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UNIVERSITY OF ECONOMICS HO CHI MINH CITY International School of Business Luc Tuan Tu IMPROVING MARKETING COST-EFFECTIVENESS A STUDY OF MEDTRONIC COMPANY IN HO CHI MINH CITY - VIETNAM MASTER OF BUSINESS ADMINISTRATION Ho Chi Minh City – Year 2020 UNIVERSITY OF ECONOMICS HO CHI MINH CITY International School of Business Luc Tuan Tu IMPROVING MARKETING COST-EFFECTIVENESS A STUDY OF MEDTRONIC COMPANY IN HO CHI MINH CITY - VIETNAM MASTER OF BUSINESS ADMINISTRATION SUPERVISOR: Assoc Prof Dr NGUYEN THI MAI TRANG Ho Chi Minh City – Year 2020 EXECUTIVE SUMMARY Recently, the profit and loss of Medtronic has experienced a decrease versus its target This circumstance is mostly impacted by increased number and amount of marketing activites The main problems belong to the low efficiency of current marketing activities, reflecting through the low number of customer coverage while the spent marketing budget exceed it limit In order to discover the issue that Medtronic facing with, meeting with two sales managers of the Business Unit as well as relevant sales representative has been implemented Through interviewing relevent subjest, using data provided by the company and using related theory, main problem was identified as low-cost effectiveness of marketing activities Towards main problem, three potential causes have been found are Lack or Low frequency of following up activities, Low competencies of sales team in order to cascade the impacts of the marketing events or Focus on wrong types of promotion activities After analysis, main cause that chosen to solve is Focus on wrong types of promotion activities This study will focus on solutions to address the cause in order to help the company to improve their Profits and Loss ACKNOWLEDGMENT Without the encouragement, guidance and support of Prof Nguyen Thi Mai Trang and other teachers, the entire master-level project would not be possible I would like to send my appreciation to my advisors It has been a pleasure working with you on this project I would like to thank my friends and family for greatly supporting me while I was working on my research Your Patience, understanding and respect were greatly appreciated TABLE OF CONTENTS INTRODUCTION 1.1 GLOBAL MEDTRONIC CORPORATION .1 1.2 VIETNAMESE MEDTRONIC CORPORATION 1.3 PINNACLE HEALTH EQUIPMENT CORPORATION SYMPTOMS PROBLEM IDENTIFICATION 3.1 POTENTIAL PROBLEMS 3.1.1 OVER-FOCUS ON LONG-TERM ACTIVITIES 3.1.2 NOT SATISFY THE CUSTOMERS ACADEMIC REQUIREMENTS .9 3.1.3 INSUFFICIENT KEY HOSPITAL MANAGEMENT .10 3.1.4 LOW COST-EFFECTIVENESS OF REGULAR MARKETING ACTIVITIES .12 3.2 PROBLEM VALIDATION .15 POTENTIAL CAUSES 17 4.1 SALES REPRESENTATIVES LOW COMPETENCIES, UNABLE TO CASCADE THE IMPACTS OF EVENTS 18 4.1.1 TRAINING ARE NOT PRACTICAL 18 4.1.2 LACK OF CONTENT-CASCADING MATERIALS 19 4.2 LACK OR LOW FREQUENCY OF FOLLOWING ACTIVITIES – INSUFFICIENT SALES REPS TO COVER .21 4.3 FOCUS ON WRONG TYPES OF PROMOTIONAL ACTIVITIES 22 4.3.1 FOCUS ON WRONG CUSTOMER SEGMENTATION 22 4.3.2 NOT CLEAR INTERPRETATION ABOUT CUSTOMERS INSIGHTS 24 4.4 CAUSE VALIDATION 25 ALTERNATIVE SOLUTIONS .26 5.1 ALTERNATIVE SOLUTION 1: RE-ALLOCATE EXPENDITURE TO OTHER CUSTOMERS’ GROUP BY DIFFERENT APPROACH 26 5.2 ALTERNATIVE SOLUTION 2: CONDUCT A SURVEY WITH DOCTORS TO UNDERSTAND DEEPLY CUSTOMERS’ INSIGHTS 28 5.3 SOLUTION JUSTIFICATION 29 CHANGE PLAN DESIGN 31 6.1 OBJECTIVES 31 6.2 TARGETED OUTCOMES 31 6.3 ACTION PLAN IMPLEMENTATION 31 CONCLUSION .34 SUPPORTING INFORMATION 35 8.1 METHODOLOGY 35 8.2 INTERVIEW GUIDE 35 8.3 TRANSCRIPTS .37 REFERENCES 45 ABBREVIATION APV Aortic, Peripheral and Venous CRHF Cardiac Rhythm and Heart Failure CS Cardiac Surgery CVG Cardiac Vascular Group EBIT Earning before Interest and Tax FY Fiscal Year HCP Healthcare Professionals KOL Key Opinion Leaders KPIs Key performance index MITG Minimally Invasive Therapies Group MedEVAR Medtronic Endovascular Aneurysm Repair MedTEVAR Medtronic Thoracic Endovascular Aneurysm Repair PnL Profits and Loss Q3 Quarter RTD Round Table Discussion RTG Restorative Therapies Group T&E Training & Education YTD Year to Date LIST OF TABLES Table 1: APV Profit & Loss (PnL) – Actual vs Target Table 2: APV Profit & Loss (PnL) – Gap Table 3: APV FY20 P&L - Marketing report Table 4: Pinnacle Performance Report Table 5: Quota Tender Report Table 6: Financial Report – Spent Budget YTD Q3 FY20 Table Training programs in 2019 Table Quantity of customers and KOLs by portfolio Table 9: Quantity of engaged implanters by sales rep Table 10 Cost & benefits for alternative solution Table 11 Cost & benefits for alternative solution Table 12 Action plan (Author synthesis) Table 13 Detailed description & objectives for specific tasks LIST OF FIGURES Figure 1: APV Organization Structure Figure 2: Pinnacle Organization Structure Figure 3: Training & Education Survey Report Figure 4: Cause-and-Effect map Figure Fish bone diagram of main problems and potential causes Figure Medtronic marketing materials Figure Cause-and-Effect map Figure Gantt-chart for action plan (Author synthesis) INTRODUCTION 1.1 Global Medtronic Corporation Medtronic PLC is a medical device company that generates the majority of its sales and profits from the U.S healthcare system but is headquartered in the Republic of Ireland for tax purposes Medtronic has an operational and executive headquarters in Fridley, Minnesota in the U.S In 2015, Medtronic acquired Irish–tax registered Covidien (a U.S tax inversion to Ireland from 2007), in the largest U.S corporate tax inversion in history, which enabled Medtronic to move its legal registration from the U.S to Ireland Medtronic operates in 140 countries and employs over 86,000 people Medtronic was founded in 1949 in Minneapolis by Earl Bakken and his brother-inlaw, Palmer Hermundslie, as a medical equipment repair shop Through his repair business, Bakken came to know C Walton Lillehei, a doctor of heart surgery at the University of Minnesota Medical School The deficiencies of the pacemakers of the day were made painfully obvious following a power outage over Halloween in 1957, which affected large sections of Minnesota and western Wisconsin A pacemakerdependent pediatric patient of Lillehei died because of the blackout The next day, Lillehei spoke with Bakken about developing some form of battery-powered pacemaker Bakken modified a design for a transistorized metronome and created the first battery-powered external artificial pacemaker The company expanded through the 1950s, selling equipment built by other companies but also developing custom-made devices Bakken built a small pacemaker that could be strapped to the body and powered by batteries Work in the new field later produced an implanTable pacemaker in 1960 The company-built headquarters in the Minneapolis suburb of St Anthony, Minnesota, in 1960 and the company moved to Fridley in the 1970s Medtronic's main competitors in the cardiac rhythm field include Boston Scientific and St Jude Medical In 1998, Medtronic acquired Physio-Control for $538 million According to a press release, the fiscal year 2019 revenue increased by 2% to $30.557 billion The net earnings in the fiscal year were $4.631 billion or $3.41 per diluted share The non-generally accepted accounting principles (non-GAAP) earnings were $7.089 billion or $5.22 in diluted earnings per share The cash flow from operations was $7.007 billion The free cash flow was $5.873 billion compared with $3.616 billion from the year prior, a 62% increase And Medtronic, currently, is the largest Medical Device Company in the world 1.2 Vietnamese Medtronic Corporation Vietnamese Medtronic Corporation was established in 2016 and a subsidy of Global Medtronic Like global company, Vietnamese Medtronic Corporation focus on therapeutic Areas: Cardiovascular Group (CVG), Diabetes, Restorative Therapies Group (RTG) and Minimally Invasive Therapies Group (MITG) In each Group, it will be divided into small sub-groups based on Therapeutic Treatment In CVG, Medtronic has sub-groups as: Aortic, Peripheral & Venous (APV), Cardiac Rhythm and Heart Failure (CRHF), Cardiac Surgery (CS) and Coronary In this thesis, we only focus on Aortic, Peripheral & Venous Group (APV) Figure 1: APV Organization Structure (Source: Medtronic internal structure) For the current group, as above figure, Medtronic has 12 salespeople, including 02 sales managers and 01 national sales manager (Mr Jason Dang) Total other sales representative will cover national wide but mainly focus on Hanoi, Ho Chi Minh, Da Nang and Can Tho Creat plan referreal List down all Select list of satellite hospitals that will hospitals (focus on A potential referral be referral hospitals from big accounts & B doctors) and hospitals like Bach Mai & Cho Ray satellite hospitals of Set KPI (Number of patients, number of big accounts like proceduce will conducted during the Bach Mai, Cho Ray, event Etc) etc A&B doctors will prioritized to be speakers Create plan for Build clear Select each program to engage A&B engage A & B doctors picture for A&B doctors for workshop Doctors Those A&B doctors will be prioritized to be speakers Create plan for Build clear Get plan to engage C doctors ( mostly in engage A, B, C picture for A&B, provinces like Hau Giang, Hai Phong, doctors by online especially platform doctors Implement and Conduct and get Pivot activities – get feedback through feedback – Wave feedback C Can Tho, Quang Ninh, etc) online survey about the activities and improvement Implement and Conduct and get Pivot activities phase II – enrich from feedback – Wave feedback phase I and get feedback Table 13 Detailed description & objectives for specific tasks CONCLUSION In general, through approaching to Medtronic, the study has initiated with the situation that the company experienced a drop in PnL This circumstance is mostly impacted by the increasing in number of Marketing budgets Through interviewing relevang people in the company, using data provided by the company and searching for related theory, the main problem was identified as Low-cost effectiveness of markeitng activities Towards main problem of the low cost-effectiveness, three potential causes have been 34 found out are Lack or Low frequency of following up activities, Low competencies of sales representative, unable to cascade the impacts of event and Focus on wrong types of promotion activities After analysis, the main cause chosen to solve is Focus on wrong types of promotion activities Towards the main cause, the best solution was to Re-allocate expenditure to other customers’ group by different approach With this solution, the company expect to increase the customer coverarge, increasing productivity of employees As a resut, the marketing cost-effectiveness will increase, improving the cost-effectiveness of whole activities, resulting in positive PnL in the future SUPPORTING INFORMATION 8.1 Methodology With the limit of time and cost of the problem solving project, this study will figure out the main problem and the main cause which lead to the inaccuracy in accounting reports and suggest proper solutions for Medtronic Type of data sources: - Secondary data: Medtronic company structure, Pinnacle company structure, financial reports, literatures in journals and researches - Primary data: qualitative research and quantitative research Type of research tools to collect primary data: 8.2 Quanlitative research: in-depth interview and focus group Interview guide Research objectives: To explore and understand the reason why Medtronic APV Vietnam has low cost-effectiveness of regular Marketing activities in this years and propose solutions to solve it Duration: 10-20 minutes Overall discussion framework: # Key sessions Objectives Timing 35 To understand the current situation of business activities in Medtronic Overall background Ho Chi Minh Explore the cause of high-cost marketing activities and define the main reason The solution 2-3 minutes To explore the main reasons that 5-10 lead to the problem minutes 5-10 To find out solutions minutes Detail interview content: # Question Could you introduce something about yourself and the position you are working in this company Do you think that Medtronic business in APV Market is potential or not? Could you please share your opinion about sales results of APV Medtronic in this year 2019? Could you share the reason why Medtronic APV company not meet the EBITA target? Mr Thao & Mr Mr Khai Quang X X X X X X X X X X X X X X X In your own opinions which are the most important causes lead to low sales results of Medtronic company? And why you think so? What are solutions that the company has taken to improve the situation What are your opinions about the effectiveness of the solution? Could you share any alternative you think should be taken to solve this problem? Among all solutions, what is the best way to do? Why you think so? 36 8.3 - Transcripts Time of interview: 9:00, 20th February 2020 in Hanoi Duration for each interviewer: 10-20 minutes Address: Medtronic Office, 11th Gelex Tower, 52 Le Dai Hanh, Hanoi City In-depth interview 1: Interviewer: Luc Tuan Tu Interviewee: Mr Pham Thao Title: North Sale Manager Age: 47 Working experience period: more than 14 years as sales manager in Medical Devices Status: currently working at Medtronic in Hanoi Luc Tuan Tu: Good morning Could you introduce something about yourself and the position you are working in this company Pham Thao: My name’s Thao, I had years working for Medtronic company and years with Biotronik And I’ve been a sales manager of Medtronic from the beginning time in 2015 Luc Tuan Tu: over years with a lot of experience Do you think that Medtronic business in APV Market is potential or not? Pham Thao: I believe that Medtronic company will have a bright future with APV portfolio since there are few competitors and the whole market is getting bigger recent time with a dizzy speed Luc Tuan Tu: Sound great! Could you please share your opinion about sales results of APV Medtronic in this year 2019? Pham Thao: To tell the truth, I see that this year acted as a milestone for APV Vietnam since we successfully launch new products as NAVION, increase Market Access in 3-4 accounts We ends this year with positive result in terms of revenue 37 Luc Tuan Tu: Could you share the reason why Medtronic APV company not meet the EBITA target? Pham Thao: We need have many aspects to concentrate in order to drive the APV performance in Hanoi, especially Aortic Franchise, currently, we have only 10-15 Key Opinion Leaders in Aortic Therapy and most of them required continuously update of knowledge For short-term activities, we mostly engage them by conducting series Educating Activities for Thoracic Endovascular Aneurysm Repair (TEVAR) or Endovascular Abdominal Aneurysm Repair (EVAR) and in those activities, those KOLs will share their experience as speakers, which help to enhance their reputation The cost of engaging those KOLs are significant As a result, the budget exceeds our proposed expenditure at the beginning of this year Luc Tuan Tu: Among factors, in your own opinions which are the most important causes lead to low sales results of Medtronic company? And why you think so? Pham Thao: I believe that currently Medtronic sales team have worked well to deliver the performance For the better part of my experience, if we want to reduce the cost of marketing, we need to find a more efficient methods or activities Regarding the causes, one of the most important thing is the requirement of following up our activities, without follow up actions, all activities are in vein For example, we cost 8000-9000 USD to sponsor for a doctor to come to US, but if there is no rep following up the post-activities of the proctor, he/she tend to forget the engagement and we will lose the money One more point could be the insufficient selling skills, that can negatively impact on our effectiveness Therefore, continuously training and assessing those MedRep about this point is crucial One of my perennial memory was that, after the National Heart Congress in Hanoi, we engaged total speakers, all of them are our main KOLs, such as Dr Nguyen Manh Hung, Dr Le Ngoc Quang, and we also invited Dr Alex Wong from the USA, which costed us at least $10000 However, we cannot measure the result accurately Actually, we not have any materials which covers all presentation If we have, I think we can it better and can incerase a frequency of the engagement Moreover, We have around 400 Healthcare Professonals (HCP) But for PV portfolio and EV portfolio, if we want to increase the revenue, we need to expand 38 the doctor-egagement list Most of our sales team are in big hopitals like Bach Mai, Hanoi Heart, Cho Ray, University of Medical center in Ho Chi Minh city Moreover, the objectives of 3rd party congress is to increase the market access, increase the customer coverage However, we have only sales rep, so maximize we can only cover around 500-600 HCPs We have developed Aortic portfolio since 2005, it has been 15 years right now and the total HCPs for this portfolio is just around 100 HCPs There are requirements to promote Aortic Products in the hospitals, such as the Hybrid Room, DSA machine and CT scan Moreover, implanters are required to complete at least years of training to it We have expand the marketing to at least 20 provinces in Vietnam So, I just wonder is that we overspend on top KOLs instead of ordinary implanters The information of Aortic is not actually new nowadays Luc Tuan Tu: What are solutions that the company has taken to improve the situation? Pham Thao: I think we can apply technology to reduce the cost As an illustration, instead of gathering all doctors in a room in a hotel, which cost us tons of money to sponsor for Meals, Teabreak, Meeting fees, we can use Webinar concept in which doctors can join through the Internet, we still can engage speakers as well as educating learners Luc Tuan Tu: What are your opinions about the effectiveness of the solution? Could you share any alternative you think should be taken to solve this problem? Pham Thao: We try the idea before, in June 2019, it was a webinar between Bach Mai Hospital & Thai Binh Hospital Dr Than shared experience through Webex and the Thai Binh’s doctors could raise their question virtually In my perspective, it is beneficial for both sides since the learners not need to travel to Hanoi For the alternative solution, increasing more Round Table Discussion could be the one, but it seem to only suiTable for new accounts Luc Tuan Tu: Among all solutions, what is the best way to do? Why you think so? Pham Thao: As I said, there are not the best way, just the most suiTable way to We can apply based on the characteristics of each hospital and the customer’s insight 39 Understanding the customers’ insights will be foremost Therefore, we can apply both ways - Time of interview: 16:00, 19th February 2020 in Hanoi Duration for each interviewer: 10-20 minutes Address: Medtronic Office, 11th Gelex Tower, 52 Le Dai Hanh, Hanoi City In-depth interview 2: Interviewer: Luc Tuan Tu Interviewee: Mr Vien Quang Title: North sale representative Age: 26 Working experience period: more than years as sales representative in Medical Devices Status: currently working at Medtronic in Hanoi Luc Tuan Tu: Good morning Could you introduce something about yourself and the position you are working in this company Vien Quang: My name’s Quang, I have been Med-Rep in Medtronic for years since my graduation from my university And currently I work for Aortic Group, focus on Bach Mai Hospital to promote Abdominal & Thoracic stent graft Luc Tuan Tu: Sound great! Could you please share your opinion about sales results of APV Medtronic in this year 2019? Vien Quang: I think that the foremost difference between Medtronic and its rivals is about T&E programs and Doctors are well aware about that Whenever they want to learn new things or want to travel to other nations to attend necessary conferences, the first option that they have in their minds will be Medtronic since they are all acknowledged that Medtronic will sponsor for them to help them to enhance their knowledge and skills Undoubtedly, it is of paramount importance for us The effectiveness of inviting customers to join 3rd party congresses is extremely good in 40 terms of educating them about new therapy and sharing experience However, I think that some of those benefits could be achieved through local congresses instead of regional ones For example, for Aortic, since we have developed the therapy in Vietnam for almost 10 years, some Vietnamese proctors, currently, have sufficient experience and knowledge to teach others As a result, some events can be replaced by other local ones to reduce cost but still achieve the objectives Luc Tuan Tu: Could you share the reason why Medtronic APV company not meet the EBITA target? Vien Quang: For my territory, mostly we engage doctors by T&E program, because in Bach Mai, we have many KOLs and most of them are main implanters, therefore, we are required to allocate more budget to invite them For those doctors, we can only engage them as speakers in local congresses and participants in global congresses since regional ones are not viable Luc Tuan Tu: In your own opinions which are the most important causes lead to low sales results of Medtronic company? And why you think so? Vien Quang: We mostly have trainings about product knowledge, product specifications and sharing case studies in which we can discuss with overseas sales reps, especially for some touching cases or complicated anatomy To follow up the content of the event, mostly, I think the reponsibility belongs to the distributors’ rep since we focus more on givign consultancy to doctors In some cases, when I invite some customers to join the meeting or event The content of the event actually is not perfectly fit with what the customer needs For example, when we invite a Cardiac Surgeon to join, however, the moderator is Interventional cardiologist, and of course, they will share about their expertise on endovascular only, instead of sugery Luc Tuan Tu: What are solutions that the company has taken to improve the situation? Vien Quang: In my perspectives, we can try to change the proportion of types of activities For KOLs, we can increase local workshop to engage them as speakers that help to reduce financial burden For other, we can request distributors to increase sales 41 rep to increase the follow-up effectiveness Among two solutions, I prefer changing the way that we allocate our budgets, as I mentioned before, currently, Doctor’s awareness about Aortic, Perpheral & Endovenous portfolios is well-developed Moreover, with $30,000 tending to spend on the research I belive that we can conduct some referral programs that we can earn more revenues about $300,000 since our margin is around 10% Besides, we have no guarantee about the effectiveness of the research Luc Tuan Tu: What are your opinions about the effectiveness of the solution? Could you share any alternative you think should be taken to solve this problem? Vien Quang: We try the idea of local workshop in Bach mai before, with two MedAortic Local & International and both of them are enormously beneficial Luc Tuan Tu: Among all solutions, what is the best way to do? Why you think so? Vien Quang: Local congresses or workshops will be preferable - Time of interview: 11:00, 10th February 2020 in Ho Chi Minh city Duration for each interviewer: 10-20 minutes Address: Medtronic Office, 11th Royal Center B, 235 Nguyen Van Cu, Nguyen Cu Trinh Ward, District 1, Ho Chi Minh city In-depth interview 3: Interviewer: Luc Tuan Tu Interviewee: Mr Nguyen Khai Title: South Sale Manager Age: 38 Working experience period: more than 10 years as sales manager in Medical Devices Status: currently working at Medtronic in Ho Chi Minh 42 Luc Tuan Tu: Good morning Could you introduce something about yourself and the position you are working in this company Nguyen Khai: You can call me Khai, I had more than years working for Medtronic company and 10 years with Philip And I’ve been a sales manager of Medtronic from the beginning time in 2018 Luc Tuan Tu: over years with a lot of experience Do you think that Medtronic business in APV Market is potential or not? Nguyen Khai: I always believe that Medtronic will go further in APV business For example in VN, we have more than 90 million people and around 2-3% of them have aneurysm, 4-5% have PAD diseases and 6-7% have Venous disorders There are huge patient pool out there Luc Tuan Tu: Sound great! Could you please share your opinion about sales results of APV Medtronic in this year 2019? Nguyen Khai: We have achieved good performance in this year with 120% performance That reflexes the great contribution of our sales members With full high skills staff, I still believe that we can go further Luc Tuan Tu: Could you share the reason why Medtronic APV company not meet the EBITA target? Nguyen Khai: The reason why we need to spend lots of budget into marketing activities is about Peripheral & Venous therapy, in those activities, since most of doctors are newbie with the techniques, and in Vietnam, we not have any proctors who can train back Vietnamese Doctors, therefore, we need to send them to other foreign centers in Singapore, Malaysia or Thailand, which enhance and burden the cost of Marketing Luc Tuan Tu: Among these factors, in your own opinions which are the most important causes lead to low sales results of Medtronic company? And why you think so? 43 Nguyen Khai: At currently, I think that one of the main cause that our sales tem not follow up the activities that we as they not know how to it Initially, we have not had trainings in order to focus on selling skills since I did not think that it was suiTable at this company, the number of doctors are quite limited and the sales reps are just required to excel in product knowledge and the distributor’s rep will the follow up In the south, Aortic portfolio and PV/ EV portfolio have had a long time to develop, we engage 3rd party congress to invite KOLs in order to update new knowledge It has costed me huge expenditure but worthy However, we are increasing the number of Round Table Discussion (RTD) to reduce cost and retain the customer engagement Luc Tuan Tu: What are solutions that the company has taken to improve the situation? Nguyen Khai: Digital activities could improve the situation Especially in smartphone, all of doctors possess smartphones, if we can utilize the channel, we can reduce the cost Luc Tuan Tu: What are your opinions about the effectiveness of the solution? Could you share any alternative you think should be taken to solve this problem? Nguyen Khai: We have to try But I think it is possible in next years All things are going in the Internet at this moment, even scientific conferences Luc Tuan Tu: Among all solutions, what is the best way to do? Why you think so? 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OF ECONOMICS HO CHI MINH CITY International School of Business Luc Tuan Tu IMPROVING MARKETING COST- EFFECTIVENESS A STUDY OF MEDTRONIC COMPANY IN HO CHI MINH CITY - VIETNAM MASTER... Bach Mai, 108 Hospital, All Hanoi Viet Duc, E Hospital, Hanoi Heart Hospital Cho Ray, UMC, Gia Dinh All HCM Can Tho, An Giang, Soc Trang Da Nang, Hue Thu Duc, Binh Dan, 115 Hospital National wide... mass marketing Another ideas, according to (7), increase selling skills for sales team in order to increase the effectiveness of each call could be considered By facilitating internal training