customer Excellence as the fourth domain of commercial excellence, alongside launch excellence, marketing excellence and sales excellence. The fourth governs whether earned value survives the journey from a clinical decision to a patient on therapy.

In practice that means designing against the six conditions across the Path to Prescribe, the Path to Fulfill and the Path to Adhere rather than inside any one of them. It means treating her effort as an economic variable with a Realization Rate attached rather than as a service complaint to be absorbed. Consumer-Grade Pharma is a capability to be designed in rather than a conviction to be held. Companies that become structurally predisposed to deliver it stop relying on individual heroics to hold the experience together.

None of this asks an organization to abandon what it already does well. It asks that HCP engagement strategy be judged against the standard the physician brought with her rather than the one the category has grown used to. Her other life is already the benchmark, whether or not anyone inside the building has agreed to it.

Key Takeaways

Pharma benchmarks its customer experience against pharma, while the physician benchmarks it against every company that has ever removed effort from her path.
Expectations travel with the person rather than with the category, so they do not reset at the clinic door.
Positivity bias leaves customers unable to separate one company from the next, which marginalizes, homogenizes and commoditizes otherwise distinct value propositions.
The Consumer-Grade Specification holds six conditions, namely Recognition, Anticipation, Coherence, Effort, Resolution and Visibility, and each one takes a concrete form in a working clinical day.
The gap she experiences is a design gap, because competent people are each doing good work inside scopes that nobody ever composed.
Experiential friction accumulates into commercial drag, which makes her effort an economic variable rather than a service complaint.

Diagnostic Questions to Consider

Name the benchmark your organization actually uses when it judges its own physician experience, and say whether any company outside pharma appears in it.
Count how many times a single physician supplies the same information to your organization across one complete access request.
Identify who owns the composite of a physician's working day with you, as distinct from who owns each separate part of it.
State which of the six conditions your current measurement can report on today, and which of them it cannot see at all.
Explain what would have to change if physician effort were treated as an economic variable with a Realization Rate attached to it.

Closing Reflection

Dr. Roswell will probably never file a complaint. She will route the next patient toward whichever path costs her the least, and from the outside the decision will look entirely clinical. That is the quiet form competitive loss takes in a converging category, and it rarely announces itself anywhere a dashboard would pick it up.

The composite she experiences can be designed, which is the more hopeful half of the diagnosis. Her other life proves the six conditions are achievable, because they were achieved by companies operating under serious constraints of their own. Pharma's constraints are real, and they govern less of her experience than most organizations assume. What remains is a design question, and design questions can be given owners.

I have come to read the distance between her two lives as the most honest measure available of how much work the commercial system is doing for the science it carries. Closing that distance does not require a new conviction about customers, because the conviction has been there all along. It requires someone to own the composite, and a standard specific enough to build against.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

Part 5/6: Reconstruct the Starbucks Brand Pyramid: The Starbucks Customer Excellence Series

Thu, 12 Jun 2025 20:57:47 GMT

CASE-IN-POINT: Recapturing the Mystique: The Starbucks Customer Excellence Series Part 3

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” Commercial (COM) Bold Move #10: Create a New Brand Identity

Part 5/6: Reconstruct the Brand Pyramid

Every company has a brand pyramid, whether explicitly documented in a formal framework or implied through its actions, messaging, and customer interactions. Even without formal articulation, a company's values, promises, and positioning are communicated to customers through its marketing, advertising, and behavior, creating a de facto brand pyramid that shapes how it is perceived.

Defined as a strategic framework used to codify how a company wants to be viewed and perceived by its target audiences and stakeholders, most often through marketing, advertising, and brand storytelling. The hierarchy of a brand pyramid typically progresses from foundational elements like functional attributes and product benefits at the base, to brand personality, brand values, and the ultimate brand promise at the top. Serving as a guiding framework, the pyramid is ultimately helpful in setting a shared aspirational identity of how a brand wants to show up in the world.

However, traditional brand pyramids rarely address the experiential attributes that define how the company will interact with customers and what they can expect in those real-world interactions. Particularly meaningful in today’s omnichannel environment, this omission often leads to a dissonance between the brand promise—what the company says it stands for—and the customer’s actual experience. When customers encounter inconsistent or subpar interactions, the gap between expectation and reality can erode trust and undermine the brand’s credibility.

Did Starbucks forget something?

In the context of the brand pyramid, Starbucks ’ new focus on the convenience of scale and speed, driven primarily by its wildly successful, super-convenient mobile app, has created a coffee factory reality that (likely unintentionally) may be competing (or potentially conflicting) with the coffeehouse perception that it originally intended. M oreover, this strategic shift seems to have occurred without Starbucks letting customers and the world know that it was going to happen! Did the company simply forget? or did it not fully appreciate the implications of this sea change? This state of affairs runs the risk of sowing confusion and diluting the hard-earned brand equity that the company has generated from the community and comfort-oriented "third place" origin experience that once set the company apart.

To realign and renew its brand proposition and address the potential dissonance between its perception and reality of its brand, Starbucks has the opportunity to reconstruct its brand pyramid to explicitly 1) harmonize its dueling coffeehouse and coffee factory propositions; 2) codify the “ideal” Starbucks Experience in non-negotiable principles, attributes, and promises; and 3) articulate its standards for service delivery. Through this realignment, Starbucks can deliver a clear and reimagined brand narrative that resonates internally and externally:

The foundation layer of the brand pyramid involves establishing explicit service standards that support the brand vision. These standards should outline the behavior and expectations for every touchpoint, whether it’s ensuring accurate, friendly service during a mobile order hand-off or creating a warm, welcoming environment for in-store guests. Functional and cultural training programs must emphasize the importance of balancing community and comfort with the convenience of scale and speed, empowering baristas to deliver meaningful interactions even under time constraints. With this foundation, Starbucks can elevate its service consistency, equip employees for success, and build stronger emotional connections with its customers.

At the heart of this reconstructed brand pyramid lies a clear articulation of the "ideal" Starbucks customer experience across all modalities, from mobile orders to in-store visits. This central layer defines the ideal experiential outcomes Starbucks aims to deliver at every interaction. For example, mobile order pick-ups should not only be efficient but also retain the brand’s "human touch", with baristas offering personalized greetings or gestures, even in fast-moving environments. In-store, the experience should reemphasize comfort and foster a sense of community through inviting spaces and consistent quality. With an emphasis on prioritizing its core community, comfort, and convenience experiential factors within an ideal experience, Starbucks can ensure that all customers, regardless of their preferred interaction mode, feel valued and connected to the brand.

At the top of the pyramid are the more traditional defining and differentiating elements that set Starbucks apart from competitors. To retain its unique identity, Starbucks must double down on its original "third place" promise while innovating for modern convenience. In practice, this could involve reimagining store layouts to create hybrid spaces that accommodate both pick-up efficiency and comfort-focused seating areas. These capstone elements help differentiate Starbucks interactions and become an organic element of the overall brand narrative, optimized to deliver not just coffee, but meaningful experiences that resonate emotionally.

Being intentional about reconstructing its brand pyramid, fortifying it with clear service standards, ideal experience attributes, and brand-defining principles, positions Starbucks to resolve the conflict between its convenience-driven innovations and its comfort-oriented legacy. This redefinition offers a cohesive identity that resonates with both new and legacy customers, aligning the company’s operations with customer expectations and organizational capabilities internally and guiding the company’s messaging and advertising internally with brand promises externally. Marketing campaigns can highlight how Starbucks seamlessly integrates convenience with its comforting heritage, reinforcing its commitment to both speed and soul. Internally, these principles should shape employee training and operational processes, ensuring that every team member understands and embodies the renewed brand promise. This alignment will strengthen trust, loyalty, and emotional connection, ensuring Starbucks remains a beacon of community, comfort, and convenience in an evolving marketplace.

Read the other parts of The Starbucks Customer Excellence Series:

Part 1: From A Customer: An Open Letter to Starbucks

Part 2: Societal Savior or Customer Experience Death Star

Part 3: Recapturing the Starbucks Mystique

Part 4: Redefine the Starbucks Culture Platform

Part 5: Reconstruct the Starbucks Brand Pyramid

Part 6: Redesign the Experience Delivery System

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

Part 4/6: Redefine the Starbucks Culture Platform: The Starbucks Customer Excellence Series

Thu, 12 Jun 2025 20:22:43 GMT

CASE-IN-POINT: Recapturing the Mystique: The Starbucks Customer Excellence Trilog y

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”, Organizational (ORG) Bold Move #5: Document Customer Excellence Principles

Part 4/6: Redefine the Starbucks Culture Platform

As often as it is mentioned in business literature, the idea of corporate culture can still seem intangible, amorphous, and even mysterious. Customer Excellence Enterprises have mastered the craft of clearly defining, documenting, and embedding their distinctive cultures at the DNA level through well-crafted culture platforms:

A culture “platform” is the foundation of its identity, embodying the shared values, principles, and practices that guide how it operates and interacts with the world.
Like the DNA of a living organism or the operating system of a computing device, culture platforms define the unique traits and essence of an organization , making it distinct from others.
To remain relevant and effective, a Starbucks culture platform must evolve to bridge the gap between the present and future while preserving authenticity, timelessness, and scalability .

Starbucks can begin redefining its culture platform for the future by honoring its journey from the past —from its humble beginnings at Pike Place to its present status as a global colossus—and tie seamlessly into its current transition and future aspirations. If it’s to become a grocery or lifestyle brand, then so be it—this means embracing a new vision that aligns its deep-rooted heritage with the evolving needs of modern customers while ensuring authenticity, timelessness, and scalability:

The journey must begin from a foundation of authenticity —a core set of non-negotiable principles centered on delivering a brand-aligned “ideal” Starbucks Experience. Principles such as embedding signature moments and measuring success by the levels of craftsmanship and excellence in every interaction become design drivers and guardrails for every facet of the company.
Celebrating and leaning on its roots in crafting ideal experiences, while embracing customer demands for personalization, engagement, and sustainability provides the grist for Starbucks to create a culture and brand narrative that stands the test of time .
The culture should also be scalable, capable of being replicated across thousands of stores globally while remaining locally relevant. For example, just as Disney adapts its storytelling to regional audiences, Starbucks can ensure that its stores reflect local traditions and flavors while upholding a universally consistent experience of high-quality, brand-aligned interactions.

Drawing further inspiration from Disney’s dedication to creating shareable “wow” moments, which connects generations through meaningful brand narratives, or the Ritz-Carlton’s unwavering commitment to service excellence, which adapts to the ever-changing expectations of the global affluent without losing its essence, the culture platform must grow and adapt like a living entity. Enlivened by rituals, systems, and success stories, this ongoing renewal ensures that the platform remains a touchstone for nurturing innovation, inspiring trust, and scaling sustainably while staying true to the core values that make the company unique.

Rewiring a culture platform for its new context doesn’t happen by accident. Following the practices of other outliers, codifying and documenting the platform allows Starbucks to systematically teach and reinforce its culture , ensuring consistency and alignment across teams, generations, and its entire global system. In doing so, Starbucks can modernize how it shows up in the world to not only support its business goals and stakeholder commitments but also reaffirm its desired role as a trusted companion in people’s daily lives.

In the end, the culture platform must be abundantly tangible, actionable, and resonant, working at the DNA level, empowering all levels and corners of the company, from baristas on the frontline to third-party operating partners in airports and rest stops, to corporate leaders alike—to learn, internalize, live and hold each other accountable to a shared standard.

Read the other parts of The Starbucks Customer Excellence Series:

Part 1: From A Customer: An Open Letter to Starbucks

Part 2: Societal Savior or Customer Experience Death Star

Part 3: Recapturing the Starbucks Mystique

Part 4: Redefine the Starbucks Culture Platform

Part 5: Reconstruct the Starbucks Brand Pyramid

Part 6: Redesign the Experience Delivery System

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

Part 3/6. Recapturing the Mystique: The Starbucks Customer Excellence Series

Thu, 12 Jun 2025 19:54:53 GMT

CASE-IN-POINT: Recapturing the Mystique at Starbucks

BOLD MOVE: The Customer Excellence Enterprise: Helpfulness as an Operating System

Read the other parts of The Starbucks Customer Excellence Series:

☕️ Part 3/6 Recapturing the Mystique at Starbucks

Synopsis. It’s “easy” to critique Starbucks from an outsider/customer perspective, but what solutions can one provide? Part 3 of Th e Starbucks Customer Excellence Series outlines key steps that the company might consider to start a journey to recapture its legacy of being a Customer Excellence Enterprise (CXE). To learn more order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

As discussed in Part 1 and Part 2 of this series and referencing “The Customer Excellence Enterprise”, Starbucks has long been celebrated for its "third place" coffeehouse ethos, defined by comfort and community-based experiences that made it more than just a place to execute coffee purchasing transactions. However, in recent years, its brand identity seems to have increasingly shifted toward providing experiences defined by scale and speed.

Supercharged by the success of its mobile app, new modalities have emerged around those attributes to replace the coffeehouse with a coffee factory vibe, potentially conflicting with and taking much of the mystique out of the company’s origin story. While mobile order pick-ups, drive-thrus, and deliveries meet the demands of our fast-paced world, do they run the of risk of creating brand dissonance in the eyes of customers, employees, and other stakeholders? Is the Starbucks Experience a respite from the busy lives of customers, or another accelerant? Perhaps it’s something in between?

Taking the Hard Road

Any corporate metamorphosis is an inherently daunting process, as it requires companies to overcome a complex web of hurdles, many of which lie beyond their span of control. For Starbucks , any meaningful transformation is likely to require confronting long-cycle, structural, and systemic issues that demand deep introspection, adaptation, and very difficult decisions involving factors outside of their control:

Capital allocation decisions must balance the costs of capital with big-ticket investments in tech, sustainability, and store renovations while maintaining shareholder confidence.
Tricky labor dynamics , including wage inflation and evolving employee expectations, add further complexity.
Broader macroeconomic trends, shifting demographics, and changing consumer preferences , such as the rising demand for health and wellness offerings, also require recalibration.
Following the example of many retailers, the company may even need to assess the prospect of rightsizing its global footprint, optimizing its presence in saturated markets where demand may have declined, plateaued, or otherwise shifted.

While external forces make corporate reinvention a multi-faceted challenge with no guarantee of success, from a Customer Excellence perspective, Starbucks holds the power to execute many structurally and systematically transformative actions that are largely within its control. In other words, taking the hard road is a choice that the company and its leadership can choose to make or not.

Most importantly, this should be familiar territory for Starbucks, a “return to itself” as it reestablishes its rightful place as one of the original Customer Excellence Enterprise (CXEs) . Choosing to become a CXE would put Starbucks on a path toward recapturing its heart, soul, and competitive edge, redefining its proposition, and strengthening its relationship with customers old and new, repositioned for its next wave of growth and success, even in the face of external uncertainties and continuous change.

Read the other parts of The Starbucks Customer Excellence Series:

Part 1: From A Customer: An Open Letter to Starbucks

Part 2: Societal Savior or Customer Experience Death Star

Part 3: Recapturing the Starbucks Mystique

Part 4: Redefine the Starbucks Culture Platform

Part 5: Reconstruct the Starbucks Brand Pyramid

Part 6: Redesign the Experience Delivery System

To learn more order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

Part 2/6. The Starbucks Mobile App: Societal Savior or CX Death Star?

Thu, 12 Jun 2025 19:00:24 GMT

CASE-IN-POINT: The Starbucks Mobile App

BOLD MOVE: Commercial (COM) Bold Move #10: Create a New Brand Identity

☕️ Part 2/6 Societal Savior or Customer Experience Death Star

Synopsis. Is T he Starbucks Mobile App TOO Good? The Starbucks Mobile App exemplifies how a highly successful digital innovation can inadvertently strain physical operations, impact employees, and erode brand equity. Its super-optimized, convenience-focused features drive increased order volumes from drive-thrus, mobile orders, and delivery, often overwhelming the in-store staff. The resultant bottlenecks and pressure on employees underscore the strategic challenge of balancing digital "front door" experiences with sustainable in-store operational performance to maintain both employee well-being and the integrity of the brand promise.

This post was written in the middle of doing “THE THING”…Yes, I have chosen to travel by air from the infamous Newark International Airport. As a customer experience marketer with a bit of The Ritz-Carlton Gold Standards in my past, my “antenna is up, and my radar is on…searching for customer experience faux pas in the travel value chain and journey optimization practices to evaluate and file away for future research, case studies and discussion topics for my Customer Experience Strategy course that I teach in the Master's of Science in Customer Experience Management degree program at The Broad College of Business at Michigan State University .

Amidst the chaos at Newark International Airport at 6:30 AM on a Saturday ( where are all these people going anyway?! ) lies an oasis. I can almost sense it before I see it — The Starbucks airport kiosk in Terminal C. With the blurry-eyed masses jockeying for position, this remote outpost of Pike Place seems so close, yet so far away. But I have a secret weapon…I have arguably one of the most powerful forces in the world of Experiential Commerce in my pocket — The Starbucks Mobile App.

On the one hand, designed to streamline ordering, boost convenience, and enhance customer loyalty, the app has been highly effective in driving traffic to Starbucks locations. Customers love the ability to customize their drinks, skip lines, and collect rewards seamlessly through this beacon of caffeinated, tech-enabled efficiency: tap-tap-swipe and boom—your half-caf, oat milk, triple-shot latte is waiting for you before you can even say “venti.” No more fumbling for the right payment option at the register, no more waiting in long lines with talkative strangers and amateur travelers, neither of whom can decide whether they want a Frappuccino or a Chai Latte ( BTW, isn’t it bad form to NOT carry the standard-issue Tumi corporate backpack and matching roller bag when traveling!? )...Anyway…For us seasoned, caffeine-starved zombies, the Starbucks mobile app is nothing short of a revelation.

While the convenience inherent to the app has led to an explosive increase in order volumes, particularly during peak times, a fundamental question must be asked: Is the Starbucks mobile app TOO GOOD?

On the other hand, let’s get to the dark side of this story. A true game-changer at the business and operating model level, the Starbucks mobile app enables unprecedented convenience for customers with mobile orders, drive-thru pick-ups, and delivery options. However, the resulting surge in demand can overwhelm in-store operations, creating bottlenecks that challenge the ability of crews to deliver on the company's dual promises of scale, speed, and convenience in a "coffee factory" (new brand proposition) and the community and comfort-oriented coffeehouse (founding brand proposition).

This conflict plays out in real ways for customers of all modalities. For example, customers placing mobile orders may prioritize speed, while in-store guests value the relaxing "third place" atmosphere. Both groups can feel underserved when these expectations collide during peak times when mobile orders flood the system. While appealing to different customer cohorts, the dual promises of a coffeehouse and coffee factory experiences can create operational dissonance for customers if Starbucks' concept of operations and experience delivery systems are not optimized.

And let’s not forget the employees. What’s it like for them to go from witty conversationalists and milk foam artists to frazzled human extensions of a clever workflow management algorithm? Instead of chatting with customers, they’re often forced into dodging a relentless stream of mobile orders while trying to offer a modicum of engagement and keep up with the human beings that are actually in the store.

To make Starbucks’ business model work, employees must rally and play "hero ball" to manage this complex blend of modalities—balancing the speed and accuracy required for mobile orders, the efficiency expected in drive-thrus, the patience and delight of in-person interactions, and the comfortable surroundings sought by some in-store customers—all within the same physical space at the same moment in time. This dynamic can strain existing systems and structures , leaving employees scrambling to meet conflicting demands while maintaining brand standards. Moreover, employees caught in the middle often bear the brunt of this chaos, pressured to sacrifice either convenience and efficiency or comfort or personalized interactions against their individual and team well-being, leading to frustration, conflict, and potential errors that further degrade the customer experience. Most importantly for all stakeholders, when the Starbucks experience delivery system is routinely brought to a breaking point, it can lead to customer defections, brand erosion, and employee burnout that can create a cycle of value destruction that can be hard to stop.

This is what a "coffeehouse vibe" conflicting with a "coffee factory" feels like.

So, what is it? Is the Starbucks Mobile App a savior for caffeine-starved consumers OR a voracious employee morale and experience-shattering Death Star turning cozy coffeehouses into coffee factories?

Questions to Consider.

Is the Starbucks Experience a case for “Good Friction” ?
How can Starbucks redesign store operations to better integrate mobile order fulfillment without compromising the in-store customer experience?
What strategies can be implemented to manage peak-time order surges caused by mobile app usage while maintaining employee well-being?
How should Starbucks balance the goals of digital innovation and operational efficiency to avoid brand dissonance between app-driven expectations and in-store realities?
What role can additional staffing, training, or technology play in alleviating the pressure on employees caused by mobile order demand?
How can Starbucks ensure that the rapid growth of its digital ecosystem aligns with its core values of quality service, customer satisfaction, and employee engagement?

Read the other parts of The Starbucks Customer Excellence Series:

Part 1: From A Customer: An Open Letter to Starbucks

Part 2: Societal Savior or Customer Experience Death Star

Part 3: Recapturing the Starbucks Mystique (COMING SOON)

Part 4: Redefine the Starbucks Culture Platform (COMING SOON)

Part 5: Reconstruct the Starbucks Brand Pyramid (COMING SOON)

Part 6: Redesign the Experience Delivery System COMING SOON)

To learn more about leadership, organizational, operational, and commercial bold moves, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”

Part 6/6: Redesign the Experience Delivery System: The Starbucks Customer Excellence Series

Thu, 12 Jun 2025 18:00:50 GMT

CASE-IN-POINT: Recapturing the Mystique: The Starbucks Customer Excellence Series Part 3

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” | Operational (OPS) Bold Move #1: Reimagine the Concept of Operations

PART 6/6: Redesign the Experience Delivery System

Synopsis. In Part 6 of the series, we build on the idea of recapturing the mystique at Starbucks, exploring how consistently delivering exceptional experiences doesn’t happen by accident. Beyond their physical locations and assets, companies like Starbucks, McDonald’s, and other multi-brand and multi-location retail and hospitality networks such as Marriott and Hilton, are fundamentally driven by the systems that underpin their operations. These business models work because of their meticulously designed experience delivery systems, where much of their enterprise value, intellectual capital, and differentiating elements reside. Particularly critical for orchestration in omnichannel environments, these systems ensure consistency, scalability, and seamless delivery, forming the backbone of how brand promises come alive and setting the standard of Customer Excellence.

Customer Excellence Enterprises (CXEs) know that exceptional experiences are never the result of mere chance. They are the outcome of a meticulously designed integrated people, processes, and platform Experience Delivery System (EDS). A well-crafted EDS combines the efforts of skilled individuals (people), efficient workflows and protocols (processes), and enabling technologies (platforms). These systems are particularly vital in consumer-intensive industries like retail, food services, and hospitality, where customer interactions directly impact brand perceptions and business outcomes.

These systems, often invisible to the customer, serve as corporate operating systems , guiding everything from staffing protocols to supply chain logistics while incorporating brand-specific elements that set companies apart. The “pure” operations aspect ensures efficiency and consistency across locations, while the brand-specific elements infuse personality and differentiation into the customer experience. For example, in a retail CXE such as Trader Joe’s, the operational processes governing inventory management are likely standardized but the in-store atmosphere and staff interaction components of the system are tailored to align with the brand’s identity, creating a unique experience.

In the case of Starbucks, the company has taken great care to optimize distinct operating systems tailored to each of its modalities— in-store, mobile orders, delivery, and drive-thru. As a result, each modality functions efficiently in its independent context, meeting customer needs and brand promises with relative precision and success. However, from the customer point of view, the company appears to lack the cohesion of a fully integrated operating model that seamlessly connects and orchestrates the independent systems in each modality as one. Resolving this fragmented approach is the key to unlocking the brand’s ability to deliver a truly fluid omnichannel Starbucks Experience.

Along with redefining its Culture Platform (Play A) and reconstructing its Brand Pyramid (Play B), Starbucks has the opportunity to recalibrate its Principles, People, P rocess, and Platform Experience Delivery System to balance its original comfort and community ethos with its current emphasis on convenience, scale, and speed. This recalibration would involve integrating elements of its heritage into a new digitally-charged, omnichannel operating system while ensuring both align seamlessly to meet customer expectations:

People are central to Starbucks’ brand identity, as its baristas have long been known for creating personal connections and delivering a welcoming “third place” experience. To recalibrate, Starbucks could enhance employee training to ensure baristas are equipped to provide friendly, personalized interactions even in high-speed environments. Incentivizing employees to focus on customer engagement, rather than solely on efficiency metrics, can help preserve the warmth and hospitality that defined Starbucks’ origins.

In terms of Processes , Starbucks has the opportunity to make the coffeehouse and the coffee factory co-exist. In practice, this means blending operational efficiency with episodes of surprise, delight, and moments of “wow”. While standardized workflows enable rapid service for mobile orders, delivery, and drive-thru customers, the company can also introduce processes that allow for small but meaningful personal touches (e.g. reconsidering how to re-incorporate the iconic hand-written customer names on cups or super-targeted promotions based on order history). Also, consistent with Operational Bold Move #3: Orchestrate the Front- and Back-of-House of “The Customer Excellence Enterprise” , Starbucks could revisit store layouts to isolate front-of-house customer interactions from the more efficiency-driven back-of-house workflows supporting delivery and mobile orders pick-up and drive-thru orders.

For Platforms , Starbucks’ sector-leading digital innovations, featuring the aforementioned mobile app, should continue to emphasize integration with the in-store experience and rewards program. Doubling down on the power and popularity of the app, Starbucks could re-establish its local coffeehouse vibe by including features that highlight local events , foster community-building, and provide options for customers to engage with Starbucks and each other beyond transactions. Additionally, using data insights and AI to reveal the tendencies and preferences of individual customers, Starbucks can personalize offerings and promotions, and use in-app messaging to replicate the personalized and witty interactions found in the original coffeehouse experience.

For Starbucks, as daunting as it may be across 40K+ outlets and countless third-party operating partners , recalibrating its experience delivery system should be viewed as an opportunity to renew its value proposition to customers, employees, and other stakeholders. With the independent momentum and appeal of both its legacy and new modalities, the company can create a cohesive operating model that honors its roots in comfort and community while capitalizing on its success in delivering convenience at scale. This balance would enable Starbucks to retain its unique identity while continuing to meet the demands of a fast-moving and tech-savvy customer base.

Read the other parts of The Starbucks Customer Excellence Series:

Part 1: From A Customer: An Open Letter to Starbucks

Part 2: Societal Savior or Customer Experience Death Star

Part 3: Recapturing the Starbucks Mystique

Part 4: Redefine the Starbucks Culture Platform

Part 5: Reconstruct the Starbucks Brand Pyramid

Part 6: Redesign the Experience Delivery System

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

Part 1/6. An Open Letter to Starbucks: The Starbucks Customer Excellence Series

Thu, 12 Jun 2025 16:26:49 GMT

CASE-IN-POINT: From a Customer: An Open Letter to Starbucks

BOLD MOVE: Leadership (LDR) Bold Move #4: Model Customer-Centric Behaviors; Operational (OPS) Bold Move #1: Reimagine the Concept of Operations

☕️ Part 1/6 From a Customer: An Open Letter to Starbucks

Synopsis. Presented as a letter from a long-time customer, this case examines Starbucks ' (intentional or unintentional) shift from its original comfort-oriented "third place" brand proposition to a scale, speed, and efficiency-driven approach emphasizing mobile ordering, drive-thrus, and delivery. While these modern modalities cater to today’s convenience-seeking consumers, they risk eroding the emotional resonance that has long defined the brand. The dissonance caused by these contrasting experiences underscores a fundamental challenge for Starbucks: maintaining a balance between the demands of convenience-oriented customers and preserving the comforting coffeehouse experience cherished by its legacy audience. Failing to bridge this gap could result in brand inconsistency, leaving customers feeling betrayed and abandoned, questioning whether Starbucks sees them simply as financial transactions or if they are truly valued for their long-term loyalty.

Dear Starbucks,

I miss you. Sure, it’s normal that we’ve both changed and moved on over the years. But you have REALLY changed…so much that I hardly recognize you. Nostalgia for my go-to extra shot grande latte has inspired me to share a few concerns weighing heavily on me. I’m compelled to reach out because I think that the current state of affairs in our relationship (yes, our break-up and my defection from you) isn’t from malicious intent but from some terrible misunderstanding or, better yet, a miscalculation:

Believing that what you offered me, why you earned a place in my heart, mind, and life, and what drew so many like me to you in the first place, was just about the coffee.

The reality is, as the definition of a commodity, coffee is and has always been available virtually everywhere—often cheaper, faster, stronger, and perhaps even fancier at local artisan coffeehouses and at insurgent premium brands that are trying to clean your clock. Recognizing the transactional, unemotional nature of selling coffee as a commodity, in your origin story, you created, marketed, and delivered a distinctive Starbucks Experience defined by "coffeehouse community and comfort" and placed it at the very heart of your brand ethos and promise.

Yes, you won me over based on the Seattle "coffeehouse vibe".

As the core experiential factors that you built your business and our relationship on, community and comfort manifested in the coffeehouse vibe through the low hum of quiet conversation, the gentle hiss of steaming milk, the chill background music, the aroma of freshly ground beans, and witty baristas. With intention and design, the magic of the Starbucks Experience was in the idea of lingering over a cup or two, the invitation to sit with a book, hold a caffeine-fueled study group, or flip through a newspaper or tablet. Whether we did so or not, the invitation was there. You offered the promise of a pause, a moment of reflection, a bit of tranquility. Yes, the coffeehouse vibe you sold me created a feeling of stepping out of the fast pace of daily life into a place where time slowed down just a little bit, a respite from the game.

Our relationship also carried over into the workplace as the “coffee run” ritual became synonymous with you as your coffeehouses became a sanctuary, a few minutes of a retreat from the grind. Contrasting sharply with grabbing a cup at a fast food joint, convenience store, or gas station, the unique, brand-specific interpretation of the coffeehouse you offered created a certain mystique and charm that showed up as my strong preference and willingness to invite you into my life. Your carefree atmosphere made coffee a secondary actor in the overall experiential story you were telling and selling, emotions and connections that, for many of us, held irreplaceable places in our lives.

But no longer.

It feels like somewhere along the way, that essence was lost. Maybe it was trying to appeal to everyone with the introduction of a dizzying array of drinks (many of which were not and are not coffee!). Perhaps the pivotal moment happened in 2011, when you dropped the word “Coffee” from your logo, signaling your desire to expand your scope and evolve into a broader “lifestyle brand.” At a minimum, with this particular decision, you granted yourself permission to redefine what you could be—no longer tethered exclusively to your origins as a coffeehouse but open to exploring new possibilities that are better aligned with your global growth aspirations. In the end, your proposition seems to have shifted from a unique, community, and comfort-driven coffeehouse experience to one built around maximizing convenience through scale, speed, and efficiency — focusing on throughput and how quickly customers can be moved through the system and how many cups can be sold per hour.

Honestly, at some level I “get it”…you had to "do what you had to do" to meet the elevated expectations of your investors and other stakeholders. But I get the sense that it’s not quite so simple...

No, of course not…your current situation is complex and highly nuanced. The many critics suggesting that you have simply forgotten about customer experience probably come across as oversimplified and unfounded inside the walls of the company. After all, you can argue and show tangible evidence that you have actually remained laser-focused on the experience of your legions of customers. Specifically, your mobile app alone is a testament to your continued commitment to customer experience, offering a clean digital interface, intelligent recommendations, and intuitive navigation that allows busy customers like me to effortlessly order and pay in seconds, skip long lines, and earn rewards along the way.

Moreover, your emphasis on adjusting store layouts and workflows to support drive-thrus, mobile orders, and delivery pick-ups are clear and tangible reflections of your positioning as a leader in modern convenience and store efficiency. So, with the elevated levels of scale and speed that you now provide, it’s understandable why the accusations that you are no longer focused on the customer experience are viewed and dismissed by you as gratuitous distractions.

But, wait just a minute…the Starbucks Experience is now defined by scale, speed, and efficiency? What happened to “community and comfort”? Did you change the essence of the Starbucks brand but forgot to tell us?

Yes, the strategic shift away from community and comfort to scale, speed, and efficiency as your guiding ethos has inadvertently distanced the Starbucks Experience from your original brand promise. From your Pike Place origin story, you distinguished yourself as my “third place” between my home and work, offering a comfortable, community-centered coffeehouse environment where I could linger, connect, and just breathe, even if it was just for a few minutes.

Your pivot to scale, speed, and efficiency—while undoubtedly successful, and probably a legitimate strategic necessity— has subtly but definitively redefined what the Starbucks Experience means and what your brand stands for. But, this redefinition, while it may have been exceedingly wise and rational, was never explicitly communicated to me and other loyal customers ...it just sorta happened. Perhaps this lack of transparency is the root of it all.

This sound yet poorly articulated strategic move has created a fundamental gap between the expectations that we jointly set as the bedrock of our relationship many years ago and the unfamiliar terrain in which we now find ourselves.

What’s the big deal, you ask?

To me, this gap isn’t trivial; it’s elemental— when there is dissonance between what a brand like Starbucks promises and what it actually delivers, like any consumer, I can’t help but feel a sense of betrayal. Based on the historical brand messaging and proposition that you served up to me, I became used to viewing you as a source of community and a comforting refuge. However, with your new emphasis on scale, speed, and efficiency, the Starbucks Experience seems to have gone from a coffeehouse to a "coffee factory", an unfamiliar and somewhat jarring reality that conflicts with the ethos that I have previously associated with the brand. As my only recourse, this breach of trust deeply impacts my loyalty to you as I actively search for and explore different options to replace your role in my daily life.

Now, for the good news.

More recently, it’s clear that Starbucks is in the midst of a thoughtful and visible turnaround. The brand’s latest commercials mark a refreshing pivot—refocusing on what originally made it iconic: the store experience, the artistry of the baristas, and the ritual of savoring a handcrafted coffee. Rather than leading with logistics—like mobile orders, drive-thrus, or pick-up mechanics—these new spots reassert the primacy of human connection and sensory atmosphere. But this shift won’t be easy. Delivering consistently on this more expansive, experience-led promise across a landscape of digital, physical, and hybrid touchpoints will require deep structural and systemic change. Rewiring systems, retraining teams, and realigning incentives to prioritize brand-defining moments over operational throughput is a heavy lift—but a necessary one if Starbucks is to fully recapture its emotional relevance and reclaim its role as the third place in a modern world.

In summary, can't tell you what the answer is…all one can do is tell you what it isn’t.

Sincerely,

A. Customer

[A Long-Time Customer]

Questions to Consider.

How can Starbucks effectively balance modern convenience-oriented offerings (e.g., mobile orders, delivery services) with the comfort-oriented experience that its legacy customers value? What strategies can they implement to avoid alienating either customer segment?
What are the potential risks of Starbucks prioritizing convenience over its original brand promise of comfort and community? How might these risks impact customer loyalty and brand perception in the long term?
To what extent can Starbucks’ embrace of technology, such as the mobile app and AI, enhance customer experience without compromising the brand's emotional resonance? How should the company ensure these advancements align with its core values?
What role does customer feedback play in resolving the tension between coffeehouse and coffee factory at Starbucks?
How can Starbucks use this feedback to avoid the inconsistency that might harm its brand identity?
How can Starbucks differentiate itself in a competitive market while maintaining the authenticity of its brand?
Should the company focus more on expansion for broader appeal or doubling down on its original "third place" concept?

Read the other parts of The Starbucks Customer Excellence Series:

Part 1: From A Customer: An Open Letter to Starbucks

Part 2: Societal Savior or Customer Experience Death Star

Part 3: Recapturing the Starbucks Mystique (COMING SOON)

Part 4: Redefine the Starbucks Culture Platform (COMING SOON)

Part 5: Reconstruct the Starbucks Brand Pyramid (COMING SOON)

Part 6: Redesign the Experience Delivery System COMING SOON)

To learn mor e about l eadership, organizational, operational, and commercial bold moves, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”

[PRACTICE NOTE] Stronger Together: Making Customer Outcomes a Shared Accountability

Tue, 25 Feb 2025 12:48:51 GMT

Organizations tend to solve a problem by naming someone to carry it. The naming feels like progress, because it produces a team, a budget line and a quarterly report. In pharma the problem named that way is the customer, and the people who carry it sit in customer care, customer experience or customer success. They are often among the most committed people in the building.

That commitment can be the reason nothing structural changes. When a small group absorbs the distance between what a company promises and what a customer can actually realize, the distance stops reading as a design problem. It becomes a staffing question instead, and staffing questions get managed rather than resolved. Nobody designs this outcome on purpose.

The objective of resequencing organizational DNA is to make customer outcomes a shared accountability across all levels and all corners of the organization. The alternative is placing that responsibility on the shoulders of a few individuals and hoping they can carry it. Instilling shared accountability is a cultural change with both a philosophical and a practical dimension. It tends to prove more enduring than routine cost takeout or technology led transformation, because it changes what a company is predisposed to do.

The cultural change has a philosophical and a practical dimension

Philosophically, the change means creating and internalizing a shared belief system built around helpfulness, which builds preference by helping customers reach their desired outcomes at an elevated standard. In practical terms it means defining company specific principles, knowledge, skills and capabilities, then cascading them into the ways of working of individuals, teams and whole departments. Neither dimension works alone. Belief without ways of working stays decorative, and ways of working without belief decay the moment a quarter gets difficult.

This is where most customer programs in pharma stall. They are built as functional capability inside one department, measured by instruments only that department controls, and defended each year by people with no line to revenue. A program designed that way can be excellent and still be structurally disposable. The question of who owns customer experience in pharma usually gets answered with a name, when ownership has to be distributed and the joins owned.

Pharma is well designed at the center and silent at the joins

A pharmaceutical commercial organization is unusually well designed at the center of each function. Medical affairs, market access, brand, field, patient services and trade each hold deep capability, clear metrics and genuine expertise. The same organization is unusually silent at the joins between them. Benefit verification, prior authorization, affordability, specialty pharmacy coordination, onboarding and first fill each sit partly inside a function and wholly inside none.

The failures therefore cluster precisely in the spaces no organization chart describes. Nobody is failing. The chart has no line for the thing that fails. Gartner measured what that silence costs elsewhere, finding that 62% of customer service channel transitions are high effort for the customer, which is the handoff problem stated as a number.

Reading this as a character gap leads to the wrong remedy every time. More training, more passion and more escalation can raise the ceiling on what committed people manage to deliver, without changing what the system delivers when nobody is watching. The work described in organizational DNA for pharma runs deeper, toward a company that is structurally predisposed to deliver well rather than one that relies on individuals to rescue the design. Heroics in that setting operate as a subsidy, paid by employees and invisible in the accounts.

Cascading Customer Excellence turns partnership into structure

Cascading Customer Excellence is the mechanism that moves customer outcomes out of one team's remit and into shared possession. It works through knowledge diffusion rather than advocacy, which matters because advocacy may depend entirely on the energy of whoever is advocating. Rather than relying on isolated champions to carry the message, a company equips a critical mass of employees with a common language for how customers are to be viewed, valued and treated. The channels are ordinary. Interpersonal conversation, formal learning, internal communications and mentoring all carry the same content into different corners.

In pharma that diffusion has a particular target. The people who encounter a broken journey first are rarely the people who hold the budget to repair it. That gap makes the voice of the frontline the earliest available signal of where value is leaking. Diffusion gives that signal somewhere to land. A field colleague equipped with shared language can describe a barrier in terms the brand team can act on, instead of filing a frustration nobody can classify.

Codified principles make good intentions trainable

Codifying the obligation to customers through company specific Customer Excellence principles turns good intentions into something that can be understood, trained, implemented and sustained. Principles do work that values statements cannot, because they describe behavior at the level of a decision rather than at the level of a sentiment. They also become the reference point for coaching, for performance conversations and for the ordinary supervisory moments where culture is transmitted.

Long before pharma, the discipline I learned at The Ritz-Carlton Leadership Center rested on exactly this. The Credo names the genuine care and comfort of guests as our highest mission . The Service Values put that obligation in the first person, with each employee empowered to create unique, memorable and personal experiences for guests. The point is one mission held by everyone, rather than four missions held by four departments. The pharma translation drops the hotel script and keeps the discipline of writing down what helpfulness means when the customer is a clinician under time pressure or a patient waiting on coverage.

Co-design is how adoption gets de-risked from the inside

A customer centric culture must be created and owned from inside the organization. Outsiders can facilitate the design process, and some of that facilitation is genuinely useful, but the culture itself has to flow from the collective consciousness of the company. The practical form is a multidisciplinary design team of culture carriers and respected corporate citizens, drawn deliberately from across functions and levels. Employee led co-design is itself an activation strategy, because participation produces ownership and ownership produces accountability.

In pharma the composition of that team decides the outcome, and I have not seen a shortcut around it. Medical, market access, field, patient services, digital and compliance each hold a different piece of the truth about where a journey breaks, and none of them holds enough of it alone. A principle written by one function often reads as that function's agenda when it reaches the others. A principle written by all of them becomes the only artifact in the building that describes the joins.

Shared accountability becomes diffuse accountability without a named owner

The honest difficulty with shared accountability is that it can dissolve into nobody's accountability. A company that tells everyone they own the customer has often told nobody in particular. Partnership between functions is a precondition for good outcomes rather than a substitute for ownership, and that distinction tends to get lost in the enthusiasm of a culture program. Every consequential handoff needs one named owner, with the authority and the measurement to match the name.

USAA built this into its operating model through Experience Owners, designated individuals who serve as stewards of excellence across one or more journeys. In the commercial organizations I have worked inside, the handoffs that fail most often are the ones everybody can describe and nobody is measured on. The pharma equivalents are ordinary rather than exotic. Someone owns the move from benefit verification to first fill, someone owns the move from enrollment to shipment, and someone owns the week a patient goes quiet.

Gartner found that low effort customers are 61% more likely to stay , which puts a price on every transition a company leaves unowned. Forrester reported that customer obsessed organizations achieved 41% faster revenue growth than the rest, a gap no single function can produce on its own. Shared accountability earns a gap like that only when it resolves into named owners at the points where value changes hands.

Customer consciousness is the test of whether partnership is real

Customer consciousness is the degree to which customer reality is present in decisions before they are made, rather than sentiment about customers. The definition is deliberately unsentimental, because sentiment is abundant in pharma while consequential presence is rare. The useful test has little to do with whether people in a meeting care about patients. The test is whether anyone in the room could describe what the next fourteen days will require of that patient.

Raising customer consciousness is the purpose of Customer Excellence, and shared accountability is how it scales past the few people who already have it. A company that is structurally predisposed to deliver well admits customer reality into decisions as a matter of routine, through principles, through diffused knowledge and through owners present at the joins. A company that relies on conviction admits customer reality whenever a committed individual happens to be invited. The second arrangement produces better meetings and worse systems.

No single function can move the Realization Rate

The share of earned value that becomes sustained therapy is the Realization Rate , calculated as realized value divided by earned value. The number falls in the gaps between the Path to Prescribe, the Path to Fulfill and the Path to Adhere, exactly where no function owns outright. Pharma does not have a sales problem, it has a systemic value realization problem, and that distinction decides where the remedy has to sit. No brand team can move the Realization Rate alone, no patient services team can, and no field organization can.

Bain put the underlying economics plainly, describing goodwill as a necessary but insufficient condition for generating revenue growth . Pharma's version of that insufficiency is a therapy genuinely needed, covered and prescribed, which still fails to reach a patient who gave up somewhere in the administrative middle. Converting goodwill into realized value asks every function to carry a piece of the same number. That obligation is the whole of the argument for partnership, and it is also the limit of it.

Key Takeaways

Accountability for customer outcomes in pharma often sits with a small group whose commitment allows the surrounding structure to remain unchanged.
A pharmaceutical commercial organization tends to be well designed at the center of each function and silent at the joins where journeys actually break.
Cascading Customer Excellence through knowledge diffusion and company specific principles turns partnership into structure rather than goodwill.
Employee led co-design operates as an activation strategy, because participation produces ownership and ownership produces accountability.
Shared accountability becomes diffuse accountability unless every consequential handoff carries one named owner with measurement attached.
No single function can move the Realization Rate, which is the practical reason partnership across functions matters.

Diagnostic Questions to Consider

Name the group that currently carries customer outcomes in your organization, and describe what would change if that group were reduced.
List the handoffs between benefit verification, prior authorization, affordability support and first fill, and name the single owner of each.
Describe the company specific Customer Excellence principles your organization has codified, and where they appear in training and performance conversations.
Identify who was in the room the last time a patient support journey was designed, and which functions were absent from it.
State your current Realization Rate and name the function that is measured on moving it.

Closing Reflection

Shared accountability endures longer than most transformation agendas because it changes the organization's default rather than its initiative list. Cost takeout removes capacity. Technology programs change speed. Resequencing organizational DNA changes what a company does when nobody is supervising, which is the only condition under which customers ever experience a company.

The work is slower than a reorganization and less satisfying than a launch, because its evidence arrives as the absence of failures that would otherwise have happened quietly. A patient who never had to call twice generates no story. A clinician who never had to chase a coverage decision writes no complaint. The value appears only later, in the Realization Rate, as a number no single function can claim credit for.

Partnership across functions is therefore worth building for an unsentimental reason. It remains the only arrangement under which the commercial system can finish what the science started. Exceptional science deserves an exceptional commercial system, and an exceptional commercial system is one where the joins have owners.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Bespoke: The Future of Experience Measurement

Fri, 24 Jan 2025 16:07:32 GMT

Organizations tend to measure what they can compare rather than what they can change. The instinct is a reasonable one, because a shared number settles arguments that would otherwise run on taste and seniority. Experience measurement inherited that instinct early, and most of the standard instruments still in use were built to travel well across companies and industries. The cost of that design choice surfaces later, when a leader asks a score to explain a specific failure inside a specific journey.

Bespoke is the claim worth defending. The future of experience measurement is company-specific and journey-specific rather than borrowed and benchmarked. That position appears in The Customer Excellence Enterprise as the ninth operational bold move, reimagining experience measurement. It has only sharpened since, because the work has moved into pharma, where the distance between a score and an action is widest.

Standard instruments were designed to be comparable

A score that means roughly the same thing in retail, in banking and in healthcare can be trended, benchmarked and defended in a boardroom. That portability is why the standard set spread so quickly, and it deserves respect rather than dismissal. Fred Reichheld's original case for Net Promoter Score in Harvard Business Review was an argument about growth, and for that purpose it largely holds. Bain reports that differences in the score explain anywhere from 10% to 70% of the variation in subsequent revenue growth.

That range rewards a moment of attention. It says the signal can be real, and it says a great deal else is moving at the same time. A measure built to be comparable across companies is, by construction, insensitive to the particular thing any one company is trying to change. Comparability and sensitivity pull against each other, and most measurement regimes never acknowledge the trade.

What a score reports and what it withholds

A relationship score tells a leader how a relationship feels in aggregate. It does not tell that leader where a journey stopped progressing, which is the only question an operator can act on tomorrow morning. Ask a frontline manager what a two point drop means for the shift she is about to run, and she will rarely know. The score was never built for her, so the failure is a design gap rather than a comprehension gap.

There is a further nuance that practitioners raise less often than they should. Likelihood to recommend measures the advocacy a company values, which makes the most widely held experience metric in the world fundamentally company-centric. Customers in the ordinary flow of their lives do not think in those terms. Measuring from the company's vantage point rather than the customer's is what drains an instrument of its capacity to move anyone to act, a problem examined further in the case of Net Promoter Score in pharma .

Reporting on a field experience metric designed for pharma field teams, CXM quoted a line I still use with clients. "Doctors don't go around asking about loyalty." The point concerned vantage rather than doctors, because what a customer is trying to do is the only honest basis for a measure. Measurement written in the customer's own terms tends to survive contact with the operating model, and measurement written in the company's terms tends not to.

Scores and journey measures belong in one frame

The position in the book was never that scores are worthless. Top-level experiential outcome metrics such as Net Promoter Score, customer success measures and company and journey-specific indicators are what equip leaders to reinforce the importance of customer value. Those measures belong linked to financial performance through objectives and key results, so that experience work and enterprise performance share one set of causal relationships. The real argument is narrower and harder than abolition.

A score without a journey-specific companion measure cannot be acted on. The companion measure is the intermediate layer, the granular driver that inflects the headline number and the business result sitting above it. Gartner's effort research shows how much lives in that layer. Low effort customers are 61% more likely to stay , and 62% of channel transitions are high effort , yet neither figure appears on a relationship dashboard.

What bespoke measurement means in practice

A bespoke regime starts from three decisions rather than from a metric catalogue. The first is which journeys the company actually competes on, because a company competing on access cannot be measured the same way as one competing on continuity. The second is which experiential factors it has chosen as its basis of competition. The third is where the thresholds sit, set per organization rather than inherited from an industry average.

Thresholds are the step most programs skip. A borrowed benchmark imports another company's operating reality, its customer mix and its cost structure, then quietly becomes the standard internal teams are judged against. Setting thresholds internally forces an organization to state what good looks like in its own terms and at its own cost. That statement is uncomfortable to write, which is usually a sign it is doing some work. The practical mechanics of this sit in the broader question of how to measure customer experience in pharma .

The Consumer-Grade Specification is a worked example

The most concrete instance of bespoke measurement in this practice is the Consumer-Grade Specification. It is a closed structural set of six conditions: Recognition, Anticipation, Coherence, Effort, Resolution and Visibility. Felt attributes such as easy, simple, fast and transparent are treated as reported outcomes rather than as design targets, because each of them decomposes into those six conditions. Thresholds are set per organization, which is what keeps a specification a specification rather than an aspiration.

The discipline of a closed set matters more than the elegance of any single condition. When a customer reports that something felt hard, the specification asks which condition failed, and the answer points at an owner and at an intervention. Recognition failures live in different systems from Resolution failures, and Visibility failures rarely sit where either of those do. A mood word cannot route work, where a structural condition can, which is the whole reason Consumer-Grade is written as a standard rather than as a sentiment.

Progression rather than sentiment

Sentiment tells an organization how it went. Progression tells it whether it went. That distinction is what makes a bespoke regime rigorous rather than merely local, because progression can be counted without asking anyone how they felt about it. Progression measurement also survives the two conditions that quietly degrade survey-led programs, which are falling response rates and the lag between a lived moment and a recalled one.

Progression is a stage in an operating loop rather than a reporting line. In the closed FieldOS loop that runs underneath field intelligence and activation work, Measure Progression sits fifth, after a signal is captured, a barrier is classified, an owner is assigned and an intervention is made. Learning follows it. In the commercial organizations where I have watched this work, measurement placed inside that sequence changes behavior, where measurement delivered as a quarterly readout largely does not.

In pharma the journeys are already named

Pharma states the case cleanly, because a commercial organization there does not control the transaction between its science and a patient. The journeys are the Path to Prescribe, the Path to Fulfill and the Path to Adhere, and progression along them is measurable on a stage ladder. The rungs are Scripts Written, Filled, Therapy Started, 90-Day and Persistence. Each rung is a count rather than a rating, which means it can be observed, owned and forecast.

Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value, and the distance between the two is where commercial value quietly goes. Dropout between rungs is largely experiential rather than clinical or promotional. A relationship score cannot see that drop at all, where the ladder can see little else.

Summary measures a finance organization can carry

Two summary measures sit above the ladder and make it legible to people who do not work in experience. The Realization Rate is realized value divided by earned value, and it states how much of what the science earned actually reached a patient. Customer Value at Risk is earned value multiplied by one minus that rate, which turns the shortfall into a figure a finance organization can carry into a planning conversation. Both are arithmetic over counted events, which is why they behave like operating measures rather than like sentiment.

The compounded version of that arithmetic deserves to be stated as an illustrative scenario rather than as a benchmark. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled, less again after early discontinuation, and close to four hundred and fifty million in realized value after long term adherence erosion. No competitor takes the difference. That shape is what value leakage looks like when it is finally measured, and only a progression measure can see it.

A borrowed score cannot be forecast with any confidence, because no one can model next quarter's likelihood to recommend from first principles. A progression measure can be forecast, because it is assembled from counted events with observable conversion behavior between stages. That single property moves experience measurement out of the insight function and into the planning cycle. Forrester reports that customer obsessed organizations saw 41% faster revenue growth than the rest, and instruments are how that posture becomes operational.

Key Takeaways

Standard experience instruments were designed for comparability across companies, which is precisely what makes them insensitive to the thing any one company is trying to change.
A score reports how a relationship feels in aggregate, while an operator needs to know where a journey stopped progressing.
Top-level outcome metrics still earn their place when they are linked to financial performance through objectives and key results and paired with journey-specific companion measures.
Bespoke means journeys the company competes on, experiential factors it has chosen as its basis of competition, and thresholds set per organization.
The Consumer-Grade Specification gives that idea a closed structural form through Recognition, Anticipation, Coherence, Effort, Resolution and Visibility.
In pharma, progression on the three paths is countable on a stage ladder, which makes the Realization Rate and Customer Value at Risk forecastable in a way no borrowed score can be.

Diagnostic Questions to Consider

Name the journeys your organization actually competes on, and state which measure sits on each one.
Describe what a two point move in your headline experience score instructs a frontline manager to do differently tomorrow.
Identify where your current thresholds came from, and say whether any of them were set inside your own operating reality.
Locate the point in each journey where progression most often stops, and name the owner of that point.
Explain how your experience measures enter the planning cycle rather than the quarterly insight readout.

Closing Reflection

The appeal of a borrowed measure is that it arrives already settled. Someone else did the construct work, the benchmark exists, and the number can be reported without an argument about what it means. I have come to treat that convenience as the signal to look harder, because a measure that cost an organization nothing to adopt tends to ask nothing of it either.

Bespoke measurement is more expensive at the front end and considerably cheaper afterwards. It requires an organization to say which journeys matter, which experiential conditions it will compete on and what good looks like at its own thresholds. Those three statements are strategy expressed as arithmetic, and once they exist the measurement regime largely designs itself.

For pharma the stakes make the choice less optional than it looks. A commercial system that sits inside the therapeutic value chain cannot govern value realization with an instrument built to compare companies rather than to track patients through a journey. Experience is the mechanism by which scientific value becomes patient and commercial impact, and a mechanism has to be measured where it works.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Experience Alpha Through Customers for Life Marketing

Tue, 21 Jan 2025 03:57:07 GMT

Experience alpha is the increment in realized value a commercial system produces above what the same brand, the same product and the same spend would have returned without the experience. In pharma that increment is recovered rather than invented, and the field is where most of it sits.

Organizations are measured on what they can start and rarely on what they can finish. Budget cycles reward created demand because created demand is visible inside a quarter, while the slower work of seeing a decision through leaves a thinner trail. Most commercial planning prices the first half of the job accurately and the second half barely at all.

In pharmaceuticals that asymmetry carries a sharper edge, because a manufacturer does not control the transaction between its science and the person who needs it. A written prescription is intent rather than realized value, and intent has to survive a fulfillment process, a benefit design and a year of ordinary life before it becomes therapy. Intent is fragile in ways spend reports never show. The commercial system that earned the intent is often not the system resourced to protect it.

What alpha means when it is borrowed carefully

Alpha in capital markets is a precise term rather than a flourish. It names the excess return an investment produces above its index, once the market's own contribution has been accounted for. A manager whose return merely matches the index has produced none of it, whatever the headline number looks like. Alpha is a residual rather than a result.

In The Customer Excellence Enterprise I carried that term across into customer relationships and named the result experience alpha. Applied to a customer-centric commercial organization, experience alpha is the increment in realized value above what the same brand, the same product and the same spend would have produced without the experience. The benchmark is the organization's own counterfactual rather than a competitor, which is what makes the measure both uncomfortable and useful.

The retention arithmetic underneath the claim

The economics beneath experience alpha will be familiar to anyone who has read a loyalty study. The cost to acquire a new customer runs five to twenty-five times the cost to retain one. It is far too costly for companies to be caught in a vicious cycle of continuously acquiring new customers while existing ones are disenfranchised.

In pharma the equivalent is a brand that keeps generating new prescribing intent while the intent it already earned quietly fails to become therapy. The spend that created the first prescription is counted, the abandonment that follows is absorbed, and the next campaign is briefed to create more intent. Fred Reichheld made the original loyalty case two decades ago in Harvard Business Review , and the arithmetic has not moved since.

Two questions that leaders tend to merge

The alpha question and the capital question are related and separate, and most commercial reviews collapse them into one. The alpha question asks for the increment above a benchmark, which is a question about effect. The capital question asks what multiple of the investment returns, which is a question about efficiency. Effect and efficiency are different tests. A system can produce real alpha and still return a poor multiple, and the reverse happens just as often.

Coverage, hit rate and velocity

The multiple decomposes into three terms that commercial leaders already recognize in other contexts. Coverage is the share of consequential moments the system actually reaches, which is a question of reach rather than activity. Hit rate is the share of those moments where the intervention changes the outcome. Velocity is how quickly that change shows up as progression once the intervention lands.

Each term fails differently, which is the practical value of holding them apart. A system with wide coverage and a low hit rate is busy and largely inert, and its reports will look healthy for some time. Diagnosing which of the three is binding usually matters more than another increase in effort.

Cycle time as compounding frequency

Cycle time is the fourth term, and it measures nothing about the quality of a single loop. It sets how many times a year that loop runs, which makes it the compounding frequency of the whole multiple. Treating it as an operational detail leaves the most leveraged variable in the model unattended.

A field organization that detects a barrier, assigns it and closes it inside a month compounds its learning twelve times in a year, while one that takes a quarter compounds four. The second organization may look identical on a coverage report and will return a materially smaller multiple on the same investment. In the organizations I have worked inside, cycle time is where the difference between two similar field models tends to live.

The arithmetic that makes the alpha real

The share of earned value that becomes sustained therapy is the Realization Rate . Customer Value at Risk is earned value multiplied by one minus that rate, which turns a value leakage story into an exposure figure a finance partner can test. Experience alpha is the recovered portion of that exposure, which is precisely why it competes for capital against the alternative of creating more intent.

Work published with TheyDo traced the sequence as an illustrative compounded scenario rather than a benchmark. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled, less again after early discontinuation, and close to four hundred and fifty million in realized value once long term adherence erosion is counted. No competitor takes the difference.

That shape carries a repricing argument worth stating plainly. If less than half of created intent survives to realization, the marginal dollar spent protecting existing intent now earns more than the marginal dollar spent creating more of it. The case for a commercial return on experience rests on that comparison rather than on sentiment about customers.

Ideal Experience Attributes carry the increment

Alpha of this kind rarely arrives from a campaign, because it is produced by how an organization shows up. The construct is Ideal Experience Attributes, five to seven of them, defined by the organization rather than imported from a consumer category. They are attributes rather than principles, and the distinction matters because an attribute can be trained, observed and measured.

In the book I worked through seven attributes that turn helpfulness into preference, namely empathy, context, reciprocity, relevance, differentiation, goodwill and trust. A pharma organization tends to arrive at a different set, because its moments sit inside a clinical workflow rather than a retail one. The discipline is the same, and naming them is what makes them part of the company's DNA rather than part of a deck.

Training and measuring for named attributes is what moves them from language into behavior, and behavior is what a customer experiences as character. In our work those attributes are embedded in FieldOS , the operating blueprint for field intelligence and activation. Its closed loop runs in six stages, Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, then Learn and Improve.

Preference is the payoff and goodwill is the balance

Preference is earned, never granted. It is what the attributes buy, and it behaves as a leading indicator rather than a lagging one. The level and intensity of preference across a customer portfolio signals current performance and the prospect of earning enduring relationships. In a clinical setting preference shows up as the therapy a prescriber reaches for when the week is crowded and the tolerance for administrative risk is thin.

Goodwill is the running balance behind that preference, a virtual account that takes deposits when experiences land and debits when they do not. No commercial system is perfect, so the balance largely determines whether a customer grants the benefit of the doubt after an inevitable misstep. Bain is blunt about the limit of that balance, describing goodwill as "a necessary but insufficient condition for generating revenue growth."

The conversion from goodwill into revenue has to be designed, and that design lives after the clinical decision rather than before it. Gartner has found that low effort customers are 61% more likely to stay with a company, which is the kind of leading signal a progression measure is built to catch. Forrester reported that customer obsessed organizations saw 41% faster revenue growth than the rest.

A contrarian claim about the field in the age of AI

This argument reaches a conclusion about the field that runs against the direction of much current planning. The field is the most expensive channel in pharma and also the most brand-defining, because it is where a company is experienced as a character rather than as a message. Character is harder to copy than a message. Channels that carry that much brand weight are candidates for reassertion rather than quiet reduction.

AI did not replace the field organization, it made it more valuable than ever, because the scarce input is now observed context rather than another message. AI will not make a fragmented commercial model customer-centric, since it makes whatever operating system already exists faster and more scalable. A fragmented system with better models often produces faster fragmentation.

That is why field force effectiveness deserves to be reframed as a value realization question rather than an activity question. The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. The paper carrying this argument in full is titled The Field Multiple, and the multiple is the capital half of the case.

What changes once the increment is measured

Every interaction either compounds value or creates drag, which is the plainest statement of the tenet beneath all of this. Once an organization can name its Realization Rate, its exposure and the increment its experience produces, the discussion stops depending on conviction. A finance partner can argue with a number rather than with a belief.

None of this reflects a shortage of patient commitment. Patient centricity is native to the industry, and the change in front of it is entering an arena where people have choice and compare what they are given. Experience is the third leg of the value proposition alongside product and brand, and it is the leg that was never deliberately built.

Key Takeaways

Experience alpha is the increment in realized value above what the same brand, product and spend would have produced without the experience.
The alpha question and the capital question are separate, and merging them hides which half of a field investment is underperforming.
The field multiple decomposes into coverage, hit rate and velocity, with cycle time acting as the compounding frequency of the whole.
Customer Value at Risk is earned value multiplied by one minus the Realization Rate, and experience alpha is the recovered portion of that exposure.
If less than half of created intent survives to realization, protecting existing intent earns more at the margin than creating more of it.
Ideal Experience Attributes, five to seven of them, become part of a company's DNA only when they are trained for and measured.

Diagnostic Questions to Consider

State the Realization Rate of your lead brand and the Customer Value at Risk that follows from it.
Separate your field investment case into the increment it produces above a benchmark and the multiple it returns on capital.
Decompose that multiple into coverage, hit rate and velocity, and name which of the three is currently binding.
Measure the cycle time between a barrier being observed in the field and a measured change in progression.
Name the five to seven Ideal Experience Attributes your organization trains for, and state how each one is observed.

Closing Reflection

The pull toward acquisition is structural rather than foolish, because created demand is easier to attribute and easier to defend in a planning meeting. Protected value leaves a quieter trail, and quiet trails lose budget arguments to loud ones. Experience alpha exists to give the quieter half of the work a number that survives the same scrutiny.

What makes this more than a measurement exercise is where the recovered value actually comes from. It was already earned, by the science, by the brand and by the clinical decision somebody made in good faith. Allowing it to dissipate in a fulfillment process or a crowded clinical week is the most expensive thing a commercial system can do without anyone noticing. Nobody else collects it.

The field is the channel standing closest to that dissipation, which is why the age of AI makes it more consequential rather than less. A capable field organization that sees barriers early and closes them quickly compounds value that no campaign can create a second time. That is the argument, and the arithmetic is now available to test it.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] The CMO's New Customer Centric Imperative

Sat, 18 Jan 2025 21:04:20 GMT

Organizations rarely fail to notice a gap in accountability. They fail to decide who closes it. The chief marketing officer sits on one of the most visible of those gaps. The response over the past decade has been to widen the job rather than to resolve it.

Marketing's remit has been stretched twice. First into demand generation, where the function absorbed pipeline, lead quality and the machinery that produces both. Then into revenue, where the function took on a number that every other part of the commercial system also touches. Both expansions were real, and both were earned, and neither closed the gap the role actually sits on.

That gap is narrow enough to state in a single sentence. Marketing is measured on the formation of intent and almost never on its survival. A campaign can perform, a brand can win preference, a customer can decide, and the value of that decision can still leak away in everything that happens next.

Two expansions of the remit that left the real gap open

Demand generation gave marketing a pipeline and a defensible contribution to it. Revenue accountability gave marketing a seat in conversations about growth that it had often been invited to observe rather than shape. Each move raised the stature of the function, and each move also tied it more tightly to the moment of decision rather than to the outcome of one.

The consequence shows up in how marketing performance is reviewed. Awareness, consideration, conversion and the cost of each are measured with real discipline, often to a level of precision the rest of the business cannot match. What the customer went on to get, and whether the value promised at the point of decision was ever realized, usually belongs to somebody else or to nobody at all.

Why a converged category stops rewarding better messaging

There is a cognitive reason this matters more now than it did, and it has little to do with media. Customers often cannot meaningfully separate their perceptions of one company from the next. Every competitor works to influence, guide and compel a preference. Customers are frequently left with the impression that all the companies involved in a decision are generally positive and generally the same.

I describe that effect as positivity bias, and its commercial consequence is severe. It marginalizes, homogenizes and commoditizes value propositions, which quietly counteracts the expensive brand messaging and advertising built to differentiate them. What remains is head to head competition over features, functions and price, which is the condition most mature categories now describe as normal.

A CMO whose category has converged is therefore being asked to differentiate on message in a market where message no longer differentiates. The budget may be intact and the creative may be excellent. The medium of differentiation has moved, and it has moved toward what the customer actually experiences in the course of trying to get something done.

What a retailer understood about where competition gets decided

Nordstrom is the example I keep returning to, because the choice it made was structural rather than promotional. In a retail category where assortment and price can be matched inside a season, the company tilted the basis of competition toward a warm and welcoming shopping experience. Attentive frontline staff, hassle free returns long before returns were easy anywhere, and a visible commitment to exceeding expectations inside every interaction became the thing that was hard to copy.

Starbucks made a comparable choice at its first store in Pike Place Market. Quality, taste and price of coffee could be matched by other specialty houses. The company built differentiated value in the emotional and experiential dimensions instead, through the physical environment, the barista interaction and personalization. In the book I called the broader shift Experiential Commerce, a way of naming how experiential factors entered lifecycle decisions alongside product and brand rather than trailing behind them.

An experience-led growth strategy belongs inside corporate strategy

The constructive version of this argument sits at the level of strategy rather than campaign. An experience-led growth strategy carries three features that distinguish it from the customer experience plans most companies have written. The first is structural. Such a strategy must be a subset of corporate strategy rather than something created in a vacuum. It flows from enterprise mission, objectives and key results before it ladders down into any measurement framework.

The second feature is a choice about where to compete. The strategy must name the experiential battlefields the company elects to contest beyond its core products and services, based on its own view of the customer and the opportunity landscape. Few companies make that choice explicitly, which is why so many experience programs read as a list of fixes rather than as a position.

The third feature is where the argument earns its name. An experience-led growth strategy must act as a strategic revenue driver across every stage of the customer lifecycle rather than as a post-purchase concern. It begins at awareness and acquisition, carries through consideration and conversion, and continues into usage, renewal and referral, influencing corporate objectives and customer goal attainment at each of those stages.

The economics of intent that does not survive

The economics here are not subtle, and they are the reason this sits with a CMO rather than with a service function. The cost to acquire a new customer runs five to twenty-five times the cost to retain one. That ratio makes the vicious cycle of continuous acquisition alongside disenfranchised existing customers far too costly to sustain. Marketing bears the acquisition cost twice when the first relationship fails quietly.

The external evidence points the same way. Forrester's customer experience index reported that customer obsessed organizations saw 41% faster revenue growth than the rest. Gartner's work on effort found that low effort customers are 61% more likely to stay , which is the kind of signal no open rate will ever produce.

Bain adds the caution that keeps this honest, calling goodwill "a necessary but insufficient condition for generating revenue growth" in its own research on loyalty. Favorable sentiment rarely converts itself. Somebody has to design the conversion, and that design work sits closer to marketing than to any other function in the building.

What changes when the customer is a prescriber and a patient

None of this is a pharmaceutical argument yet, and the translation is where it becomes uncomfortable. A pharmaceutical CMO owns narrative, evidence and credibility, which are three of the hardest assets in commercial life to build. That same CMO owns almost none of what happens after a prescribing decision has been made.

After the decision, the value of the science travels through coverage checks, prior authorization, pharmacy fulfillment, specialty logistics, onboarding, titration, support programs and the long arithmetic of persistence. I think of those stretches as the Path to Fulfill and the Path to Adhere, and they sit largely outside the marketing organization's instruments and budget. The commercial system in pharma is part of the therapeutic value chain, and experience is the mechanism by which scientific value is realized as patient and commercial impact.

This is where the first doctrinal commitment of my practice does its work. Written prescriptions are intent rather than realized value, because scientific value is realized when the patient accesses, starts, continues and benefits. A brand team can hit every demand measure it owns and still watch a meaningful share of earned value disappear into value leakage that no competitor collects.

Marketing excellence is one domain and Customer Excellence is the fourth

Pharma already runs three recognized domains of commercial excellence with real rigor, namely launch excellence, marketing excellence and sales excellence. Each has owners, budgets, benchmarks and a seat at the planning table. Customer Excellence is the fourth domain , and it is the one that was never built. That absence is why the work of carrying intent through to realization has no natural home.

The imperative that follows is therefore narrower than it first appears. Marketing does not need to absorb fulfillment, support or adherence, and attempting it would be a design error. A CMO occupies a position no other executive does. What that position allows is a refusal to let the work sit unowned, and an insistence that the question of ownership gets settled in the open.

Two measures that make the argument auditable

An argument about unowned work can be dismissed as organizational complaint unless it comes with instrumentation. Two measures turn it into something a finance organization can examine. The Realization Rate is realized value divided by earned value, and Customer Value at Risk is earned value multiplied by one minus that rate.

Those two numbers change the conversation a CMO can have with a chief executive. Instead of reporting reach, response and share of voice against a growth expectation, marketing can report how much of the value it earned was realized and how much remains exposed. I have found that a leadership team may argue about the inputs to those figures for some time. The argument itself tends to be productive. It is often the first occasion on which the organization has had to name who is accountable for the gap.

Key Takeaways

The CMO's remit has widened twice in a decade, and neither expansion made marketing accountable for whether intent survives the journey that follows it.
Positivity bias tends to flatten competing value propositions, which leaves message based differentiation working against the grain of how customers actually decide.
An experience-led growth strategy sits inside corporate strategy, names the experiential battlefields a company chooses, and drives revenue across every lifecycle stage rather than after purchase.
Retention economics are unforgiving, because the cost to acquire a new customer can run five to twenty-five times the cost to retain one.
A pharmaceutical CMO rarely owns what happens after a prescribing decision, so the practical imperative is to insist that somebody does.
The Realization Rate and Customer Value at Risk give marketing a language for value that a finance organization can audit.

Diagnostic Questions to Consider

Whether marketing's scorecard stops at the formation of intent or follows that intent through to realized value.
Which experiential battlefields the company has actually chosen, and whether anyone outside marketing can name them.
Where value leaves the system after a prescribing decision, and which function is accountable for each of those losses.
What the Realization Rate is for the largest brand in the portfolio, and who is responsible for reporting it.
Whether the experience leg of the value proposition has a designer, a budget and an owner, or only a set of good intentions.

Closing Reflection

The three legs of a value proposition are product, brand and experience. Pharma has built the first two to a standard few industries can match, and has largely left the third to default while the other two were designed. A CMO is the executive most exposed to that asymmetry, because the promise made at the point of decision is made in marketing's voice.

I learned the standard for this outside pharma, at The Ritz-Carlton Leadership Center. The Credo there names the genuine care and comfort of guests as "our highest mission" , a line every employee could recite. More to the point, the operating model behind it made the sentence true in practice. Culture of that kind does work no campaign can do, and it is built deliberately rather than declared.

The customer centric imperative for a CMO is not a request to care more. It is a request to carry accountability further down the lifecycle than the role has traditionally been asked to reach. Every stretch the role cannot reach itself needs a named owner. A function measured only on the formation of intent will keep producing intent, and the organization will keep wondering where the value went.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Operationalizing Voice of the Customer for Commercial Success

Fri, 17 Jan 2025 14:55:23 GMT

Most organizations have built a listening program. Very few have built a listening system. A program collects what customers say, while a system routes it to an owner, acts on it, and can show what changed. That difference decides whether customer voice earns its place in a commercial model or quietly becomes another reporting obligation.

A listening program collects and a listening system acts

Institutions rarely fail to hear their customers. The more common failure arrives after the hearing, when nothing consequential happens to what was heard. Collection has become cheap and abundant, so the scarce capability is no longer capture at all. The scarce capability is consequence, which has to be organized rather than inherited.

In pharma this gap costs more than it does in most industries, because the commercial organization does not control the transaction between its science and a patient. Everything the organization learns has to travel through other people's hands before it can become an effect. A signal that stops inside a report becomes a liability, because the asking continues while the acting does not.

Asking without acting teaches customers that the asking is ceremonial

A customer who is asked and then sees nothing change has learned something durable about the organization that asked. The lesson is that the question was ceremonial, and that lesson costs more trust than never asking would have cost. Survey fatigue is often described as a measurement problem, and in my experience it is closer to a credibility problem. Response rates fall because customers have correctly inferred that their answers do not travel anywhere.

Amazon's chair at the table is often read as a ritual, and the reading is incomplete. The empty chair in the meeting room works because something follows it, which is a decision that someone can be held to. Organizations that sustain customer voice tend to have both the ritual and the decision rule, and they rarely confuse one for the other.

Leaders who get this right behave differently at a structural level rather than an attitudinal one. They not only listen actively and value customer feedback in their individual decisions, they integrate the customer perspective into their thinking and their management systems. That integration shows up on a deliberate cadence, inside the monthly and quarterly business reviews where resources are actually moved. Customer voice that cannot survive contact with a resource allocation conversation has no mechanism for becoming an outcome.

Deloitte found that 82% of life sciences executives are satisfied with their customer engagement strategies while only 28% of physicians say those strategies meet their needs. A gap of that size rarely reflects indifference, and it often reflects a signal path that confirms rather than corrects.

Four conditions separate operational voice from ceremonial voice

Four things make customer voice operational, and their absence is usually what people mean when they say a listening program went quiet. The first condition is a route , which can be supported by technology without being a technology decision. Signal has to have somewhere to go that is not a report, which means a named destination inside an existing workflow. The test is whether the person about to act can see what the customer said in the tool she already uses. If she cannot, the organization has a reporting program rather than an operating one.

The second condition is an owner for each class of barrier the signal reveals. Insight without an owner is an observation, and observations do not consume anyone's week. USAA built this into its operating model through Experience Owners, accountable for one or more journeys across the experience lifecycle.

The third condition is a cadence , so that listening sits inside a management system rather than an annual event. Of the four, I have found cadence to be the one most often skipped, because it obliges leaders to keep a slot open for uncomfortable news. Organizations that listen annually can only act annually, whatever their dashboards say about real time.

The fourth condition is a measure of what changed , so the loop closes visibly and the next round of asking stays credible. Gartner has reported that low effort customers are 61% more likely to stay , which is the kind of movement a working system should be able to claim. Measurement here works less as reputation than as the mechanism that makes the next question worth answering.

The closed loop that turns signal into consequence

These four conditions assemble into a single mechanism, and inside FieldOS that mechanism is a closed loop with six stages. Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, Learn and Improve. Each stage exists because a program missing it fails in a predictable way, since classification without ownership produces a taxonomy and intervention without measurement produces activity.

AI sits at the center of that loop rather than occupying a stage of its own. Its work is to classify at volume, hold context across interactions and keep progression visible. That placement matters, because AI will not make a fragmented commercial model customer-centric. It makes whatever operating system already exists faster and more scalable.

The health of the loop can be measured directly, and the measure is the Transfer Coefficient. It is the proportion of meaningful intelligence that survives the journey from customer observation to consequential organizational action and measured effect. A low coefficient rarely indicts the people doing the listening, because it describes a design gap rather than a character gap.

Scale comes from consistency and co-design rather than a center

Sustainability and scale are usually treated as sequencing problems, where a pilot proves the case and a rollout follows. The more reliable path runs the other way. Rather than isolating the practice in a centralized or isolated part of the organization, the aim is enterprise wide consistency from the start. Consistency is also what makes signal comparable, because a barrier classified one way in one market and differently in another cannot be aggregated into an argument for investment.

Adoption is then de-risked through co-design, for a reason that has little to do with change management fashion. What must be owned from inside cannot be installed from outside, and a listening system is either owned or decorative. Outsiders can facilitate the design, though the substance has to come from the collective consciousness of the organization itself. Employee led co-design is itself an activation strategy, because it produces ownership and therefore accountability.

Knowledge diffusion carries the rest of the distance, because a multidisciplinary design team of respected colleagues spreads the practice faster than any communications plan can. Demand pull for customer insight, rather than a push from a small team selling the customer's voice, is the clearest sign that a system exists.

In pharma the richest source of voice is the frontline

Pharma's listening problem has a particular shape, because the industry's most valuable customer signal does not arrive through a survey instrument. It arrives through people. The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. A field colleague learns that an account's prior authorization pathway has changed weeks before the fill data shows the consequence.

I have watched this pattern repeat, where the colleague who notices tells someone and the telling has nowhere to land. That signal then gets treated as anecdote, which is a reasonable thing to do with information that has no route. Anecdote is what intelligence becomes when there is no classification scheme, no owner and no cadence waiting for it. The voice of the frontline is not a substitute for listening to customers directly, and it belongs inside the same voice of the customer architecture with a different job. Direct listening establishes what customers value, while frontline listening establishes where that definition is being defeated account by account.

Why field intelligence outperforms the instruments brands rely on

The brand team ostensibly owns the brand end to end, though its instruments sit almost entirely in the Path to Prescribe. Prescribing data, market research, message testing, share tracking and promotional response all describe intent and attention rather than progression. They are poor instruments for finding out why a patient who was prescribed never started.

Field intelligence has four properties that make it unusually hard to argue with. It is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke. That last property matters most operationally, because signal arriving with its context attached can be classified and assigned in the same week it was captured.

None of this diminishes the field organization's selling role, though it does change what that role is worth. AI did not replace the field organization, it made it more valuable than ever, because the sensing half of the job is now the scarce half. The talking tools have largely converged, while the listening systems have not.

The Realization Rate is the number a working system moves

A listening system has to be justified in the same terms as any other commercial capability, which means it needs a number. Scientific value is realized when the patient accesses, starts, continues and benefits, rather than when the script is written. Written prescriptions are intent, and intent is not realized value. The Realization Rate , realized value divided by earned value, is the number that distinguishes the two.

Every barrier the frontline captures and the organization resolves moves that ratio, while every barrier left unclassified shows up later as value leakage. Bain's work on loyalty economics puts the general case plainly, describing goodwill as "a necessary but insufficient condition for generating revenue growth." Sentiment that is never converted into a changed process is goodwill with no transmission mechanism. Forrester's index points the other way for organizations that do convert, reporting 41% faster revenue growth among customer obsessed organizations.

Measurement choice becomes consequential here, because a system reporting a score and a system reporting a barrier resolved are doing different work. How experience gets measured in pharma therefore decides whether the listening system has anything to show for itself. Customer Excellence as an enterprise capability depends on that showing, rather than on conviction about customers, which pharma has never lacked.

Key Takeaways

Most organizations have built a listening program, and very few have built a listening system that can be shown to have acted.
Collection without a route costs more trust than never asking, because customers correctly infer that the question was ceremonial.
Four conditions make voice operational: a route, an owner for each class of barrier, a cadence, and a measure of what changed.
Scale comes from enterprise wide consistency and employee led co-design, because what must be owned from inside cannot be installed from outside.
In pharma the frontline is the richest available source of voice, because its signal is observed, account specific, current and attached to the moment progression broke.
The Realization Rate is the number a working listening system moves, which is what makes the capability arguable in commercial terms.

Diagnostic Questions to Consider

Name the destination a customer signal reaches inside an existing workflow, and the person who acts on it once it arrives there.
Identify the owner for each class of barrier your listening already reveals, and whether that ownership appears in a performance objective.
State the cadence on which customer signal enters monthly and quarterly business reviews, and what has been reprioritized as a result.
Calculate the proportion of meaningful frontline intelligence that reaches consequential action and measured effect.
Decide which number the listening system is accountable for moving, and whether that number describes sentiment or progression.

Closing Reflection

The organizations that get this right are rarely the ones that listen hardest. They are the ones that built somewhere for listening to go, then protected that path when it became inconvenient. A route, an owner, a cadence and a measure are unglamorous commitments, and they are the whole of the difference between a program and a system.

For pharma the stakes are specific. Value the science has earned is lost in the distance between a decision and a therapy that continues, and much of that distance is visible to someone in the field this week. Whether that observation becomes an intervention depends on a design choice that costs less than most of the alternatives being funded instead.

Exceptional science deserves an exceptional commercial system, and a commercial system that cannot hear its customers falls short of that standard at any level of investment. The listening is the cheap part. The acting, the owning and the proving are where the capability actually lives.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PRACTICE NOTE] Up-Leveling Voice of the Customer for Competitive Advantage

Wed, 15 Jan 2025 19:01:49 GMT

Voice of the customer is usually run as a measurement function, and it belongs in the strategic half of the commercial system. The difference shows up in the portfolio rather than on a dashboard.

Organizations listen in the way they are built to listen. A function assembled to report will produce reports, and a function assembled to decide will produce decisions, whatever arrives at the door. Voice of the customer has spent most of two decades inside the reporting half of that divide. Pharma inherited the arrangement intact and had reasonable grounds to keep it.

Those grounds deserve respect. A manufacturer that does not control the transaction between its science and a patient has every incentive to measure what it can defend. The cost arrives later, when the listening apparatus can describe sentiment in detail and still cannot tell a brand team what its customers' lives are about to require. Up-leveling is the work of closing that distance.

Three levels of listening, and only the third is strategic

Voice of the customer can be run at three levels, and the levels form a progression rather than a menu. The first produces a score, the second a diagnosis, the third foresight. Each level costs more to operate than the one beneath it and returns something that one cannot see. Most organizations run the first, fewer run the second well, and almost nobody runs the third on purpose.

Voice as a score tells an organization how it is doing

At the first level the organization learns how it is doing. A score is comparable across periods, benchmarkable against peers, and simple enough to survive a quarterly review. Those virtues are real, and the research underneath them was sound. Fred Reichheld's original loyalty research argued that what customers say about a company predicts how it will grow.

Bain reports that differences in Net Promoter Score explain anywhere from 10% to 70% of the variation in subsequent revenue growth. A range that wide is a finding about listening rather than an instruction to install an instrument. Most industries drew the second lesson, pharma among them.

A score is also close to impossible to act on. Two brands carrying the same number can be failing for opposite reasons, one losing patients at fulfillment and the other at the first refill. I have watched capable teams spend a full cycle debating a two point movement that no decision depended on, which is part of why Net Promoter Score in pharma has aged poorly.

Voice as diagnosis finds where a journey stops progressing

The second level asks where progression breaks and for whom. Measurement here attaches to a stage rather than to a relationship, which makes it specific enough to assign to an owner. A prescription written and never filled is a measurable event with a cause, and that cause usually sits in a handoff rather than in a sentiment.

This is the level at which value leakage becomes visible as something other than an accounting surprise. Each break has a location on the Path to Prescribe, the Path to Fulfill or the Path to Adhere, and each carries a measurable effect on the Realization Rate. Gartner's work on service channels found that 62% of customer service channel transitions are high effort , and every handoff between pharma functions is one of those transitions. Diagnosis of that kind is genuinely actionable, which is why it earns its investment.

Its limitation is that it remains reactive, because a diagnosis describes a journey that already exists, built around a need the market recognizes. Deloitte's work on engagement shows how far an internal reading can drift from the external one. Only 28% of healthcare professionals believe pharma's customer engagement strategies meet their needs, while 82% of life sciences executives are satisfied with those same strategies . The internal view measures the organization's own effort and the external view measures the customer's, which puts the listening itself in question.

Voice as foresight reads a world before a market forms

The third level is the strategic one. Here the organization learns what its customers' lives are making them need, before any market has formed around that need. Customer consciousness in its upstream sense is exactly this, the capability that produces categories rather than campaigns. Very few organizations run it deliberately, which is why the ones that do tend to look lucky in hindsight.

Signals at this level rarely sit inside an instrument. They sit in what people do when nobody is asking them anything, in what they tolerate, what they work around, and what they quietly reorganize a week to accommodate. In my book I grouped the unmet needs that matter most here as underlying, unarticulated, undervalued, unrecognized and unaddressed. Each category is invisible to a question, because a customer cannot report a need she has not yet named.

What observation catches that an instrument never will

The research behind The Customer Excellence Enterprise was observational and ethnographic rather than survey based. It examined how customer experience outliers such as Amazon, Chick-fil-A, USAA, Trader Joe's and The Ritz-Carlton behave in front of customers, over time, in public. What the method surfaced was a shared organizing principle, which I named helpfulness. No survey would have produced it, because no respondent describes an organizing principle.

Behavior tends to be a better signal than self report, because behavior escapes the courtesy that surveys invite. A physician asked to rate a manufacturer will often be generous, and the same physician, observed, will route around a portal she finds unusable without filing a complaint. Her workaround is the finding, and no instrument was ever going to collect it.

I learned this before I learned pharma. At The Ritz-Carlton Leadership Center, where I led delivery, the Credo names the genuine care and comfort of guests as "our highest mission" . Care of that kind cannot reach a guest who has not first been understood. Forrester reports that customer obsessed organizations saw 41% faster revenue growth than the rest.

The seven conditions of the Convergence Readiness Model

Foresight of this kind can be run as a method rather than left to instinct. The Convergence Readiness Model is the instrument built for it, reading seven conditions in a customer's world. Those conditions are persistent need, normalized burden, identity intensity, cultural readiness, self recognition, scientific unlock and ecosystem potential. When enough of them hold at once, a category is close to forming whether or not anyone has named it yet.

The useful property of all seven is that each is observable in public behavior rather than in proprietary data. Burden normalizes in plain sight, in what people stop bothering to complain about, and identity intensity shows up in how a condition gets discussed by those living with it. A reading like that is available to any organization willing to run it, so the advantage goes to whoever looks rather than to whoever owns the largest dataset.

Pharma's version of the third level has already happened

The clearest recent example here is one I have written about at length. Two companies read the human context of obesity correctly, seeing a need that was metabolic and also bound up with identity, mobility, confidence and standing in a room. Much of the industry treated the result as weather, a demand event to be reacted to rather than a reading to be learned from. My work on customer consciousness and the GLP-1 phenomenon sets out what those companies saw and when they saw it.

What the episode reveals about the commercial system matters more than the category itself. A need that had been persistent for decades, normalized as personal failure, and intensely tied to identity was legible well before a market existed. Reading it required attention to how people live rather than access to a proprietary panel.

The frontline is already running an upstream listening system

Pharma holds an advantage at the third level that most industries would envy. The frontline is one of pharma's most underutilized intelligence systems, encountering barriers long before dashboards detect them. Field colleagues observe rather than recall, in specific accounts rather than sampled ones, and currently rather than in arrears. Their intelligence arrives attached to the moment progression broke, which makes it the most unimpeachable material in the commercial system.

The difficulty here is structural rather than human. Most field organizations have no path by which an observation becomes a consequential decision, so it dies in a weekly call. FieldOS exists to build that path, and its loop runs in six stages: Capture Signal, Classify Barrier, Assign Owner, Intervene, Measure Progression, and Learn and Improve. The Transfer Coefficient measures how much intelligence survives the trip from observation to measured effect, and that proportion is low.

A voice of the frontline capability is not an addition to voice of the customer. It is the part of it that reaches context no instrument can reach. Pharma's position, standing one step away from the patient transaction, makes that reach more valuable here than almost anywhere else.

Voice run at the strategic level becomes a portfolio input

The test of whether up-leveling has happened has little to do with the sophistication of the listening stack. Customer consciousness is the degree to which customer reality is present in decisions before they are made, rather than sentiment about customers. By that test, a program that produces an elegant quarterly report and no earlier decision has up-leveled nothing.

At the first level, voice is a service input. It tells a service organization where to apologize and what to repair. At the second level it becomes a commercial input, informing where to intervene on a journey and what the intervention is worth. At the third level it becomes a portfolio input, informing what to develop, which populations to design around, and which category to enter before it is one. That last move is the one pharma has most to gain from and least practice at.

The instruments are ordinary. Reviews, panels, observation, social listening and field conversation have existed for decades, and the consumer companies that read their markets early mostly used exactly those. The advantage came from treating what the instruments produced as direction rather than as decoration.

Key Takeaways

Voice of the customer can be run as a score, as a diagnosis or as foresight, and the three levels return very different things to the business.
A score is comparable and benchmarkable, and it is close to impossible to act on without a diagnosis underneath it.
Diagnosis locates where progression breaks on the Path to Prescribe, the Path to Fulfill and the Path to Adhere, which makes it assignable and reactive at the same time.
Foresight reads what a customer's life is making her need before a market forms, and the seven conditions of the Convergence Readiness Model make that reading repeatable.
Observation often beats self report, because behavior escapes the courtesy that surveys invite.
The frontline already holds upstream context, and the limiting factor is the absence of a path from observation to consequential decision.

Diagnostic Questions to Consider

Name the last three commercial decisions that changed because of something a customer said or did, and state how far upstream each decision sat.
Describe which of your listening instruments produces a score, which produces a diagnosis, and which produces foresight.
Identify where in your brand plan an unarticulated need appears as a design input rather than as a research finding.
Estimate what proportion of frontline observation survives the trip to a consequential decision inside your organization.
Explain which of the seven convergence conditions your category currently satisfies, and name who is accountable for watching them.

Closing Reflection

Most organizations do not have a listening problem in the sense they believe they have one. They hold a great deal of customer data and very few places where that data arrives before a decision is made. Adding another instrument rarely changes the picture, because the constraint sits in the operating model rather than the collection layer. Much of the work of voice of the customer in pharma is the work of moving the arrival time earlier.

The three levels are cumulative rather than competing. An organization still needs to know how it is doing, and a diagnosis without a score loses its sense of proportion. What changes at the third level is the horizon, because the question stops being how customers are experiencing what has been built and starts being what their lives are about to require. Answering that second question well may be the closest thing pharma has to a durable commercial advantage.

Experience was left to default in this industry while brand and product were deliberately designed, and listening largely inherited the same fate. Rebuilding it as a strategic function is slow work, and it starts with an admission that a score was never going to carry the weight placed on it. Scientific value is realized when the patient accesses, starts, continues and benefits. Listening that cannot see that far ahead has not yet been up-leveled.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[PART 3] Five Essential Shifts to Renew the CMO and Marketer Value Proposition

Sun, 12 Jan 2025 20:19:40 GMT

[Part 3]: The Future of Marketing is Customer-Centric: Five Essential Shifts to Renew the CMO and Marketer Value Proposition

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”: Chapter 10: Reimagining Commercial DNA

Five Essential Shifts to Renew the CMO and Marketer Value Proposition

How can CMOs and Marketers renew their value proposition amid significant change and disruption by Experiential Commerce, AI and the democratization of marketing tech?

In The Future of Marketing is Customer-Centric (PART 3), we build on the fundamental question: Are CMOs, Marketers and Marketing Disposable? that we explored in Part 2 by going in-depth about the 5 essential shifts that CMOs and Marketers can make towards a Customer-Centric Marketing paradigm.

Synopsis. The macroeconomic shift to Experiential Commerce, combined with the rise of the AI replacement narrative and the democratization of digital marketing technology, is redefining the role of CMOs and marketers in real time. This moment presents both a challenge and an unprecedented opportunity:

Are the machines really coming for our marketing jobs?
Will contemporary marketing playbooks—rooted in differentiating product features and functions, brand storytelling, and campaign-driven engagement—still be sufficient in a world where customer experience outliers companies keep resetting the bar?
How will increasing exposure to personalized, frictionless, and emotionally resonant experiences from customer experience outliers shape evolving customer expectations?
How can CMOS and marketers seize the opportunity , rather than succumb to the threat?

With the structural implications of these major forces, CMOs and marketers must redefine their strategic value proposition by championing a DNA-level transformation that extends beyond the traditional remit of the marketing discipline. Yet, true transformation can feel daunting, even paralyzing, as it requires rethinking entrenched assumptions, breaking down silos, and challenging the status quo.

Accordingly, despite years of discussion, many companies have yet to close the gap between talking about customer centricity and actually embedding it into their DNA. The responsibility—and opportunity—to bridge this divide now falls to CMOs and marketers. Stepping up beyond their traditional execution-focused commercial remit, they must lead a broader transformation that redefines how their companies view, value and treat customers. This shift isn’t just about elevating marketing; it’s about reshaping the entire enterprise to align closer to customers and create sustained competitive advantage.

Whether it’s reimagining the retail experience (as Nike does with its House of Innovation) or embedding digital convenience into the customer journey (**as Starbucks has with mobile ordering and rewards**) success in Experiential Commerce hinges on marketing’s ability to influence not just customer perception, but their lived reality. Fortunately, as a guiding light, this journey has been mastered by today’s customer excellence enterprises, those perennial performance outliers that win not just by promoting their products and telling compelling stories, but also by ensuring their promises come to life in every interaction.

(**How the Starbucks mastery of mobile order has impacted the in-store experience is another story for another day!**)

The macroeconomic shift to Experiential Commerce, combined with the rise of the AI replacement narrative and the democratization of digital marketing technology, is redefining the role of CMOs and marketers in real time. This moment presents both a challenge and an unprecedented opportunity—not just for marketing, but for how companies define and measure value itself. This Customer Excellence Transformation is not without form, it is anchored in five essential shifts that CMOs, modern marketers, along with customer experience professionals must collectively facilitate to future-proof their organizations and careers paths.

SHIFT #1. From Tangible to Intangible Value Exchange.

As the modern customer increasingly prioritizes intangible elements of value, Experiential Commerce is reshaping not only customer expectations but also how CFOs and capital markets assess value creation or destruction potential. This evolution is neither anecdotal nor transient; it is structural and customer-led. According to the World Bank, the global economy has steadily transitioned from an industrial, tangible product-based model to an intangible value exchange, now accounting for over 65% of global GDP and more than 75% of GDP in high-income countries (World Bank, 2023) . For CMOs and marketers, this shift presents a massive opportunity: by embracing intangible value exchange, they can expand the dimensions of their brand’s core propositions and position their companies as indispensable partners in customers’ lives. Customer Excellence Enterprises like Airbnb, Starbucks, and Tesla have already proven the case, demonstrating that value is no longer just about what or how a company sells, but about how it integrates into customers’ daily lives—creating ongoing relevance, emotional loyalty, and sustained differentiation. As capital markets increasingly reward companies that deliver on these intangible drivers, CMOs who step up to lead this transformation won’t just redefine marketing’s role; they’ll influence how their companies are valued and positioned for long-term growth.

How to get started on Shift #1. Collaborate with CFOs to quantify the impact of experiential factors on financial outcomes, such as premium pricing, customer stickiness, and reduced churn.

SHIFT #2. From a Campaign-Centric to Customer-Centric Marketing Model.

Experiential commerce in particular is a forcing function for CMOs and marketers to reevaluate the status quo and undergo a paradigm shift—moving from a campaign-centric to a customer-centric marketing model. Marketing has revolved around promotional campaigns, often operating in a hit-or-miss cycle of awareness, promotional and demand generation that prioritizes acquisition and short-term sales spikes over sustained engagement. This “launch and leave” approach leaves enormous untapped value on the table. A customer-centric mindset, in contrast, does not reject campaigns but repositions them within a broader, more holistic strategy —one where marketing is not just about selling but about building meaningful, ongoing relationships. This shift tempers the instinctive over-reliance on promotions with a deeper focus on experience as an organic and enduring component of the value proposition. This evolution requires that marketing move beyond episodic interactions and instead become a steward of the entire customer lifecycle, ensuring that every touchpoint reinforces trust, loyalty, and differentiation.

How to get started on Shift #2. A Lifecycle Mapping Workshop forces marketing teams to step out of the campaign mindset and see the brand through the eyes of the customer. It helps marketers break free from the “launch and leave” cycle of promotional campaigns and instead design experiences that drive continuous engagement, retention, and expansion.

SHIFT #3. Experiential Factors as Equal Partners to Product and Brand Factors in Value Propositions.

The formula 3 < 2 represents a fundamental shift in competitive strategy —recognizing that companies that compete on product, brand, and experience unlock greater opportunities for customer value and differentiation than those that rely solely on the traditional product-brand paradigm. In this new conception, experience is no longer an afterthought or a “nice-to-have” enhancement; it is an equal pillar in shaping customer perceptions, driving preference, and fostering long-term loyalty. Product features and brand reputation may attract initial interest, but it is the experience—how seamlessly, intuitively, and emotionally a company engages with customers— that cements relationships and sustains competitive advantage . Industry leaders such as Apple , Tesla , and Ritz-Carlton have demonstrated that when experience is woven into the value proposition alongside product and brand, it becomes a key differentiator that commands premium pricing, increases retention, and fuels organic advocacy. CMOs and marketers must integrate experience as a core element of customer strategies rather than a secondary support function, future-proofing both their market position and career paths.

How to get started on Shift #3. Move beyond traditional marketing KPIs (impressions, clicks, conversions) to include experiential metrics like customer value-at-risk, emotional engagement scores, and experience-driven retention rates.

SHIFT #4. Evolving from a Transactional to a Relationship-Based Mindset

Another core attribute of the shift to customer-centric marketing is to move beyond transactional interactions to cultivate enduring relationships. Although this shift is as much about organizational mindset as anything, it is best expressed through measurement—marketers must go beyond transaction-based campaign metrics, such as click-through rates and conversions that measure marketing performance at a tactical level. While these metrics provide valuable insights into the effectiveness of campaigns, they fail to capture the broader financial impact and intricate value story of marketing relative to customer acquisition cost (CAC) . For this, customer-centric marketing becomes the rationale to layer in Customer Lifetime Value (CLV) as a strategic metric. CLV provides a forward-looking view of a customer’s long-term value, enabling marketers to assess whether acquisition costs align with projected returns. Furthermore, understanding the causal relationships that drive CLV—such as customer satisfaction, retention rates, and upsell pull through—helps marketers make targeted interventions that move the needle and calibrate strategies with an eye on maximizing lifetime profitability.

How to get started on Shift #4: Integrate CLV as a core strategic metric alongside traditional campaign performance indicators, and identify the key drivers to ensure that acquisition costs align with long-term customer value, making smarter investments that prioritize enduring relationships over short-term wins.

SHIFT #5. Delivering Value Across the Entire Customer Lifecycle

A key feature of this Customer Excellence transformation is rebalancing the marketer’s remit and resource allocation across the entire customer lifecycle . Too often, marketing strategies can over-index on customer acquisition at the front-end of the customer lifecycle, viewing it almost as the exclusive engine of growth while neglecting the untapped potential of customer retention and expansion "beyond the funnel” . Experiential Commerce challenges this mindset by emphasizing the need to provide differentiated value throughout the entire customer lifecycle. Retention becomes more than preventing churn ; it involves consistently delivering value, surprising and delighting customers to integrate into their daily routines and workflows. Expansion, in turn, means unlocking organic opportunities to deepen relationships through natural upselling and cross-selling pathways, grounded in the customer’s known, unknown and ever-evolving needs (the functional variety as well as their societal and emotional counterparts. This more holistic full-lifecycle approach ultimately aligns to the very human desire for customers to seek the comfort and assurance that comes from finding a select few companies to integrate into their lives as trusted partners.

How to get started on Shift #5: A critical first step for CMOs and marketers is to first measure to identify imbalance, then rebalance strategies and resources across the entire customer lifecycle as needed to drive customer value and commercial success.

Customer-Centricity is Winning.

Companies that have embraced this customer-centric philosophy, including “the usual suspects”— Chewy, Amazon , The Four Seasons , Singapore Airlines , Zappos , etc. —and countless others exemplify how a customer and experience-infused value proposition can fuel a customer acquisition, retention, and expansion flywheel of elevated revenue performance and sustained growth. Their success is rooted in designing and delivering seamless, personalized, and emotionally resonant interactions that align to customer preferences, meet customer needs and often provide moments of “wow” to them. For CMOs and marketers, the challenge is clear: to lead their companies in building similar Customer Excellence Enterprises and brand-aligned experience delivery systems that make a clear break from any lingering perceptions that marketing is a cost center rather than an indispensable enabler of enduring customer relationships and outsized success.

Key Takeaways for CMOs and Marketers

With intangible services and experiences becoming the dominant source of value to customers , CMOs must redefine their strategies to align with this new customer reality.
Marketing must evolve beyond episodic campaigns designed to generate short-term sales and instead become a continuous engagement engine that fosters emotional connections that enhance revenue performance, retention, and expansion.
Winning companies integrate marketing into the entire customer journey , ensuring value is consistently delivered.
The traditional product-brand paradigm is no longer sufficient for sustainable differentiation. Companies that embed experiential factors as an organic pillar of their value proposition create stronger customer connections, higher retention, and pricing power. CMOs must champion this strategic shift.
CMOs must lead their companies to move beyond one-time conversions to delivering sustained value and emotional engagement throughout the customer lifecycle.
Marketing has traditionally focused on acquisition , leaving retention and expansion underdeveloped . Future-proof CMOs must extend their impact beyond the funnel , driving customer success, advocacy, and lifetime value by integrating marketing into customer excellence disciplines—engagement, success, experience management, and customer care.

Readiness Questions to Consider

How well does our marketing strategy reflect the shift from tangible to intangible value?
Does marketing operate in isolated, campaign-driven bursts , or is it deeply embedded in the entire customer lifecycle, ensuring customer value beyond promotions?
Do we treat customer experience as a separate discipline from marketing, or is it an equal strategic pillar to product and brand?
Are we still measuring success through transactional KPIs, or do we track relationship-driven metrics ?
Are we only engaging customers pre-sale , or do we play a meaningful role in post-purchase engagement, customer success, and retention building initiatives ?

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

[PRACTICE NOTE] Reimagining Marketing and Sales for Experiential Commerce

Sun, 12 Jan 2025 01:09:19 GMT

CASE-IN-POINT: Reimagining Marketing and Sales for Experiential Commerce

BOLD MOVE: The Customers for Life Imperative. The Shift: Experiential Commerce

Synopsis. In the era of Experiential Commerce, aside from the ubiquitous “funnel”, one thing that unifies marketing and sales organizations is that neither has visibility or accountability for the quality of the end-to-end purchasing journey or customer lifecycle. Often resulting in fragmentation and inconsistency, these disconnects can create excessive effort and frustration for customers as they contemplate purchasing, loyalty and other lifecycle decisions. The stakes are high—the cumulative impact of negative commercial interactions on the overall customer relationship can be uncertain, and the long-term effects on brand perception can be difficult to measure, exposing companies to potentially costly setbacks to revenue performance.

Key Question.

Setting aside the entire customer lifecycle for a moment, are marketing and sales themselves causing customer pain and frustration even before the purchase is complete?

What’s the Situation?

Marketing and sales organizations have typically operated in functional silos, with each focusing on different stages of the purchasing journey. In this common corporate construct, each function may have different views on customer needs, leading to its own tactical priorities, ways of working, and KPIs to hit. Overlaps, friction, and high-risk hand-offs become predictable outcomes of this functional division, potentially causing effort and frustration for customers very early in the customer lifecycle.

Adding another layer of complexity, marketing and sales interactions are often seen as separate from the broader customer experience. With their collective focus on transactional campaigns and sales calls, these interactions are typically not well orchestrated into holistic, integrated commercial journeys. Whether an in-person pitch, a phone call, an email blast, or a digital ad, these interactions can come across as highly variable , influenced by the techniques and stratagems of individual brand managers and sales reps, which can leave customers feeling disoriented as they are forced to navigate through disjointed paths to purchase.

Why Does This Matter?

With the advent of Experiential Commerce, the transition of value exchange from tangible goods to intangible interactions, where the customer relationship is driven increasingly by the quality of experiences rather than solely by products and brand factors. In this model, customers increasingly prioritize exceptional, personalized experiences alongside traditional considerations like product quality, price, and brand reputation when making purchasing and loyalty decisions. It reflects a fundamental shift in consumer preferences and behavior, where emotional connections and memorable interactions are key determinants of value.

Additionally, customer expectations are now set by customer experience "outliers" from outside of traditional industry boundaries and shaped by word-of-mouth feedback from peers on social media and review platforms, a fragmented approach is no longer acceptable. This new paradigm acknowledges that the purchasing journey is no longer linear and that customers interact with companies across a wide range of touchpoints—both digital and physical. Every interaction, including commercial interactions, can leave customers with brand impressions ranging from delightful to confusing to undesirable, with each having corresponding effects as triggers or barriers to purchasing behaviors.

Marketing and sales must also no longer exist through isolated campaigns and sales call transactions but by creating orchestrated, high-value experiences that lead to long-term win-win relationships . Also, gone are the days when these interactions were seen as separate from the broader customer experience. This is consistent with customer preferences as, according to Salesforce, 84% of customers say that the experience a company provides is as important as its products and services, and 70% of buying experiences are based on how the customer feels they are being treated.

Key Issue. Unfortunately, despite these truths, many companies continue to view marketing and sales interactions as immune from the idea of delivering high-quality customer experiences.

What CXEs Do: Turn "Ideal Experiences" into Unique Selling Propositions

Rather than being viewed as a threat, Experiential Commerce offers CMOs, modern marketers, sales leaders and other commercial practitioners the opportunity to realign their marketing and selling capabilities to the way customers are evaluating options and making purchasing decisions. Following the practices of Customer Excellence Enterprises (CXEs), rather than through product factors and brand factors alone, companies can create and offer differentiated value to customers by combining product, brand, and experiential factors into unique selling propositions that are truly unique. This type of change cannot be done superficially, it must be done structurally, starting with the rewiring ways of working to consistently deliver high-quality commercial experiences that resonate with customers at scale.

To ensure that marketing and sales interactions are consistently high-quality while still allowing for flexibility, companies need to focus on training their teams based on key principles that define their brand-aligned Ideal Experience . The Ideal Experience concept serves as a documented vision and set of guiding principles that can be applied to every customer interaction, ensuring that marketers, sales representatives and other customer-facing functions maintain the brand’s core values while tailoring their approach to individual customer needs.

Focusing on the key interaction attributes of the Ideal Experience —such as empathy, simplicity, personalization, and transparency—companies can empower their teams to create genuine, meaningful connections with customers with distinctive points of differentiation at the point of engagement and sale. These principles should be integrated into every interaction and touchpoint in the customer journey , from initial marketing campaigns to post-sale follow-ups, ensuring that customers feel heard, understood, and valued at every stage. This requires not only crafting Ideal Experiences but also targeted training and up-skilling to embed this ideal into the ways of working for marketers and sales representatives.

Key Issue. Sales and marketing training often leans heavily on developing functional skills, such as crafting product messaging, articulating brand benefits, and mastering sales techniques. While these are essential, this focus can lead to a transactional approach that prioritizes promoting features and benefits over delivering meaningful customer experiences.

What CXEs Do: Apply Blended Training for Brand-Aligned Interactions

Customer Excellence Enterprises recognize that true competitive advantage lies in creating emotionally resonant, brand-aligned experiences across the customer lifecycle, inclusive of the purchasing journey. These very different types of companies supplement functional marketing and sales training with an intentional focus on cultivating skills and behaviors that deliver interactions that embody the brand’s identity and values . This dual-focus training ensures that every touchpoint reinforces the brand’s identity and commercial outcomes. Through intention and design, the act of training marketers and sales reps not only on what to do, but on how to do it, and why it matters, CXEs build a culture with supporting systems and structures that reinforce excellence across every interaction.

Disney serves as a prime example of this holistic approach. While Cast Members (Disney employees) receive comprehensive functional training to perform their specific roles—such as operating attractions, managing queues, or serving food—they are also meticulously trained to uphold Disney’s standards for guest interactions . Disney defines these standards through attributes such as friendliness, attention to detail, and a commitment to creating magical moments. For instance, Cast Members are taught to make eye contact, smile warmly, and proactively assist guests to ensure that every interaction reflects Disney’s promise of exceptional customer service.

Key Issue. In the pursuit of consistently delivering high-quality experiences and Ideal Experiences at scale, rigid rules and overly structured approaches to sales and marketing interactions can stifle creativity and spontaneity—the qualities that often differentiate exceptional sales representatives and marketers from average ones.

What CXEs Do: Balance Structured Selling Systems with Individual Empowerment

The highest performing marketing, sales and commercial teams rely heavily on processes and systems to maintain high standards and consistency in their efforts. Well-defined systems help ensure that messaging, branding, and customer interactions are aligned across teams and channels, reducing variability and delivering a predictable, high-quality experience . While a consistent, brand-aligned standard of interaction can pay commercial dividends, CXEs recognize the effectiveness of commercial interactions often hinge on the ability of individual reps to respond to customer needs in real-time, in a way that feels authentic and personalized to the unique context of each customer. Overly strict guidelines or inflexible scripts can remove that sense of spontaneity and thinking on your feet capacity that good sales reps and marketers seem to have.

At the core of this practice, CXEs excel at striking the right balance between structured systems and empowering their marketing and sales teams to deliver personalized, brand-aligned experiences. These organizations implement systems and processes as frameworks rather than rigid rules. Particularly relevant in the digital arena, it is fairly routine for marketers to follow standardized workflows for campaign planning and execution, and sales reps may rely on playbooks that outline best practices for each stage of the purchasing journey. However, these frameworks are designed with flexibility, allowing teams to tailor their approaches to individual customer needs. With the capacity to strike the balance, CXEs ensure that every touchpoint reflects the brand’s promise while being relevant to the customer’s specific situation. Rather than being disruptive and full of effort and frustration for customers, this approach fosters trust, loyalty, and differentiation, creating a purchasing journey that is not only consistent but also commercially impactful.

Key Takeaways

In Experiential Commerce, where every touchpoint matters , companies must facilitate high-quality purchasing journeys that align with customer expectations and deliver commercial results
This shift requires a fundamental change in how companies approach marketing , sales and commercial interactions.
While consistency is crucial, companies must avoid constraining marketers and sales reps with overly rigid rules that limit their ability to connect with customers in an authentic and personalized manner
Training marketers and sales reps on the principles of the Ideal Experience —and empowering them to apply those principles in context—can create more engaging, effective interactions that drive sales and marketing performance

Questions to Consider

Are our sales, marketing, and commercial systems designed to deliver seamless and personalized experiences across all interactions and the entire customer lifecycle?
Do we measure success using customer-centric performance indicators (CPIs) that reflect customer success and goal attainment, rather than relying solely on traditional campaign or transaction-focused KPIs?
How effectively do our teams collaborate to align the entire purchasing journey with customer expectations while driving commercial results?

To learn more you can get started by downloading a 29-page preview , connecting with us as partners on the journey, and ordering “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

[WHITE PAPER] The Mag 7/FAANG Stocks: The Biggest Value Creation Myth in Business?

Sun, 12 Jan 2025 00:36:12 GMT

[WHITE PAPER] Are the "MAG 7" a Tech or Customer Experience Phenomenon?

BOLD MOVE: The Customers for Life Imperative. The Shift: Experiential Commerce

EXPERIENTIAL FACTOR(S): Consistency, Seamlessness, Convenience, Preferences

SYNOPSIS: Now expanded to become the "Magnificent 7" with the additions of Microsoft , NVIDIA , and Tesla (and removal of Netflix ), the original FAANG stocks— Facebook (Meta), Amazon, Apple, Netflix, and Google (Alphabet)—are economic marvels. Accordingly, the mythology surrounding these outlier companies suggests that their "secret sauce" lies in their cutting-edge technology. Curiously, their technology, as impressive as it may seem, is fundamentally a commodity—available to any business willing to invest. this article challenges that belief, arguing that the real reason behind their success might be something far less visible yet far more impactful. The mythology surrounding FAANG’s technological prowess distracts from the deeper lesson they offer: that it’s not the technology itself but how it’s wielded in service of customers and their experiences that create their competitive edge.

The original FAANG stocks— Facebook (Meta) , Apple, Amazon, Google (Alphabet) , Microsoft, NVIDIA, and Tesla —have delivered an unprecedented value creation "supercycle", dramatically outpacing the broader market. Between 2010 and 2023, these companies generated a combined market capitalization increase of over $6 trillion, accounting for nearly 40% of the S&P 500’s total returns during that period. Behind the headlines, an equally significant phenomenon has occurred—Particularly with the original FAANG component of the MAG 7, their dominance has also triggered a capital investment supercycle, as companies of all shapes and sizes attempt to emulate the financial good fortunes of FAANG. Whether in retail. entertainment and media, auto manufacturing, or financial services, trillions of dollars have been poured into digitalization, tech stacks, algorithms, AI, cloud computing, and everything in between, ostensibly to mimic the FAANG approach, capture some of their financial magic, and being reborn as proper tech companies.

Despite these significant investments, as the other side of market cap and total returns story tells, virtually every other company in the S&P (or any index for that matter) has struggled to achieve results anywhere near FAANG levels. As a prominent case in point, through its "Predix" software platform, even a legacy industrial enterprise like GE made a very public effort to transform itself from a traditional portfolio of manufactured products and associated services into a software-powered “digital industrial company.” To that end, the company invested heavily to attract top-tier tech talent in data science, AI, and software engineering akin to FAANG. GE’s ambition to emulate FAANG-like success showed uncharacteristic aplomb and vision, but the commercial results were decidedly mixed. In essence, reflecting a pattern across industries, GE was able to replicate what it perceived as the FAANG playbook but was unable to replicate the results.

While the reasons for GE’s specific outcomes ran the gamut from culture and strategy to execution and timing, they bring up critical questions:

With sustained investment and democratization making technology accessible to everyone, why haven’t more companies been able to generate performance anywhere near those levels?
What does MAG 7/FAANG do that’s different?
Beyond tech, what’s their real secret sauce?

This scenario reinforces the primacy of the MAG 7/FAANG and reveals a critical paradox. Entering its second decade, this economic marvel is broadly celebrated as a technology phenomenon, borne of Silicon Valley genius and exceptionalism. This mythology has set off the aforementioned supercycle of capital investment and corporate envy and brought algorithms, coding, hoodie-wearing founders, and legions of seemingly extraordinary engineering talent out of basements and dorm rooms and into popular culture. However, with the exception of technology pure-play NVIDIA , a closer more nuanced examination of the MAG 7 narrative reveals that their success might have been mischaracterized as a technology phenomenon when it could more accurately be characterized as a customer experience phenomenon .

While the MAG 7/FAANG companies have reset the bar on what tech can do, the tech itself is just a means to an end. Specifically, the subtle, but significant nuance in the MAG 7/FAANG playbook indicates that their endgame is to create differentiated value for customers and outsized performance for themselves by consistently delivering exceptional customer experiences. In effect, rather than technology being the source of their value creation and differentiation formulas, the MAG 7/FAANG “secret sauce” is to put the power of technology to work in service of consistently delivering exceptional and innovative customer experiences .

Key Takeaway: Crucially, as a defining element of their status as Customer Excellence Enterprises (CXEs), for MAG 7/FAANG customer experience is not an abstract concept, it is fundamental to their business models, corporate success formulas, and unique selling propositions. Amazon redefined convenience with one-click ordering and lightning-fast delivery. Netflix created value by understanding user preferences through recommendation algorithms. Tesla delivered intuitive online ordering to over-the-air updates and exceptional post-purchase support. Transcending the utility of widely accessible, but fundamentally non-differentiated technology, MAG 7/FAANG’s collective focus on customer experience redefines differentiation and value and serves as the (somewhat hidden) mechanism to compound and sustain their competitive advantage.

Redefining Differentiation.

In markets where access to technology has become ubiquitous and democratized, this customer experience-led approach challenges traditional notions of differentiation and shifts the paradigm. Historically, competitive differentiation was often tied to proprietary technology, economies of scale, or resource control. However, MAG 7/FAANG companies demonstrate that meaningful differentiation must increasingly come from creating seamless, personalized, and frictionless customer experiences rather than just technological superiority. In commoditized markets, where competitors often offer similar products or services, MAG 7/FAANG companies stand out by focusing on intangible elements such as ease of use, trust, and emotional connection. Apple’s success, for instance, lies not only in the hardware of its devices but also in its ecosystem, which integrates hardware, software, and services into a seamless, intuitive user experience. Google’s dominance is not just about search algorithms but about organizing the world’s information in a way that feels effortless for users.

Redefining Value.

As another critical pillar, MAG 7/FAANG has mastered the art and science of leveraging those readily available technologies in innovative and concentrated ways to enhance customer and stakeholder value. In fact, MAG 7/FAANG’s focus on customer experience introduces a new model of value creation that is structural, systemic, and cultural rather than superficial, functional, and episodic . This means that MAG 7/FAANG has embedded the ethos of customer-centricity into their leadership, organizational, operational, and commercial DNA, making it difficult for competitors to decode and replicate the specific drivers of their success. In the MAG 7/FAANG context, it’s not just the "technology stack" that drives their differentiation and value but their commitment to Customer Excellence, which includes the data-driven insights, cultural alignment, and leadership conviction needed to be in a continuous and perpetual state of improvement on behalf of the customer experience. This alignment creates advantages that are durable and resilient to the inevitability of technological commoditization because they are rooted in a fundamental reverence for customers and a commitment to helping them live their best lives.

Capturing the MAG7/FAANG Magic.

The MAG7/FAANG supercycle is an unparalleled chapter in economic history, demonstrating the transformative power of technology-driven value creation. But technology by itself is no longer enough to differentiate—it has become a commodity accessible to all. What sets outliers like MAG 7/FAANG apart is their ability to use technology in a way that humanizes interactions, builds trust, and delivers consistent value to customers. Fortunately, the MAG7/FAANG “secret sauce” of leveraging technology in service of customer experience excellence and innovation is accessible to any company willing to take the hard but infinitely rewarding road to becoming a Customer Excellence Enterprise. However, a general lack of understanding of customer experience as a source of value creation has led many companies to marginalize it as a discipline, making it a superficial layer rather than an organic component.

In the spirit of trying to catch some of the MAG7/FAANG “lightning in a bottle”, breaking the legacy thinking related to customer experience involves adopting tech like AI, data analytics, algorithms, and automation to anticipate customer needs, deliver seamless experiences, and create deep emotional connections and positive cognitive responses . As with any strategic move, this transformation begins at the top, with leaders clearly stating their intent, building conviction, and modeling behaviors to shift their company’s perspective on customer experience. It must no longer be seen as a cost center, an operational afterthought, or a nice-to-have but as a strategic pillar essential to elevating financial performance, creating deep differentiation, and generating sustainable competitive advantages.

To learn more you can get started by downloading a 29-page preview, connecting with us as partners on the journey, and ordering “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

[PART 1] How Experiential Commerce is Reshaping Purchasing Decisions

Sun, 05 Jan 2025 21:06:26 GMT

This note draws on The Customer Excellence Enterprise: A Playbook for Creating Customers for Life , Wiley 2024, and in particular on Chapter 10, Reimagining Commercial DNA. It opens a three part series on the future of customer centric marketing.

Synopsis

Institutions tend to notice a change in their market only after that change has already repriced them. The basis of competition has moved from what a company makes toward the cumulative experience a customer has with it, and I named that shift Experiential Commerce. It carries implications for what customers expect, how companies deliver value to them and how they face off against competitors, because it reflects a redefinition of value in the eyes of customers.

What follows is an argument about marketing, which has been measured on the formation of intent and almost never on its survival. Under Experiential Commerce the factors that decide a purchase sit largely outside the places marketing controls, which leaves the discipline with instruments narrower than its accountability. The constructive answer is an experience-led growth strategy. Pharma is the hardest version of the same problem, and the final section points at where that case is already made.

The ground under global commerce has moved

Picture global commerce and most people still see factories, assembly lines and container ships. That picture gets less accurate every year, because the backbone of the economy is now intangible value exchanged through services, interactions and human experiences. Physical goods still matter, and the functional utility of a product still has to hold. What changed is that experiential attributes can now carry equal or greater significance than the core product itself in the hearts and minds of customers.

Emphasis is now placed on the cumulative experience a customer has with a company. That underscores the primacy of the underlying factors that drive Experiential Commerce, shape customer expectations and influence their decisions. Experiential factors are the intangible, emotionally focused aspects of a company's proposition, and they include helpfulness, consistency, personalization, simplicity and transparency. They arrive through complex ecosystems of in person and digital interactions, which is why no single function owns them.

Experiential factors now decide the close

Consider the last purchase anyone made between two near identical options. Product and brand earned both of them a place on the shortlist, and something else closed it. The close often turns on how easy the buying was, how the customer was treated and what happened after the money changed hands. Those are experiential factors, and in a crowded market they frequently work as the tiebreaker.

Product and brand remain essential. They have simply stopped being sufficient. In my book the value proposition stands on three legs, product, brand and experience, and the third is the one most companies never deliberately built. Experience in those companies is left to default while the other two are carefully designed.

Expectations no longer respect industry borders

Customers now carry the same expectation into every interaction regardless of category. Applying for a mortgage, grocery shopping and the other jobs of daily life all get judged by one standard. Across mobile, in person, phone, chatbot or blended channels, customers expect and in some cases demand a similar level of convenience. Expectations and definitions of value are increasingly set outside industry boundaries by a small number of customer experience outliers. A company therefore no longer competes only against the firms it benchmarks itself against.

That is why cross-industry comparison deserves more respect than it usually gets inside planning cycles. The outliers reset the standard of business for everyone, and they manage it without ever entering anyone else's category. I learned that lesson years before I worked in pharma, at The Ritz-Carlton Leadership Center. The Credo there holds that the genuine care and comfort of guests is "our highest mission." A company that sells rooms and a company that sells therapies are measured by customers against the same accumulated memory.

Positivity bias flattens the value proposition

The sharpest consequence of this shift is a cognitive one, and it rarely gets the attention it deserves. Positivity bias is the tendency for people to lump competing options together into a generic, overly optimistic category of sameness. It grants some benefit of the doubt to every option, good or bad, which equalizes the playing field and makes real differences hard to discern.

Companies work hard to influence, cajole, inspire, guide and otherwise compel customers to prefer them. Customers are nonetheless often left with the mistaken impression that all companies involved in a lifecycle decision are generally positive and generally the same. That is the cognitive cocktail that marginalizes, homogenizes and commoditizes value propositions. It quietly counteracts expensive brand messaging, and what remains is head to head competition over features, functions and price.

Positivity bias is also why a campaign can test well and still fail to move preference. The cumulative experience is what builds the mental scorecard customers use to rank companies against each other. Each positive or negative interaction gets noted and assigned a value, mostly below the level of conscious thought. Preference is therefore earned in the interactions and only confirmed in the messaging.

Marketing is measured on intent, not on its survival

Marketing has long been accountable for the formation of intent and almost never for what happens to that intent afterward. The discipline is measured on awareness, consideration, message recall, campaign response and share of voice. Every one of those instruments sits upstream of the moment a customer discovers whether the promise was kept. Under Experiential Commerce the factors that decide a purchase sit largely outside the places marketing controls.

That gap is a design gap rather than a character gap. Marketers are not failing at their jobs, and the people doing the work deserve respect. The instruments they were handed are narrower than the accountability they carry, which makes this a structural problem rather than a performance one. No function can be held to the survival of a promise it has no visibility into.

An experience-led growth strategy is the constructive answer

An experience-led growth strategy closes that gap, and three features distinguish it from a conventional customer experience plan. First, it must be a subset of corporate strategy rather than something created in a vacuum, which means it flows from enterprise mission and objectives before laddering down to measurement. Second, it must name the experiential battlefields a company chooses to compete on beyond its core products, based on its own view of the customer and the opportunity landscape.

Third, it must drive revenue across every stage of the lifecycle rather than sit in post-purchase operations. That last feature is the one most often lost in execution. When experience work stays confined to service recovery it can only repair value, never create it. Done properly, it turns functions long treated as cost centers into contributors to growth.

The supporting economics are not exotic. Research on customer effort reports that customers who find a company easy to deal with are 61% more likely to stay . Work behind the customer experience index reports that customer obsessed companies saw 41% faster revenue growth than the rest. Neither figure settles the question of causation, though both point in a single direction.

Pharma is the hardest case for this argument

Every industry feels this shift. Pharma feels it hardest. The manufacturer controls almost none of the interactions that decide whether its promise is kept. Coverage review, prior authorization, pharmacy pickup, onboarding, titration and persistence all happen inside systems the manufacturer does not own. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written.

The evidence that experience carries the decision holds even where safety and efficacy govern the choice. Research on pharma commercial productivity found that about 40% of a doctor's drug recommendations relate to overall experience , and that physicians who rate a company highly are 2.3 to 2.7 times more likely to prescribe its products. Those findings describe a market where the experiential layer already carries a measurable share of clinical choice. The third leg of the value proposition is the one the industry never built.

Two measures carry the weight of that argument in my practice. The standard a patient applies is Consumer-Grade , which is a structural specification rather than an aspiration. The measure of whether a promise was kept is the Realization Rate , the ratio of realized value to earned value. Launch excellence, marketing excellence and sales excellence are mature domains in pharma, and Customer Excellence is the fourth and missing one .

That case is made in full elsewhere, so this piece only points at it. What belongs in Part 1 is the prior claim it rests on. Value is not created when an organization makes a promise, it is created when the customer can actually realize it.

Key Takeaways

Experiential Commerce describes a redefinition of value, where the cumulative experience a customer has with a company increasingly decides lifecycle decisions.
Experiential factors such as helpfulness, consistency, personalization, simplicity and transparency are the intangible drivers that shape expectations and influence decisions.
Positivity bias leaves customers with the mistaken impression that competing companies are generally positive and generally the same, which commoditizes value propositions.
Marketing has been measured on the formation of intent and almost never on its survival, which leaves its instruments narrower than its accountability.
An experience-led growth strategy must sit inside corporate strategy, name the experiential battlefields a company chooses, and drive revenue across the whole lifecycle.
Pharma is the hardest case, because the manufacturer controls almost none of the interactions that decide whether its scientific promise gets realized.

Diagnostic Questions to Consider

Describe how your organization measures experiential factors today, compared with how rigorously it measures product and brand factors.
Identify the stages of the lifecycle where marketing has real visibility into whether a promise survived contact with delivery.
Name the experiential battlefields the company has deliberately chosen to compete on beyond its core products and indications.
Estimate the share of preference in your category that forms inside interactions the commercial organization does not control.
State who is accountable when intent gets formed correctly and value is never realized by the customer.

Closing Reflection

The shift described here is a redefinition of value rather than a passing marketing fashion. It changes what customers expect, how value reaches them and how companies separate themselves from one another. Marketing is the function most exposed by that change, because it carries accountability for preference without owning most of the places where preference now forms.

My own reading is that the discipline is far from disposable. It is under-instrumented, which is a different problem with a different remedy. The remedy is to extend marketing's field of view across the whole lifecycle and to give it measurement that makes experiential factors visible, fundable and defensible. Part 2 of this series takes up that question directly.

Experiential Commerce was the frame I used to describe this change when I wrote about it, and it remains the clearest way to name what moved. Where the argument travels next, in pharma especially, is toward the mechanics of realization. That is the work the rest of the series takes on.

About the Author

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

[REPRINT] When Touchpoints Become Painpoints, it’s Time for a Muda, Mura and Muri Intervention

Wed, 01 Jan 2025 19:07:36 GMT

CASE-IN-POINT: When Touchpoints Become Painpoints, it’s Time for a Muda, Mura, and Muri Intervention

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”| Operational (OPS) Bold Move #11: Mitigate Systemic Deviations

[REPRINT} When Touchpoints Become Painpoints, it’s Time for a Muda, Mura, and Muri Intervention

Synopsis. Leaders and practitioners in customer-centric operations, CX, and other experience and service-intensive roles recognize that simply focusing on “getting the job done” is no longer good enough to consistently meet the new standard of delivering exceptional experiences. On the heels of establishing core infrastructure for CX measurement comes the really hard, ongoing work of aligning, optimizing, and rewiring customer and employee journeys to that elevated standard.

Originally published on CustomerThink: Link to the full article.

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

[REPRINT] Super-charge the Journey to Customer-Centric Culture

Wed, 01 Jan 2025 18:55:28 GMT

CASE-IN-POINT: Super-charge the Journey to Customer-Centric Culture

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”| Organizational (ORG) Bold Move #4: Create a Framework for Culture Sustainability

[REPRINT} Super-charge the Journey to Customer-Centric Culture

Synopsis. Customers have more choices than ever on where to spend their time and money. Having strong voices in social media and on-line rating sites have further shifted the balance of power, creating the “hyper-empowered customer”. Accordingly, organizations large and small are keen to create cultures that are inherently more customer-centric, if not customer-obsessed. For perennial customer experience leaders and best-in-class service brands, this means going beyond traditional change management to adopt an underlying organizing principle that fundamentally re-sequences organizational and operational DNA.

Originally published on CustomerThink: Link to the full article.

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

[REPRINT] Winning through Experience: Make HR & CX BFFs

Wed, 01 Jan 2025 18:45:56 GMT

CASE-IN-POINT: Winning through Customer Experience: Make your HR & CX organizations BFFs

REFERENCE: “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” | Organizational (ORG) Bold Move #7: Embed Principles into People Processes

[REPRINT} Winning through Customer Experience: Make your HR & CX organizations BFFs

Synopsis. Measuring and quantifying customer experiences, and other “hard factors” alone may not be sufficient to capitalize on the promise of the rapidly evolving CX field. Find out the role of “soft factors” in the brand power of perennial service and experience leaders, such as The Ritz-Carlton, USAA, Zappos, Nordstroms, Chick-fil-A, Navy Federal Credit Union, and Southwest Airlines.

Link to the full article.

To learn more, order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

A NEW "Why" for CX #3: Protect Customer Value Already Captured at The Four Seasons

Sat, 28 Dec 2024 19:19:12 GMT

CASE-IN-POINT: Protecting Customer Value at The Four Seasons

BOLD MOVE: Commercial (COM) Bold Move #2: Make the Experience the Proposition

EXPERIENTIAL FACTOR(S): Attention to Detail, Precision, Personalization, Consistency

A New "Why" for CX #3: Protect Customer Value Already Captured.

SYNOPSIS. An excerpt from a full article originally published with the Broad College of Business, Michigan State University , this article explores a transformative approach to customer experience ROI and value, positioning it not only as a catalyst for growth but also as a safeguard for a company's most valuable assets—its customers. Through the integration and symbiotic relationship between the Earned Growth Rate (EGR) metric with the Customer Value-at-Risk (CVaR) metric, the framework provides a holistic method for evaluating customer experience and related Customer Excellence investments. To learn more, refer to "The Customer Excellence Enterprise: A Playbook for Creating Customers for Life"

A new conceptual framework leverages the risk-based Customer Value-at-Risk (CVaR) metric to create a comprehensive method for measuring and communicating the value and ROI of customer experience and related Customer Excellence investments. CVaR focuses on quantifying the potential loss of value from customer churn, offering businesses a risk-adjusted lens through which to evaluate their customer value. This complementary relationship with the Earned Growth Rate (EGR) , which measures the value generated from retained customers, this framework provides a dual perspective: EGR captures the upside of loyalty and advocacy, while CVaR highlights the downside risks tied to disengagement or dissatisfaction.

The integration of CVaR creates a New “Why” for customer experience by shifting the narrative toward protecting the value already captured within the customer base. Traditional CX strategies often emphasize growth through acquisition or satisfaction improvements, but this framework underscores the importance of safeguarding existing customer relationships. It recognizes that a single churn event, especially among high-value customers, can significantly impact profitability. This lens allows the entire portfolio of Customer Excellence disciplines to be applied as the mitigation measures and strategies necessary to retain and nurture customers, which reduces the risks of losing those customers.

A New “Why” for CX #3: Protect Customer Value Already Captured.

This approach reframes Customer Excellence as not just a growth driver but also a protective shield for a company's most critical assets—its customers. The forward-looking potential of EGR combined with the defensive insights of CVaR equips leaders with a more strategic and balanced justification for Customer Excellence investments, ensuring that the value already captured remains secure and continues to grow over time.

Through its legendary commitment to Service Culture, The Four Seasons protects customer value for long-term relationships by prioritizing personalized service, consistent excellence, and emotional connections. Through meticulous attention to detail and anticipating guest needs across the customer lifecycle , the brand fosters trust and loyalty among its multi-generational clientele. As a critical ingredient in this endeavor, at the middle to back end of the lifecycle, as a business model choice, The Four Seasons invests heavily in training its staff to deliver memorable experiences, ensuring every interaction enhances the guest's perception of value.

Questions to consider:

How effectively does our organization currently measure and track customer retention and churn, and are these insights integrated into decision-making processes for customer experience investments?
Do we have the analytical capabilities and data infrastructure necessary to calculate and leverage both Earned Growth Rate (EGR) and Customer Value-at-Risk (CVaR) metrics effectively?
Are our CX strategies designed to balance the pursuit of new customer acquisition with the protection and growth of value from our existing customer base?
How well do our leadership teams and stakeholders understand the financial implications of customer churn and the potential ROI of initiatives aimed at mitigating this risk?
What processes or frameworks are in place to ensure that insights from EGR and CVaR metrics drive continuous improvement and alignment across marketing, sales, and customer success teams?

To learn more, refer to "The Customer Excellence Enterprise: A Playbook for Creating Customers for Life"

A NEW "Why" for CX #2: Recover Customer Acquisition Cost + Reduce Customer (Re)acquisition Cost

Sat, 28 Dec 2024 17:12:37 GMT

CASE-IN-POINT: Salesforce, CX Strategy, Brand Strategy, Business Model Innovation, Commercial Model Innovation

BOLD MOVE: Commercial (COM) Bold Move #2: Make the Experience the Proposition

EXPERIENTIAL FACTOR(S): Transparency, Seamlessness, Personalization, Surprise

A New "Why" for CX #2: Recover Customer Acquisition Cost + Reduce Customer (Re)acquisition Cost

SYNOPSIS. Return on investment and value aren’t the same thing— ROI is a calculation, and articulating value is a conversation. Through the integration of customer experience management with customer success, customer engagement, and customer care into the new unifying discipline of Customer Excellence, a New financial “Why” for CX emerges in the form of a multi-faceted financial Value Narrative built around recovering customer acquisition cost and reducing customer (re)acquisition cost. Collectively, in concert with marketing and sales, these functions ensure that newly acquired customers not only achieve their desired outcomes and maximize value realization but also ensure that companies can break even and deliver profitable returns relative to their initial acquisition investments. To learn more, refer to "The Customer Excellence Enterprise: A Playbook for Creating Customers for Life"

Business leaders seem to single out CX ROI for scrutiny because, unlike traditional investments in marketing or sales, the financial impact of CX initiatives can be harder to isolate and quantify. CX spans multiple touchpoints and often delivers value through intangible outcomes such as loyalty, advocacy, and brand perception, which are difficult to measure in immediate financial terms. Leaders seek clear evidence to justify CX investments, asking for data that links improved customer satisfaction and advocacy directly to measurable financial outcomes. This demand frames the need for companies to overcome key challenges to reposition CX ROI within a broader value narrative that connects its benefits to the customer lifecycle and the company's financial goals.

Challenge #1. Complex, but not Complicated

Return on Investment (ROI), while a persistent question and widely accepted metric for evaluating financial performance, has proven to be ineffective in compelling leaders to prioritize sustained investments in customer experience. Curiously, calculating the ROI of customer experience is, in theory, a straightforward exercise using a common formula: compare the financial gains generated by customer experience initiatives to their associated costs.

Key Takeaway: However, the real challenge lies not in the math but in articulating the value of experience within a broader business context.

ROI is a measure of efficiency—quantifying the returns on a specific investment—but value encompasses a broader perspective, reflecting the long-term strategic benefits customer experience delivers. This distinction highlights the core difficulty: while ROI can show whether customer experience investments "pay off" in a narrow sense, it often fails to capture the imagination of leaders, or the holistic, enduring contributions that customer experience and related disciplines make to financial performance.

Challenge #2. The Attribution Disadvantage

Revenue, the crown jewel of corporate metrics, is typically attributed first to marketing and sales, as these functions are directly accountable for customer acquisition and the resultant revenue capture. This clear attribution framework gives marketing and sales a decisive advantage in demonstrating their ROI. In contrast, customer experience and other functional disciplines associated with “Customer Excellence”-- customer success, customer engagement, and customer care-- face significant challenges in attributing revenue gains to their specific efforts or investments. This disconnect leaves customer experience undervalued, even though its strategic importance is critical to sustainable growth and competitive advantage.

Compounding this challenge is the short-term focus of many companies, which prioritize immediate gains over the cumulative benefits of CX, failing to capture the nuanced and long-term revenue dynamics that customer experience drives. Effectively, the impact of customer-centric disciplines is often diffused, spanning multiple lifecycle stages and time horizons, making its contributions harder to isolate and quantify. This disadvantage leaves customer experience—competing for recognition, as their individual and collective value—though substantial in terms of retention, churn reduction, and lifetime value maximization—remains less directly tied to immediate revenue gains compared to marketing and sales. As a result, leaders often struggle to see the full strategic value of customer experience-related initiatives, leading to underinvestment in areas that can significantly enhance competitive positioning and financial performance.

Challenge #3. Viewing CX in Isolation

Another less visible issue of why measuring the ROI and articulating the value of customer experience has proven challenging is the simple truth that customer experience does not operate in isolation—it is inherently interconnected with other critical functions across the customer lifecycle. Customer experience must be evaluated relative to marketing and sales on the front end of the customer lifecycle. However, the true value of customer experience becomes more apparent in the middle and back end of the lifecycle, where other tightly connected “Customer Excellence” functions--customer success, customer engagement, and customer care—come into play more prominently.

As a collective, Customer Excellence functions ensure customers derive ongoing value from the core offering in as seamless, frictionless, and delightful a way as possible, relative to brand promises and customer expectations. Failing to account for these interconnected dynamics simultaneously oversimplifies and obscures the specific role of customer experience management in fostering retention and expansion opportunities and amplifying marketing and sales effectiveness while reducing costs associated with customer churn and reacquisition. A siloed ROI approach thus fails to capture the compound benefits of customer experience as an integral part of a broader, interconnected system driving sustainable revenue growth.

Context is Everything

Customer Excellence Enterprises (CXEs), those outlier companies that are structurally and systematically predisposed to consistently deliver exceptional experiences, the true impact of customer experience is extends beyond traditional ROI calculations. Specifically, CXEs understand that, rather than being seen as an isolated cost center, customer experience must be positioned as an essential component of a value model following three key principles

The ROI of customer experience is best understood as part of a multifaceted value model that highlights its interconnectedness and causal relationships with other business metrics and functions.
CXEs evaluate ROI within the context of the entire customer lifecycle, from acquisition to retention and advocacy. This comprehensive approach ensures that every interaction contributes to long-term value, creating a seamless journey that fosters loyalty and maximizes lifetime customer profitability.
CXEs have also internalized, quantified, and attributed the pivotal role that the entire Customer Excellence collective of disciplines plays in value realization, and reducing churn, revenue leakage and the associated costs for reacquiring previously acquired customers after they defect.

Customer experience management serves as the overarching framework that aligns and integrates customer success, engagement, and care to deliver a cohesive and meaningful end-to-end experience for customers.
Customer success focuses on helping customers achieve their desired outcomes with the product or service, ensuring they realize the value they expected at purchase. This value realization builds trust and positions the company to retain customers, minimize churn, and reduce reacquisition costs.
Customer engagement fosters ongoing interaction and loyalty, creating opportunities for upselling, cross-selling, and relationship deepening, which drive revenue expansion.
Similarly, customer care addresses issues effectively, protecting relationships and preventing revenue leakage. Together, these functions amplify profitability and pave the way to maximize customer lifetime value, turning initial acquisition costs into long-term, scalable returns.

The interdependence between ROI, Customer Excellence functions and the customer lifecycle also cannot be overstated. For example, a seamless and personalized purchasing journey at the front end of the customer lifecycle builds trust, accelerates purchase decisions, and increases conversion rates. Specific initiatives from across the collection of Customer Excellence disciplines, such as live support, omnichannel orchestration and guided paths to purchase, can directly reduce friction in the sales process, leading to higher close rates and average order values. When these outcomes are combined with marketing efficiencies, the result is a compounding effect on overall business performance.

A New Financial “Why” for CX

To articulate its value, one must evaluate CX and related investments within a value narrative that puts it relative to other foundational business metrics such as marketing and sales efficiency, customer acquisition costs (CAC), and the often-overlooked costs of customer reacquisition. A positive customer experience is part of a continuum of value focused on fostering retention and churn reduction, which translates to expansion opportunities and lower CAC over time. Conversely, poor experiences erode trust and satisfaction, requiring higher investments to reacquire dissatisfied customers—a cost that traditional ROI metrics fail to account for comprehensively.

As part of a value narrative rather than a standalone metric, CXEs demonstrate how investments in CX contribute to reduced churn, stronger lifetime customer value, and greater ROI on marketing and sales efforts. This interconnected perspective helps leaders see CX as a multiplier of business outcomes, reinforcing the importance of integrating it into the broader strategic framework. Retaining existing customers through superior experiences is significantly more cost-effective than acquiring new ones. High-quality execution across customer success, customer engagement, customer experience management, and customer care minimizes churn risks by being preemptive about addressing pain points, fostering trust, and building lasting relationships. It also mitigates revenue leakage by ensuring customers remain engaged and satisfied throughout their lifecycle, thereby protecting and enhancing the bottom line.

A New “Why” for CX #2. Recover Customer Acquisition Costs and Reduce Customer (Re)acquisition Cost

Perhaps the most compelling case for sustained investment within the value narrative comes within the context of Customer Excellence and its collective impact on CAC recovery and customer lifetime value (CLV). Customer experience and other Customer Excellence functions—customer success, customer engagement, and customer care—ultimately play a critical role in ensuring that the initial investment in customer acquisition reaches its breakeven point and is then nurtured to a level that brings those investments to sustained profitability and maximum lifetime value.

Case-in-Point. Companies like Salesforce have mastered the art and science of recovering customer acquisition costs and driving sustained profitability toward maximizing lifetime value. Salesforce also invests across the customer lifecycle to ensure customers see continuous value, reducing churn while opening up long-term expansion opportunities for upselling and cross-selling.

A more Impactful and Holistic Approach

In the context of the customer lifecycle, the interplay between customer marketing, sales, and Customer Excellence creates a cohesive financial value model that frames the ROI of CX in a more impactful and holistic way. Articulating how CX enhances marketing efficiency, boosts sales conversions, and reduces customer acquisition and retention costs, presents a more compelling narrative of interconnected value. This approach shifts the focus from isolated metrics to a unified strategy where CX serves as a critical driver of both short-term financial performance and long-term competitive advantage.

Questions to consider:

How effectively are we aligning our customer acquisition strategies with targeted customer segments that demonstrate the highest potential for lifetime value?
Do we have robust systems in place to monitor and reduce churn, and how well are we leveraging customer feedback to improve retention and satisfaction?
Are we maximizing cross-selling and upselling opportunities by anticipating customer needs and offering relevant products or services at key touchpoints?
How well are we investing in post-purchase support, training, and engagement to ensure customers experience consistent value throughout their journey?
Do we use data-driven insights to measure customer profitability over time, and are these insights guiding resource allocation toward high-value customer segments?

To learn more, refer to "The Customer Excellence Enterprise: A Playbook for Creating Customers for Life"

[PRACTICE NOTE] A NEW "Why" for CX #1: Making Unique Selling Propositions Truly Unique

Thu, 26 Dec 2024 18:53:17 GMT

CASE-IN-POINT: CX Strategy, Brand Strategy, Business Model Innovation, Commercial Model Innovation

BOLD MOVE: Commercial (COM) Bold Move #2: Make the Experience the Proposition

EXPERIENTIAL FACTOR(S): Transparency, Seamlessness, Personalization, Surprise

A New "Why" for CX #1: Making Unique Selling Propositions Truly Unique

SYNOPSIS. As an equal partner to brand and product, companies must integrate experience into the mix to fundamentally strengthen the relevance differentiation of their core value propositions in today's discerning customers' hearts, minds, and lives. Products can be replicated, and brand messages can be imitated, but a consistently exceptional experience is far more difficult for competitors to match. Together, these three dimensions form a more holistic, durable, and authentic “unique selling proposition” that connects how companies market and sell to how customers are evaluating and purchasing. This is the New “Why” for Customer Experience. To learn more, refer to "The Customer Excellence Enterprise: A Playbook for Creating Customers for Life", Commercial Bold Move #2: Make the Experience the Proposition.

It’s almost a right of passage, the moment business leaders (presumably on behalf of the CEO and CFO) ask THE Question: “What’s the ROI of CX?” After witnessing this dynamic play out in several industries over several business cycles, I’ve realized that this isn’t always a question of reason or logic, it’s often a philosophical question, a stream of consciousness that I interpret as “Why can’t we be like Amazon or Chewy or USAA or The Ritz-Carlton when it comes to customer experience excellence? After all, C-Suite leaders have surely experienced the difference between great interactions and bad ones in their “other lives” as consumers. They must be able to calculate the financial impact of customer churn and the reputational damage and brand erosion that happen when bad customer service episodes go viral.

So, what gives?

Mired in their daily grind, when leaders are hit with a cacophony of satisfaction and advocacy metrics that don’t seem to move much, many of them can’t see the light or connect the dots. Therefore, as a major actor in this corporate right of passage, they ask THE Question as the first signal that CX may be on notice, potentially making the corporate restructuring shortlist.

This should come as no surprise. Far too many companies have come to view CX as a nice-to-have—a somewhat quirky, supplementary functional discipline sitting awkwardly between building surveys in market research, designing journeys and user interfaces, and uncovering pain points in operations. Either way, the discipline is often on the outside, peering in on the “real” revenue and value creation engines dominated by marketing and sales. This perspective has often led to CX initiatives being contemplated in isolation rather than as integral parts of business models, struggling to demonstrate value and trying to elbow in on the revenue performance and value creation results already claimed by the more muscular sales and marketing machines.

So, how can CX break out of obscurity, get into the direct revenue and value creation game, and finally get a seat at the “adult table”?

Moving beyond “Mad Men” Marketing

Companies have relied on product and brand factors as their primary mechanisms to differentiate and drive their value propositions. Beginning in the industrial and post-industrial eras, companies focused on creating and offering superior products—leveraging manufacturing acumen, access to raw materials, labor relations, quality systems, and innovative functionality to set themselves apart. This approach worked well in markets where technological advancements were relatively slow, competition was limited, and consumer expectations were largely centered on maximizing the functional utility of product features.

As markets matured and began to become saturated with competing product offerings, the idea of branding emerged as a critical differentiating factor. To that end, companies engaged the infamous “ Mad Men ”, including originals such as David Ogilvy and Walter Landor . They then invested heavily in brand building using storytelling, advertising, and emotional resonance as the mechanisms to foster preference, generate demand, and create differentiated perceptions of value.

Over time, companies sharpened their approach further by combining product with brand factors to create enduring company narratives built around unique selling propositions (USPs). As the ultimate byproduct of branding, marketing, advertising, and other commercial endeavors, USPs are the essential ingredient in aligning corporate aspirations with customer needs at the critical moment of truth—the point of sale.

A well-crafted USP serves as the bridge between what a brand promises and what the product delivers, making it clear why a customer should choose one offering over another. Iconic brands such as Coca-Cola and Nike became leaders not just because of their products and brands in isolation but because of their ability to artfully blend the two into unique selling propositions — points of perceived or real differentiation— that crystallize their value in a way that evoke strong emotional connections, build cultural relevance, and resonate with customers when they are making their purchasing and loyalty decisions.

However, with the weaponized scale of always-on digital marketing and countless channels to engage customers, the two-dimensional model of product-brand is increasingly facing challenges. Digitization and the democratization of technology enable faster commoditization of products, the focus on competing solely through product and brand factors has become increasingly unsustainable, forcing companies to evolve their mindsets, strategies, and ways of working. Markets have become noisier and more crowded than ever, product lifecycles become shorter, and global competitors have worked their way up the value chain, making it difficult for companies, products, and brands to truly stand out from the crowd.

Key Takeaway: Simply put, with product and brand factors alone, it has become increasingly difficult to create unique selling propositions that are actually unique.

From Tangible to Intangible

Underpinning the modern value exchange between companies and customers is an even more significant change — customers today evaluate value not just by tangible attributes like product cost and functionality but also by the quality of the experience they receive before, during, and after a purchase. This shift has only accelerated and deepened with the wide-scale digitization of interactions post-pandemic

The significance of this relatively invisible shift cannot be overstated, having far-reaching implications for how companies create, deliver, and capture value. Specifically, t he shift in the value exchange from tangible to intangible is not simply a trend; it is a seismic structural change in consumer behaviors and preferences. According to World Bank data, inherently intangible service industries now make up over 65% of global GDP, reflecting the growing significance of intangible value over tangible goods alone.

Companies like Circuit City failed largely because they focused solely on outdoing competitors through product-led promotional strategies (for example, pitting sales promotions for 50-inch TVs against 55-inch TVs), increasingly commoditizing itself and getting out of sync with consumers. Alternatively, direct competitors like Best Buy and Amazon are executing contemporary success formulas that reflect commitments to the intangible value derived from superior in-store and digital experiences, respectively.

Many Companies are Stuck

Unfortunately, many companies are still wired and focused on delivering tangible value, consumers have moved on as they are now placing equal, if not greater, emphasis on intangible value—such as convenience, personalization, trust, and simplicity. Accordingly, they remain trapped in a cycle of trying to define their unique selling propositions (USPs) through product and brand-based propositions alone. The TV ad campaign and the iconic fedora of the "Mad Men" era have been replaced by the social media influencer campaign and trucker hat of the modern-day ad agency, but the strategies haven’t really changed. These companies continue to rely primarily on creating perceptions of differentiation, without addressing the intangible factors that influence customer behaviors today or align with how they make purchasing and loyalty decisions. This approach often results in short-term gains but often fails to establish a meaningful connection with customers or a sustainable competitive edge.

While product and brand factors are obviously essential, given the aforementioned changes in the business and customer landscape, they are no longer sufficient. True differentiation in the modern era must be crafted at the intersection of brand, product, and experience—the new lever of the unique selling proposition. While the brand sets the tone and establishes emotional resonance, and the product delivers functionality and innovation, it is the experience that brings these elements to life. Seamless, personalized, and memorable interactions at every touchpoint are what truly set companies apart. Brands that fail to integrate CX into their strategies risk being overshadowed by competitors who understand that experience is no longer an accessory to the unique selling proposition but a pillar in its very core.

Breaking the Tyranny of Uninspiring CX Metrics

The shift in perspective underscores the urgent opportunity for the discipline of customer experience management to reassert itself in the corporate psyche in the form of a New "Why" for CX #1: Making Unique Selling Propositions Truly Unique. The time for this shift is now — the current orthodoxy and predominant rationale of CX being centered on improving customer satisfaction or fostering advocacy have simply not been enough to mobilize many companies around the customer organizations or to make customer-centric cultures commonplace. To be clear, while satisfaction and advocacy goals remain relevant, they alone have proven insufficient to build conviction for customer experience within leadership teams or be considered seriously by boards of directors when contemplating enterprise value and risks.

New "Why" for CX #1: Making Unique Selling Propositions Truly Unique.

No longer can CX simply be defined by surveys, journey mapping, or the tyranny of uninspiring metrics. Crucially, CX must now be reframed to be about strengthening unique selling propositions, realigning how companies are marketing and selling with how customers today are evaluating and making purchase decisions. This means repositioning CX as an equal partner to the brand and product in the core value proposition, reflecting how customers perceive and interact with companies today. The brand creates the emotional resonance and trust that draws customers in, the product delivers on functional needs, and the experience ensures the promises of the brand and product are fulfilled in as seamless, effortless, frictionless, and delightful a way as possible, delivering episodes that customers value deeply and remember vividly.

With its implications for the unique selling proposition, reframing CX in this way demands that it be integrated into a three-dimensional framework, alongside brand and product, reflecting the discipline’s integral role in defining how companies compete, differentiate, and show up to customers. In this context, experience is no longer viewed and treated merely as an enabling function on the fringes of value creation—it becomes an organic element of the company’s reason for being, as critical as the brand’s identity and narrative, and the novelty of the product’s quality, features and functions.

As an added benefit, positive experiences can generate capital-efficient organic growth through word-of-mouth and social sharing, while building goodwill and long-term relationships with customers. In increasingly noisy and crowded markets, companies can reposition CX as more than something to dabble in—it becomes an essential pillar for short-term revenue performance and long-term viability and vitality.

Questions to consider:

How clearly is our USP defined, and what percentage of it is centered around customer experience rather than just product features or brand identity?
How do we measure the impact of customer experience on our overall business performance and market differentiation?
What role does customer feedback play in shaping our USP, and how often do we adapt based on evolving customer needs?
To what extent do our frontline employees, systems, and processes consistently deliver on the promises made by our USP?
How does our USP compare to competitors in leveraging customer experience as a competitive advantage?

To learn more, refer to "The Customer Excellence Enterprise: A Playbook for Creating Customers for Life"

[PRACTICE NOTE] Doing Digital Experiences Differently at Porsche AG

Mon, 11 Nov 2024 14:30:58 GMT

PRACTICE NOTE: Doing Digital Experiences Differently at Porsche AG

BOLD MOVE: Operational (OPS) Bold Move #3: Orchestrate the Front- and Back-of-House.

EXPERIENTIAL FACTOR(S): Transparency, Seamlessness, Personalization, Surprise

Synopsis. Orchestrating front-of-house customer-facing assets with back-of-house operations is critical for delivering seamless, exceptional experiences in a complex omnichannel world. In “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life”, we call this CXE Operational (OPS) Bold Move #3: Orchestrate the Front- and Back-of-House.

Orchestrating the front- and back-of-house is a concept rooted in hospitality, where seamless coordination between guest-facing and behind-the-scenes operations is essential for basic business model execution and delivering memorable experiences. In hotels or restaurants, the front-of-house staff interacts directly with customers, while back-of-house teams work tirelessly behind the scenes to ensure that everything flows smoothly. This approach, however, has broad applications across industries. In retail, for example, successful orchestration means aligning sales staff and inventory teams to guarantee products are readily available when customers need them. In healthcare, coordination between medical staff and support teams ensures patient care is efficient, yet empathetic and personalized.

As a CXE, Porsche does digital differently

Through this type of Bold Move, well beyond core products and brand propositions, embedding the ethos of customer centricity and customer experience into every aspect of the business opens a world of possibilities for customers and companies alike. As a specific case in point, car culture used to be about passion and connection, punctuated by moments of anticipation and ‘wow’. At Porsche, that spirit is alive and well because, as a CXE, the iconic sports car company shows how creating customers for life is not an abstract concept. Specifically, Porsche demonstrates how taking a structural and systemic approach to embedding desired customer outcomes into all stages of the customer experience is an intentional element of the company’s brand promise and success formula.

The “My Porsche” customer portal provides an exclusive, personalized digital platform where Porsche owners can access a wide range of services and information. It offers functional features such as vehicle management, service scheduling, and the ability to monitor maintenance records. Commercially, owners can also explore tailored offers, stay updated on the latest Porsche news, and engage with community events. As CXEs are prone to do, with the “Behind the Scenes” function in the portal, Porsche has taken OPS Bold Move #3 to heart in novel ways on behalf of their customers.

This program provides a unique, immersive experience for customers waiting for their bespoke vehicles. Through this capability, customers can virtually follow their car's journey through the production process, receiving updates and visuals directly from the factory floor. With an element of anticipation infused into the bespoke production process and ordinarily mundane functional interactions, Porsche customers can get photographs of their ordered car as it moves step-by-step to completion. From initial assembly to quality checks, Porsche allows customers to witness and engage in the craftsmanship and care that goes into building their vehicle, bridging the emotional gap in what is often a lengthy wait.

Representing a true expression of the passion and deep emotional connections that define the brand, this type of experience-led strategy doesn’t happen by accident…it happens only with intention and design. This transparency keeps customers engaged and excited, enhancing brand loyalty as they feel more involved and connected to the Porsche experience every step of the way. Through the intentional act of orchestrating front-of-house, customer-facing assets with back-of-house production capabilities, Porsche has created a differentiated proposition that builds deep emotional connections and elicits positive cognitive responses for the brand that turn regular transactional customers into passionate advocates and ‘customers for life.’

Questions to Consider:

How can your company embed differentiating moments of ‘wow’ into customer journeys?
How can you engage customers through the entire customer lifecycle?
What back-of-house capabilities can you expose to build deeper connections with customers?

To learn more about “OPS Bold Move #3: Orchestrate the Front- and Back-of-House” , and other leadership, organizational, operational, and commercial bold moves, you can get started by downloading a 29-page preview, connect with us as partners on the journey, and order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.

[PRACTICE NOTE] Turning Customer-centric Culture into Authentic Brand Storytelling at Chick-fil-A

Mon, 11 Nov 2024 14:30:58 GMT

CASE-IN-POINT: Turning Customer-centric Culture into Authentic Brand Storytelling at Chic-fil-A

BOLD MOVE: Commercial (COM) Bold Move #10: Create a New Brand Identity

EXPERIENTIAL FACTOR(S): Transparency, Seamlessness, Personalization, Surprise

Chick-fil-A’s Customer-Centric Approach

Chick-fil-A is a quintessential example of a Customer Excellence Enterprise (CXE), building its brand around consistent and authentic customer experiences. Unlike ordinary companies that often emphasize internal processes or focus solely on product features, Chick-fil-A stands apart as a CXE with a unique brand identity rooted in deep customer empathy and service and experience delivery excellence. In pursuit of “being America's best quick-service restaurant at winning and keeping customers,” their brand promise reflects a broader focus on the totality of the experience beyond just selling food. The company is known for having employees deliver food with a smile, engage in polite, personable conversations, and go the extra mile to create memorable customer experiences. Chick-fil-A’s dedication to customer excellence is evident in every aspect of its brand expression. The company doesn’t just sell food; it focuses on helping customers “live their best lives,” whether that means offering exceptional service in-store, providing a friendly greeting at the drive-thru, or ensuring prompt and accurate service. This orientation towards customer well-being has fostered a brand image that feels genuine and human, resulting in deeper connections with customers.

However, as CXEs typically do, through COM Bold Move #10: Create a New Brand Identity , Chick-fil-A has further amplified the power of customer experiences by partnering with customers to tell brand stories in their own words. Following the principles of COM Bold Move #10, through the customer testimonials in its advertising, Chick-fil-A showcases how the heart of its brand pyramid is about the customer and how they are to be viewed, valued, and treated. The real stories of positive experiences embedded deep in the brand pyramid highlight how its expertise and impact go above and beyond simply selling chicken sandwiches to connecting emotionally with customers. This approach is about sharing success stories and crafting an authentic brand narrative that resonates with customers and non-customers alike

Through this type of Bold Move, Chick-fil-A continually drives outsized system-wide revenue growth and brand value by interpreting customer needs through a lens of empathy and support. This strategy has made the brand resilient and more connected, able to thrive in competitive and noisy markets and deliver on brand promises.

Questions to Consider:

Are you listening to customers and identifying exceptional experiences that can be shared?
Do your brand promises and customer stories convey or reinforce how your company prioritizes and enhances customer lives?
Are the customer excellence values outlined in your brand pyramid evident in real customer experiences and feedback?
Does your company have specific, measurable standards that reinforce the commitment to customer excellence in every interaction?
Are each of your brand pillars—values, beliefs, and attributes—designed with the customer’s needs, expectations, and emotions in mind?
How effectively do your brand attributes and differentiators demonstrate a commitment to customer excellence?

To learn more about “COM Bold Move #10: Create a New Brand Identity” , and other leadership, organizational, operational, and commercial bold moves, you can get started by downloading a 29-page preview, connect with us as partners on the journey, and order “The Customer Excellence Enterprise: A Playbook for Creating Customers for Life” at all major booksellers.