Sales in a hospital group is real
Every hospital group has a sales function. Most of them will not say so. The org chart calls it corporate relations, business development, patient services, international, or simply marketing. The people in those roles carry targets, visit accounts, negotiate rates and lose sleep over a quarter. That is sales. The industry’s refusal to name it is not modesty — it is a hangover from a regulatory frame in which the word sits uncomfortably next to the word doctor, and from a belief that patients simply arrive because the hospital is good.
They do not simply arrive. In a multi-unit group, a meaningful share of admissions comes through channels somebody had to open and keep open: a corporate that empanelled you for its employees, an insurer whose network you are on, a referring physician in a Tier 2 town who trusts your cardiac team, a facilitator in Dhaka or Nairobi who chooses between you and three other groups every week. Each of those is a relationship with a commercial logic. Each has a person on your side who is, in every sense that matters, selling.
I came to this from the demand side — the digital funnel, the contact centre, the paid channels. It took me longer than it should have to see that the funnel I was optimising sat beside a second, older engine that nobody measured properly and nobody governed at all. This is about that engine: what it is, how to structure it, how to measure it and how to keep it clean in a market where a doctor cannot be paid for a referral and should never be asked to be.
The five channels nobody calls sales
Strip the euphemisms and the function has five parts. Corporate empanelment: getting onto the approved-provider lists of employers and their benefit administrators, and then getting their employees to actually use you. Referral networks: the physicians, nursing homes and small hospitals in your catchment who send you the cases they cannot handle. International: the facilitators, embassies and overseas partners who route patients across borders. Insurer and TPA desks: the network contracts, the tariff negotiations, the pre-authorisation relationships. And the field teams — the people with cars and territories who visit clinics, corporates and referrers, who are variously titled and universally underpaid relative to what they move.
What unites them is that a human relationship, maintained over time, produces admissions. What separates them is the economics. A corporate account pays cash or near-cash at negotiated tariffs and fills your health-check and OPD capacity. An insurer network fills beds at rates you may regret. A referral relationship brings the high-acuity cases your Centres of Excellence exist for. International brings margin and volatility in equal measure. Treating these as one function with one target is the first mistake, and it is a common one.
Why the pretence costs you
When a function is not named, it is not funded, not measured and not governed. I have sat in unit P&L reviews where the corporate desk’s contribution was invisible because its admissions were booked as walk-ins — the patient walked in, after all. I have seen referral coordinators report to the medical director in one unit, to the unit head in another and to nobody in a third. I have seen an international desk run on the personal phone of one manager whose departure would have taken a country with him.
The pretence also removes the ethical guardrails. If you do not admit you have a sales function, you cannot write its rules. The people doing the work improvise — and improvisation in a market where referral payments are prohibited and widely practised is exactly what you do not want. Naming the function is the precondition for policing it.
Corporate empanelment decides your payer mix
Empanelment is a listing. Utilisation is the sale. Most groups conflate them and celebrate the first. A corporate with three thousand employees on your panel is worth nothing if their HR still sends people to the hospital across the road because it has a smoother billing desk.
The work after empanelment is what matters: the on-site health camps that remain the most reliable OPD driver I know, the dedicated helpdesk number that HR can actually reach, the quarterly utilisation report that lets you have a commercial conversation with the benefits manager rather than a courtesy one. The account manager who does this well is a salesperson with a book of business. Pay them like one, within limits I will come to.
Tariff discipline is where the CFO has to sit at the table. Corporate rates are negotiated under pressure — the account is large, the competitor is offering a package, the quarter is short. Without a floor and an approval matrix, the corporate desk will trade margin for volume every time, and the unit will discover it in the mix analysis six months later. I have built the case for a central tariff committee more than once. It is unglamorous and it works.
Referral networks and the line you do not cross
This is the channel where the industry’s discomfort is earned. Paying a physician for a referral is prohibited under the professional conduct regulations, and every operator knows it happens. The question for a group that intends to stay on the right side of that line is: what can you legitimately offer a referring doctor?
The honest answer is service. A referral line answered by a person who can get a bed. A discharge summary that goes back to the referrer within a day, not a fortnight. A consultant who will take the call when the referring doctor wants to discuss the case. Continuing medical education that is actually good. A named coordinator who knows the referrer and their patients. None of this is a kickback, and all of it is more durable than one — because the referrer’s own reputation with their patient depends on you doing it well.
The field team that maintains referral relationships must be structured so that they cannot pay. No discretionary cash. No sponsorship approved at the territory level. No incentive scheme that rewards the field officer on referral count without a compliance check on how it was earned. I would rather lose the referrer who wants to be paid than keep them and find out later what else the field officer has been doing.
International is a margin story with a facilitator problem
International patients carry the best average revenue per admission in most groups, and the most fragile channel. Facilitators — the agents who bring patients from Bangladesh, East Africa, the Gulf, Central Asia — sit between you and the patient and take a commission. Their loyalty is to the commission. Their ethics vary.
You can build a direct channel, and you should: country desks, digital enquiry in the source-market languages, overseas OPDs with your own consultants, relationships with embassies and referring hospitals abroad. I have run the demand-side version of this and it works slowly. In the meantime, the facilitator relationship needs a written agreement, a commission that is disclosed to the patient in the estimate, and a hard rule that no facilitator fee is ever hidden inside the clinical bill. The groups that have been embarrassed in this channel were embarrassed by exactly that.
Insurer and TPA desks: where sales meets finance
The insurance desk is usually treated as back office. It is a sales function with a finance function stapled to it. The network contract determines whether the insured patient can choose you cashless; the tariff determines whether you want them to; the pre-authorisation relationship determines whether the case gets approved before the surgeon has to reschedule. Each of those is negotiated by someone, and that someone is selling.
The trap is volume without margin. Insurer and government-scheme tariffs can sit below cost for whole procedure categories, and a unit that fills its beds with them will report strong occupancy and weak contribution. This has to be a deliberate mix decision taken with the CFO and the unit head — which specialities, which packages, what ceiling — not an accident of who the desk said yes to. The desk needs a scorecard that shows contribution by payer, not just admissions by payer.
How to structure the function
The model I would defend at an executive committee is a central growth function that owns policy, targets, incentives, pricing floors and compliance, with account and field teams deployed to units. The unit head owns the relationship day to day; the centre owns the rules and the numbers. This mirrors what works in centralised marketing, and it fails for the same reasons if the centre tries to run the accounts itself from a head office.
Separate the channels into distinct teams with distinct targets. Corporate and insurance can sit together — they share the payer logic. Referral and field belong together and need clinical liaison. International is its own business with its own P&L. Do not give one person a blended target across all of them; they will chase whichever is easiest that quarter.
Put the digital funnel and the sales channels under one growth leader. Referrers use the same appointment system, the same contact centre and the same CRM as everyone else. Corporate employees are also consumers who see your campaigns. The two engines have to be reconciled or you will double-count every admission and argue about it in the quarterly review.
How to measure it
Measure contribution, not admissions. An account that brings admissions at a tariff below your cost floor is not a win. This requires the CRM and the HIS to carry payer and source on every encounter, which in most groups they do not. That data work is the unglamorous foundation and it has to be done first.
- By channel: admissions, revenue, contribution margin, average revenue per admission, and mix by speciality.
- By account: empanelled headcount, utilisation rate, revenue per empanelled life, receivable days.
- By referrer: active referrers this quarter against last, cases referred, case acuity, discharge-summary turnaround.
- By field officer: visits, new active relationships, and a compliance flag reviewed before any incentive is paid.
- International: enquiries by source market, conversion to arrival, revenue per patient, facilitator commission as a share of revenue.
Report these at the unit P&L review, in the same pack as occupancy and length of stay. Once the unit head sees that the corporate desk drives a fifth of OPD, the desk stops being back office.
Keeping it ethical when the market is not
Write the policy before the targets. It should say plainly that no payment, gift or benefit goes to any referring clinician or their family; that all facilitator commissions are contracted and disclosed; that corporate tariff discounts follow an approval matrix; that incentives to sales staff are paid on contribution and compliance, not on count. Then make the compliance review a real gate — someone outside the sales line signs off before variable pay is released.
Cap variable pay. Sales incentives in a hospital should be meaningful but not life-changing. A field officer whose bonus is a multiple of salary will find ways to earn it that you do not want. Reward account development, service metrics and retention as much as new volume.
Expect to lose some business. There are referrers and facilitators who will take their patients to a competitor that pays. Let them. The clean version of this function grows slower and lasts longer, and it is the only version you can put in front of a board.
If you’re starting this next quarter
- Inventory every person in the group whose job produces admissions through relationships. Include the ones under marketing, patient services and international. You will find more than you expected.
- Fix the source and payer fields in the CRM and the HIS so that every admission can be attributed to a channel. Without this nothing else is measurable.
- Write the conduct policy and the incentive design together, and take both to the executive committee before you announce any targets.
- Set up the central tariff committee with the CFO in the chair. Route every corporate and insurer rate above a threshold through it.
- Build the channel scorecards and put them in the unit P&L pack. Run them for a quarter before you attach incentives.
- Rationalise the international facilitator list to those who will sign a disclosed-commission agreement. Expect the list to halve.
The hospital that says it has no sales function has one. It just has no idea what it is doing.
Questions people ask
It is the set of people who produce admissions through relationships: corporate empanelment, referral networks, international desks, insurer and TPA negotiations, and field teams with territories. They carry targets, visit accounts and negotiate rates. That is sales. Groups call it corporate relations or business development because the word sits uncomfortably next to the word doctor, and because of a belief that patients simply arrive when the hospital is good. In a multi-unit group they do not simply arrive.
Corporate empanelment, referral networks, international, insurer and TPA desks, and field teams. What unites them is that a human relationship maintained over time produces admissions. What separates them is the economics. Corporate accounts pay near-cash at negotiated tariffs and fill health-check and OPD capacity. Insurer networks fill beds at rates you may regret. Referral relationships bring the high-acuity cases your Centres of Excellence exist for. International brings margin and volatility in equal measure. Treating them as one function with one target is the first mistake.
Because a function that is not named is not funded, not measured and not governed. I have sat in unit P&L reviews where the corporate desk’s admissions were booked as walk-ins and its contribution was invisible. I have seen an international desk run on one manager’s personal phone, whose departure would have taken a country with him. And without a named function you cannot write its rules, so the people doing the work improvise in a market where referral payments are prohibited and widely practised.
Empanelment is a listing. Utilisation is the sale. Most groups conflate them and celebrate the first. A corporate with three thousand employees on your panel is worth nothing if their HR still sends people to the hospital across the road with a smoother billing desk. The work after empanelment is what matters: on-site health camps, a helpdesk number HR can actually reach, and a quarterly utilisation report that turns a courtesy conversation with the benefits manager into a commercial one.
Service. A referral line answered by a person who can get a bed. A discharge summary back to the referrer within a day, not a fortnight. A consultant who takes the call when the referring doctor wants to discuss the case. Continuing medical education that is actually good. A named coordinator who knows the referrer and their patients. None of this is a kickback, and all of it is more durable than one, because the referrer’s own reputation with their patient depends on you doing it well.
A central growth function owns policy, targets, incentives, pricing floors and compliance, with account and field teams deployed to units. The unit head owns the relationship day to day; the centre owns the rules and the numbers. Separate the channels: corporate and insurance can sit together because they share payer logic, referral and field belong together with clinical liaison, and international is its own business with its own P&L. Never give one person a blended target — they will chase whichever channel is easiest that quarter.
Contribution. An account that brings admissions at a tariff below your cost floor is not a win. By channel, track admissions, revenue, contribution margin, average revenue per admission and specialty mix. By account, empanelled headcount, utilisation, revenue per empanelled life and receivable days. By referrer, active referrers quarter on quarter, acuity and discharge-summary turnaround. Report these in the unit P&L pack next to occupancy and length of stay. Once the unit head sees what the corporate desk drives, it stops being back office.
Because corporate and insurer rates are negotiated under pressure — the account is large, a competitor is offering a package, the quarter is short — and without a floor and an approval matrix the sales desk will trade margin for volume every time. The unit discovers it in the mix analysis six months later. Scheme tariffs can sit below cost for whole procedure categories, so payer mix must be a deliberate decision. I have built the case for a central tariff committee more than once. It works.
Cap variable pay so it is meaningful but not life-changing. A field officer whose bonus is a multiple of salary will find ways to earn it you do not want. Pay on contribution and compliance, not on count. Reward account development, service metrics and retention as much as new volume. Make the compliance review a real gate — someone outside the sales line signs off before variable pay is released. Write the conduct policy and the incentive design together, and take both to the executive committee before announcing targets.
Payer and source on every encounter, carried consistently in both the CRM and the hospital information system. In most groups they are not, which is why corporate admissions get booked as walk-ins and referrals show as self. Fixing those two fields is unglamorous and has to be done first; without it nothing else is measurable and every channel will argue over the same admission. Run the channel scorecards for a full quarter on clean data before attaching any incentive to them.
It carries the best average revenue per admission in most groups and the most fragile relationship. Facilitators sit between you and the patient, take a commission, and are loyal to the commission. The groups that have been embarrassed in this channel were embarrassed by a facilitator fee hidden inside the clinical bill. Insist on a written agreement, a commission disclosed in the patient’s estimate, and a hard rule against hidden fees. Expect the facilitator list to halve when you enforce it, and build a direct channel in parallel.
Yes. Referrers use the same appointment system, contact centre and CRM as everyone else. Corporate employees are also consumers who see your campaigns. If the two engines sit under different heads, every admission gets double-counted and argued over in the quarterly review. I came from the demand side and it took me too long to see that the funnel I was optimising sat beside an older engine nobody measured. Putting both under one growth leader is how they get reconciled.
Inventory every person whose job produces admissions through relationships, including those under marketing, patient services and international — you will find more than you expected. Fix the source and payer fields in the CRM and HIS. Write the conduct policy and incentive design together and take them to the executive committee. Set up the central tariff committee with the CFO in the chair. Build channel scorecards into the unit P&L pack. Rationalise the facilitator list to those who will sign a disclosed-commission agreement.
A single hospital has one already — usually a corporate desk, a person who visits nursing homes, and someone who negotiates with TPAs — and the same problems of invisibility and improvised ethics. The structure is simpler because there is no centre-versus-unit question, but the conduct policy, the tariff floor and the contribution scorecard matter just as much. In a Tier 2 city the referral network is usually the largest channel and the one most exposed to the wrong currency, so start there.
