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main challenges facing sellers in these hdls industries today let's start with you again I know you could talk about this yeah I could go on for a while here but um Let me let me categorize my expertise and and the framing for how I'll respond to all these questions I'm a medical device guy which means it's procedures in rooms that means it's widgets that are used once and thrown away or implanted and and they're with the patient for life the main challenge in that over my career over the last 30 years the number of hospitals has stayed roughly the same but the number of Corporations running the hospitals has gone up massively so what used to be individual hospitals are now called idns or integrated delivery networks there's a challenge with that because not only uh as a seller are you selling Dr Jones or Dr Smith and and responding to his or her preferences then you have to go up the chain to What's called the value add committee so you have to sell into that to make sure that your product has the right cost benefit for a procedure and oh by the way it either reduces cost in a demonstrable way or increases Revenue in a demonstrable way or the two most recently it needs to be both yep not all the time but very often very very challenging the last place you can break that code is if you have a technology that is so massively Advanced that they actually use it to change patient flows that's what we did at intuitive surgical right the robot I set the price 2.1 million dollars very first unit ever sold we moved patient volume with that technology so it became a fomo I need one no I need one I need one and it just went rampant that way so the number of hospitals has has again stayed about the same now idns are controlling large volumes of hospitals in that same time period the number of Ambulatory Surgery centers has gone from something like a thousand to something like twelve thousand whoa so what does that mean for a sales force sixty percent of a sales Force's time in this industry is spent driving driving so they're going to and from procedures and let me give you a sales day for a moment if you're in Orthopedics you're probably up at 5 30 5 45 in the morning you check your email and you find out the procedures you had scheduled at nine o'clock or move to 9 30 or 10 but there's two emergent ones that are at 6 45 you hop in your car grab your trays from the local location that they're sterilized throw in the back of your car run to the inventory Surgery Center and do a case and you got a hot shot to another procedure somewhere else but you find out the second case in the first location was delayed and now you can't get to the second one that's life in med tech sales it's that wild right now here's the problem with that with something like 12 000 Ambulatory Surgery centers about 5500 hospitals during that time period the number of people in the field has not increased a corresponding ratio so each person now has more facilities they need to cover well that's kind of a problem if you have the conflict I just described right here's another thing that's terribly terribly important commission-based sales generate most of the revenue for for um uh sorry most of the compensation commission does if you're in a hospital selling a knee by way of example it's four thousand bucks at a hospital same part number in an Ambulatory Surgery Center down the street 2200 2400 something like that exact same part number made worse by the fact that it's the same dock in both locations so it's not like you can there's price transparency issues you have to deal with so what are you going to do you're going to service the hospital right right but that Doc's going to get annoyed if you don't go to the ASC so now you got to go to the SC and you you've got to drive it's lower procedure volume in the ASC relative to the hospital it's lower Revenue per procedure and fewer procedures but you're wasting the time challenges are logistical challenges are keeping up with sites of service challenges are the process from Hello to I'm using this regularly for a new product all of that is a heavy heavy burden on a field team that literally keeps the population alive and well quite literally yeah and and making no mistake sales people in the medical device industry wildly passionate about what they do incredibly valuable to the industry overly burdened so those logistical problems are serious headaches well logistical problems are a serious headache um I will say the variability of patient need and device selection and inventory and tracking and it's just all a heavy burden on a group of men and women that dedicate their life every day to making sure that your procedures go well and Justice ground set a little bit here if you were to go in for a knee procedure today at four o'clock there's a 90 chance there's a sales rep in the room it feels a little weird to most people I'm seeing some eyebrows go up why are they in the room not because the doc doesn't know how to implant a knee but because they might be using one of ten knees from the company I'm going to pretend for a moment say it's Jane J Depew they might be using one of 10 knees from Depew but they're regularly used to using Striker knees each one of those knees comes with racks of instruments because everybody's body's a little different and all of the instruments are variable based on what's needed for that patient so they could be pulling two from tray 19 and 7 from Trey 48 and so all these equipment comes in the rep knows all of that to make sure that the dock has the right equipment to get something done that's just Orthopedics that's one of the more complicated ones it's across the entire industry but I'm using that illustratively yeah useful and because of that the the Reps have a lot of logistical challenges there's a lot they need to care for let's talk Omar about some of the tech challenges sure is it magnifying or multiplying those logistical issues are the tech or tooling or lack thereof that sales teams don't have that makes life double a triply complicated tough just about what you see there from a digital sales maturity standpoint yeah absolutely I think like a lot of us goes back to access access both to sell a new product but also access to supporting the account on you know for SAS you called customer success for us we usually call it clinical right this is where you know one area that Daniel's uh company Avail focuses on right when you have a lack of access right the sales reps have more time but they also don't know how to get their job done not only the logistical challenges let's say with servicing account but more specifically getting deals into pipeline right and because we've had these scaled up complexities not only in terms of the deal because it used to be back in the day you know 20 30 years ago I mean my father was a surgeon I used to remember I used to just walk into the hospital go back to the or and say Hey you know I'm here to hang out with Dr khadib nobody asked me who I was yeah sure just grab some scrubs and I just walked back 13 years old you know oversized scrubs not happening yeah and so when it comes to the sale it used to be an event right you you go you talk to the doctor that's why they call carrying the bag you show up you go to the doctor's Lounge you know hang out doctor comes out and say hey Doc I notice you have three of these procedures and what a coincidence I got three of these things that are just for that procedure doc goes and does it and then Hospital gets built and that's it but now those dot those days are gone it's so much more complicated even when the doctor says I want to use this product there's supply chain there's procurement there's all these communities not to mention the fact that you know so Daniel mentioned that you have these idns and corporations who are watching everything and so now that you've introduced all this complexity to the deal right I mean we all know how complex it is to sell these days you need more complicated and or not complicated more sophisticated processes to manage these things right however I hate to say it and this is part of the reason why I started my company the reason why that Daniel's up on the stage is that our sales processes and how we run Revenue in the industry has not changed there are I will mention them uh Fortune 500 companies that are billing multiple billion dollar market caps that are still running these processes through spreadsheets right with very little quality controls on it you know and as a rep think of it like this in the SAS world what's nice is that you have the sales process broken up you have sdrs for outreach you have the AES you have a sales engineer for medical devices that same person that Dan just described who's in case is doing these things they're also required to prospect do demos find new business all these things and so that leaves very little time to actually get information and data into a CRM if one exists let's just say it's a spreadsheet and so if a day goes by you know whatever a lot of reps they just say I'm going to update this stuff by the end of the week by the end of the week that number one may have turned into a 1.5 or something else and this compounds over time and then sales leaders and marketing leaders end up fighting every single quarter because everybody's freaking out and saying we got to get numbers to the boards because is what's our Revenue going to be like this quarter what can we predict for pipeline next week versus next year versus Etc and then you get the sales team together everybody's reporting the weather it's very subjective based and that's kind of the you know the way the industry is right now yep so we have sellers spending 60 of their time traveling not selling we have logistical issues that are requiring even or creating more headaches and then we have data issues or the lack of data capture that are slowing teams down what do you solve first how do you approach this if you're a sales leader what are these companies what do you do there's some whack-a-mole going on can I jump in on this yeah I think I think the first the first thing and again this is this is why like I really appreciate what avails Avail is doing I've never worked for Avail I wish that Avail existed when I was in the industry right but I think that the first thing is like how do you make the cases and the Reps accessible to the hospital the people they need to help and also influence at any time during the day because back when I was you know ahead of marketing it was a it was a whole field day to figure out how do we get a rep in a room versus let's say r d needs to go Etc so I think that's the one thing on the clinical success side but also on the seller's side you know and again I'm going to say some things are shocking to people in our industry it's normal it was very normal and it still happens today that if you're a rep and you're like I gotta sell to the chair of cardiothoracic surgery um I'm going to pretend that I'm just going to I'm going to hang on this bathroom and wash my hands like 50 times until I know for a fact that his case is going to end at this time they're going to walk in and I'll just be like what a coincidence right so we can't do that anymore because the hospitals are not allowing it so how do we make those sellers able to scale their sales processes remotely and on the other side is a clinical success side or customer success how do we scale that ability so that a rep can be in a room no matter what because not everybody works in San Francisco some of these cases are in the middle of nowhere right and accounts are like an hour two hours apart I have a Instagram Channel called All Hail medical sales and the Reps send me videos and everything you know sometimes it's very common for rep where in the morning they're in you know let's say I since we're in the Bay Area they're in San Francisco and in the afternoon they got to be in San Jose maybe Santa Cruz to cover something and they don't know what time they're going to get home you know so those are the big complexities that we have I bet you did so um I'm remembering a statistic that I can't attribute to the company that provided to me that wouldn't be appropriate but they did a review of multiple divisions in the U.S for getting International for just a moment they came back and told us that 11 of a sales reps time is spent selling oh yep just let that number just settle in for you 11 percent 60 in the car yeah 11 selling you got a whopping 71 what of the other 29. junk just pure junk junk that software ought to be able to take care of frankly okay we're focusing on the 60 percent and we're helping them increase their revenues by getting them into rooms when they couldn't otherwise by way of example one of our very important Partnerships is with Medtronic neurovascular largest neurovascular business in the largest med tech company in the world we have an exclusive partnership to put our units in just a very quick summary we put Hardware in rooms that allows people to video themselves in bring themselves in remotely and see everything in the room they can control cameras and see images that are necessary during the procedure I'll stop there it'll get too clinical but that basic notion is fully solved in yeah there are Skeptics those folks who've been in the business forever ah I'm not doing this remote thing I don't trust this thing we have one of those well one of those just covered a case at seven o'clock in the morning that he couldn't have otherwise covered because he was somewhere else they'd have lost business 20 or so thousand dollars of business which in the med tech space that's a big case that's an important case it's a meaningful chunk of revenues and they wouldn't have supported that physician which wouldn't have gone too well is that physician needed him right that's what Avail is all about so we're kind of taking care of that 60 percent the 11 percent is spent selling I hope you guys can figure out how to do the 29 yeah right um because there's just too much time spent right um inventory tracking is on paper barcodes it's it's just a bunch of silliness that to me software ought to be able to solve yeah um the prospecting process is very very complicated um and it gets more complicated because of the idn excuse me it also gets complicated because if you're selling cardiovascular products and you're part of a large company that also has something in Orthopedics and something else in in general surgery uh that whole bundle is sold at the corporate level yep so you might be trying to sell a widget at X dollars per unit but at the corporate level they're selling it at x minus and you can't control it as part of your process right right because you're just that sales rep down at the street level right I use the word just I shouldn't have that's what your function is that's at that level but at the corporate level their deals getting cut that impact what you have to do every day right um so that complexity adds into it also some something that we have done that clary's focused on for technology companies is standardizing the process standardizing the sales processing governing that process the way that you two are describing the sales process for hcls it seems like it's kind of it's not it's never one size fits all but it seems like there are certain ways that you could streamline things create more of a repeatable process out of it so Omar over to you what do you where do you see the opportunities to add a bit more governance add a bit more standardization into the sales process yeah absolutely so I'm gonna for just for for the sake of using our imaginations imagine a world where a lot of companies are using let's say a veil so that's 60 time that the rep usually driving around let's just say it gets cut down to you know I don't know 10 20 so they have you know 50 more time back right at the end of the day when these companies they put certain business roles we want to do 10 million in Revenue this quarter and to get to that 10 million we have these objectives x amount of meetings Etc the only thing the rep actually controls is their daily and weekly activity that's it so that percentage of time that they just got back these Reps don't know what to do with it right and so I think you know when it comes to processes when it comes to revenue and collaboration across the organization just because there are past time doesn't mean they want to spend it manually entering things into the into the into Salesforce but then on top of it a lot of stuff needs to be automated like it just has to like even if you're very good about data data entry like human bias is there for a reason and you you know for one rep that's okay one time but then that stuff compounds over time and now your projections are way off and this is why the board gets really pissed every quarter because it's like you know they don't know what to expect every board meeting is like what surprise is gonna happen and so I feel like with that time you introduce software and Technology to essentially automate these processes automate the activity and that way the rep who for me I look at sales reps especially in our industry like athletes they want to get better and so you have to give them the right activities that are objectively measured to give them the guidance as to where should they focus and how should they focus if you do this right over time right after I I hope after like a year Revenue becomes a true process where you can actually predict when something's going to close and then look at a board and say you know what this deal has been there for x amount of time with this little touch punch like we have to put more effort there too many times like especially in the world of Capital Equipment like robots things that are really expensive essentially um when you have deals when I used to run deals like having two deals to run there's so many people to deal with most reps have more than two deals right right like they have to have five or eight or ten there's no way on planet Earth Somebody can manage that in their head it's just impossible so you need software to create this process to tell you these are the activities you should be focusing on these are the accounts that are at risk here's where we should put our attention this is where we should put resources and this also helps with marketing because marketing has a budget and they don't know where to spend it sales just comes and says we need this or that right and then that becomes this you know friction with marketing because sales is being subjective very emotional they don't have data to guide them and then marketing let's say you know spends money on certain events in one place when it should have gone somewhere else you know they're saying something similar well actually my question for you is more about we're introducing these new technologies you're bringing the virtual experience into the operating room that's what Avail is is doing in large part Omar's talking about ways that we can automate data capture and relieve some of that manual data entry burden are you seeing resistance from sellers to that kind of pretty radical change yeah I mean I would say the resistance is the lack of familiarity and the comfort with the status quo sure so um what we find out of Ale is there's as true with any New Concept there are early adopters yeah then there's the late early's right that start to smell their way into the kitchen and want to start eating a little bit um then there are the folks that just plain need to Hands-On several times before I'm gonna that rep I described in that particular category a moment ago was a non-believer great performer one of those folks that just somehow gets all that stuff done that I described right but late adopter yeah from the mindset of it and after one experience said wow you know what that that was that was great not sold yet right still need it a little more got another one oh well that's pretty good too and we're starting to chip our way into it right um there is a my status quo has worked for me my entire career mindset um that I think needs to get broken candidly um so I do I do see some resistance in that manner the other thing that's true in med tech because of what Omar said a little while ago of um I'm gonna hang out in the washroom or I'm gonna hang out in the surgeon's Lounge um the in person matters a lot yes to folks yes okay so for Avail we run into that that you're not in person if you're remote definitionally so what happens when my competition is in person and I'm remote um so lots of people have challenges getting over that notion but if you're remote you're actually in there you're just on the screen that's how we describe that and we get folks over that problem I want to touch back on something you said before because I don't want to lose a point you had asked is there a way where there's some standardization that could happen in okay the answer to me is yes ASCS need to be managed a certain way because of the lower volume procedures per site of service that's what we call it in the industry is site of service one ASC is a site of service a hospital is a site of service because of of the low relative volume of the site of service and the lower selling price for the same part number there versus an acute care hospital that we're all familiar with that should be sold differently you can't bring the cost structure from selling Stanford to a joint location uh joint replacement location down the street that does 100 procedures a year you can't bring that cost structure there because you'll lose money so there has to be some other way of managing that not only from the standpoint of support which is what we do but from the standpoint of sales process right there has to be another way and that's an entity that should have some formulaic things that can be built around it software wise sure my head right so that that should be there Capital equipment's another one that's very very different from widgets that are used one time the selling process is entirely different right and there's some folks actually from my team right here who have experience in selling capital and there is a methodical process multi-layered it is it requires lots of management and right now it's not necessarily done in the best way from an automation standpoint selling to an individual hospital or a small group of hospitals totally different than selling to Common Spirit or HCA the two largest hospital changes in the country there are different people that service those there are street level folks and then there's what are called corporate accounts that interaction is a wholly different way of selling that's a model so my point being that there are a couple of different types of categories that can help but on the discouraging side I'm familiar with a very large med tech that has Salesforce in I'm going to say 90 percent of their divisions it's used in about 30 percent of their divisions brutal oh they paid for it they have on staff people trying to integrate right and they're just not getting the traction as they want so so why is that Omar is it the what's in it for me just isn't there yeah no 100 because if you think about it like when from a rep's perspective it's like okay I only have so much time in the day even if if it's capital capital rep they're not in cases but if they have so much time in the day in which you're being judged on is your ability to put deals in Pipeline and close and this CRM is essentially and I the marketers get pissed when I says but essentially it's it's a tool for marketing to see what you're doing so it's like okay if I don't close a deal or get anything in pipeline into activity I'm going to lose my job if I don't get things into the CRM and data wise like I'm gonna get yelled out by marketing my VP is going to have a conversation with me and then like an associate's gonna just do it for me so I'm just not going to do that right I think probably because the big thing is the value's not there and again you know we've talked about this like you know there's uh uh sales I forget a Salesman who we always say like selling isn't is is not an event it's a process but I think in this case when you make Revenue a process right it becomes more objective when it becomes an event it's a subjective thing that everybody gets together on once a quarter they look at award and they start debating what should be done it's being triage so it's like oh we got to close this deal and like we're having these issues so the marketing tries to triage and throw money at it versus when it actually gets broken up through as a process which only happens when you automate the data entry and you have clean data then everybody across the organization not just sales but sales marketing clinical and customer success can objectively look at the process and say Hey how do we manage each one of these variables and what levers do we have to pull it when yep right and that's a much easier way to do things and it's a scalable way yeah I think the big thing that our industry is facing around and across the board is that covid changed a lot of things and it exposed a lot of weaknesses in our industry and now we've kind of realized that hey this business model of med tech the way we've run it for decades you it's no longer functional it's no longer scalable it doesn't fit anymore and so how do we adapt and change that so again like going from that event in a certain a Physicians lounge or or at a conference where you sell to more of a process whether it's like little widget or a piece of cap equipment it's all become a large more collaborative process and it's more complicated so we're talking a lot about how we can add we can streamline the sales rep experience we can drive more efficiency more predictability at the board level at the executive level what about the patients what's in it for them how do these advances and how do this adoption of digital sales technology how is it better for it's a great question yeah I've I've got a uh a very very deep opinion that um all of this logistical stuff we're taking care of um at a veil and all of the process things that we don't take care of but I know you guys are going after hurts patients because it keeps sales reps out of the room and just fundamentally you can't help a patient if you're driving right I mean you just can't do that you can't help a patient if you're banging out a spreadsheet yep and um you know I've been in the industry a really really long time I've seen literally thousands of procedures across every specialty you can possibly think of I've seen sales reps make some recommendations to Physicians about device choice that have benefited the patient on the table in ways that have gone from better outcome to saving a life I've been in those rooms I've watched it happen dozens of times what if that rep wasn't there that day if he or she were driving or he or she were in her home office working on some spreadsheet because the stuff's not collected for them in a more cost or a time saving way that's insane and I think every one of us would agree that for ourselves for our family members I'm just telling you you want the rep in the Rope yeah be it virtually be it in person whatever this you want that rep available because they're knockout great at what they do but if they can't be in the room because there's some stuff that can be managed by software or some stuff that can be managed by hardware and software in our case so they don't need to drive so much that's kind of a problem yeah now to be clear there are loads of procedures where they're frankly not needed in the room and they're there anyway because they're trying to keep relationship they're not needing to run because clinically it's a straightforward procedure the technology is straightforward the procedure is straightforward there's no need for them really really to be there except for when they are needed and the problem is you don't know between patient one and patient two on the same day who have the exact same procedure whether or not you'll be needed so as a rep you're caring for that customer that surgeon that interventionalist and whether or not he or she needs you in a moment if they turn around and you're not there that's a problem right and that's the mindset that the Reps go through um and in some respects I feel for them because the industry has not evolved with tools right to help them have more time to service their customers I'd be interested in that same survey I described that yielded 11 percent selling what it was when I started in my career I'm going to guess it was more like 40. wow 35 or 40. wow I'm going to guess that's my gut yeah right that's just not right right so we got it we have solvent literally saving lives that this is literally a steak here literally that Omar anything to add to that same question like put on let's put on the the patient lens and talk about benefits for them yeah and just just so like so people understand like why is why would why is Daniel saying that like you want the rap in the room is that you know surgery has gotten it gets infinitely more complicated over the years because new technologies get introduced you know things that used to be commonplace like oh you're you know it's common for a patient to have this kind of infection Etc it's no longer a pro you know you know you don't you don't have to have that anymore but when you introduce all these new technologies and ways of managing patient no doctor can manage all that and so a lot of these reps and I you know I worked for a company like this we became hyperized Specialists we almost went through Medical School practically to understand one specific area of the procedure every way that it can better gone wrong Etc and they're of course like in any industry because someone might you know someone once once said is like oh well what if the rep's trying to make quota they're gonna recommend their product there's always a rep like that but the majority of our industry and I've worked with a lot of reps maybe not thousands but definitely in the hundreds of them will oftentimes recommend a patient a competitor over theirs just to make sure the compete you know I'll give you a great example I don't want to mention her name but there's a young lady out of South Carolina her company's product um got recalled okay and so she's not going to make quota that week and I talked to her on the phone she spent the entire week taking her competitor into every one of her accounts wow and introducing them to make sure that that competitor's product was used instead right and so again like I think that the more we're able to automate these processes because again these these things aren't going to go away like the complexity of selling into it I didn't let only even like a standalone Hospital which by the way there's very few of those these days um aren't going away but how do you make it so that all these things are are automated the data is captured and the rep is able to focus on the most important thing which is growing the business uh driving recurring revenue and more importantly helping patients at the end of the day and I think like something like Clary aside from closing deals where it could really help is that once once a product is in it's very hard to predict our our recurring Revenue which is like the ReUse of the product so how do you get the right data and understand oh you know what um we need to give more attention to this account over that account this is how we can allocate budget and the whole thing becomes a much better process versus this thing where it's like once a quarter sales and marketing gets together and then they like you know go head to head on it and it's it's just a mess like it really really is a mess it doesn't help anybody at the end of the day the people that ended up uh suffering as a result is usually patience because they don't get the Technologies to do on and I want to add like one other thing just so people understand this the reason why this is this happens this way is that medicine and Physicians as a whole are pretty much followers like if you decide to do something new and Innovative it's very dangerous you might kill something so it takes a lot for a position to adopt a new product so a lot of times the greatest Innovations you're seeing being used robotics AI Etc it's because a sales rep understood the problem so well that they were able to have a academic discussion with a physician and convince them that this is the best thing for the patient and that's when the physician converts yeah let me tag on to that with a comment that I think um we're facing in healthcare we face in healthcare probably more than otherwise outside of Health Care and that structural resistance to change Behavior because we're in an industry where we care for patients every day when somebody's on the table and you see a certain Anatomy on the screen if it's like a angioplasty for the heart or something you have your go-to's there's a list and then there's this new widget kind of go not today and you put it to the side well the Reps just they got to make their quota they're talking they're trying and they're trying to convince to the to the point that's structural in that piece of the business now I'm going to back it out and talk about sales process for just a second um I I always knew intellectually that digital tools are only as useful as the behavior they can change right I always knew that intellectually starting a veil what I came to understand is that um that we are as hardware and software company yes 100 percent we're changing Behavior across an industry and um that was a board member I just wow hi just there you go um we're we're structurally changing behavior and I will say that um kovid put an attention on the notion of remote it didn't change Behavior it changed awareness sure okay the first right I mean you know you don't know you have a problem you can't solve your problem until you admit you have a problem so the industry admitted they have a problem and then years and years and years went on and I it's inappropriate for you to mention the name of of of of the uh individual who said where I'm getting ready to suggest equally inappropriate to name the company or the setting but in a recent investor setting one of the CEOs of a top three med tech company commented that sale that uh operational efficiencies from this point forward will include remote procedure support that's a change that we at Avail and the folks who were sitting in those stairs right there for my team made happen yeah that was not a minute that's hard to do in this industry right so I would I would submit a challenge of Behavioral change through technology is I of course I've only been in this industry um but I'm gonna say it's probably a little harder than in some other Industries because of the nature of what we do every day but I will also submit that once the behavior is changed you've got the positive side of that good luck on seeding that behavior right so you might invest your way into changing that behavior but once you're locked standards are hard to break right super hard to break in this industry and as somebody who's been involved in multiple change events robotics my last company in angioplasty was that thing that somebody looked at and said wait what are you talking about it's now standard of care and now Avail I can I can just tell you that the stickiness on the other side of that fence is phenomenal yeah oh Mark Daniel thank you so much this has been certainly fantastic really appreciate it thank you thank you [Applause]