Confluence Marketing: A Union of Forces for a Shared Outcome Confluence marketing is a philosophy and a process for sharing ideas across key customer groups and breaking down traditional divides. It is precisely at the confluence of these groups that true marketing power is unleashed, and when the marketing agenda should be set. VIEW on confluence marketing Confluence marketing creates a network of interactions among customer groups and constituencies to shape an agenda favorable to a brand, a corporation, or a cause, according to Daniel Teper, Pharm.D., CEO of Energy & Company. The goal of confluence marketing is to create conditions that enable the confluence, or the flowing together of the customer groups’ diverse and sometimes discordant ideas and perspectives into a larger, singular entity. Like smaller streams coming together to form a large river, the new agenda is more powerful than any individual group’s agenda could ever be. It is focused, consensual, and owned by the constituent groups. “Often the expectations of physicians, the patients, and the payers are not aligned,” Dr. Teper says. “Confluence marketing is a dialogue between the different customer groups and stakeholders with the objective of moving toward either a common agenda or a common understanding of a particular issue.” Confluence marketing turns customers into sought-after experts who lead discussions, identify collaboration platforms, define common goals, and design or implement strategies. Simply put, Dr. Teper says, confluence marketing gives stakeholders a chance to recognize what the agenda should be, generate an owned concept of what really matters, and develop the opportunities and scientific support to measure how well patients fit that standard. Eventually, stakeholders become advocates for their new agenda, and from that point, the new agenda is what determines market expectations. “Working with all customer groups ensures that marketers are communicating effectively — and efficiently — within the market from the very beginning of the process,” he says. Dr. Teper cites The Vascade Alliance as one example of a coalition of working with top medical specialists and food and pharmaceutical company partners and other key societal stakeholders to promote an integrated approach to the management of obesity, diabetes, and cardiovascular disease. “Currently these illnesses are treated by multiple medical specialties, and those medical specialties have their own organizations that issue guidelines,” Dr. Teper says. “The idea is to bring together a hypertension specialist, a diabetes specialist, and a lipid specialist so that they can evaluate a patient as a whole to address heart-attack prevention and determine the practical application of the guidelines and optimal patient care. By involving food companies and the media, the idea is to get influencers in each of these constituencies to agree to undertake initiatives to affect change.” The Steps to Confluence Marketing Confluence marketing is both a philosophy and a process, which exists within and above day-to-day marketing. It must have a leader who can think outside the traditional sequence of marketing planning and who can stimulate a dynamic, inclusive, and cross-functional environment. Confluence marketing can address a broad issue or answer a specific marketing problem. Dr. Teper outlines four broad steps that marketers should follow. • Start with the strategy. Define a hypothesis that addresses the issue, gap, missing link, or necessary connector across the groups. • Go to the customer. Identify all relevant customer groups. Form a cross-customer advisory or editorial board to simulate reality. Determine the values that go across groups. Map the interdependencies, consistencies, and balance across groups. Understand and interpret the shared motivators, constraints, and potential. Study how the group reacts to its environment and demands. • The Eureka! moment of confluence can be a revelation or may require judgment or deliberate processes. Unleashing the power and shaping the agenda is an iterative and creative process that requires holism, openness, and good listening. • Take the agenda back into the silos. This unified agenda feeds branding and creative brainstorming exercises across all marketing and communications functions. The result will be an aligned, focused, and powerful marketing message. Pharmaceutical marketers, Dr. Teper says, have to break down the silos of the different departments, the different brands, and the different corporate communications agencies to forge better working alliances. “A lot of money is spent promoting brands, and that has helped to treat more patients more appropriately,” Dr. Teper says. “But, we’re at a stage where U.S. patients and consumers need more balanced information. It is preferable that information come from a group of related constituencies, including pharma companies, rather than from a single commercial source.” Confluence Marketing Through Integrated Communications “Once a common agenda has been agreed to by the key stakeholders, integrated communications programs allow efficient dissemination of the message to various customer groups,” Dr. Teper says. Heart4Health is an example of such an approach taken by The Vascade Alliance to reach out to patients and consumers concerned about cardiovascular health. It combines TV programs broadcasted on cable and network channels; a Website (heart4health.org) located on WebMD, editorial in consumer magazines; direct mail; and community-based events produced in partnership with HealthExpo where thousands of people get screened for cardiovascular risk and receive advice for healthy eating, appropriate physical activity, and treatment compliance. At every touch point the consumer is encouraged to register for more information and become part of a community. Heart4Health strategic priorities and key messages are determined in a dialogue between representatives of industry and medical authorities, such as Antonio Gotto, M.D., D.Phil., dean of Weill Cornell Medical College, Ed Horton, former president of the American Diabetes Association, Peter Libby, M.D., chair of cardiology at the Brigham and Women’s Hospital, and Henry Black, M.D., a top hypertension specialist. Confluence Marketing to Redefine a Category Certainly, traditional advertising and promotion are powerful tools to introduce the product, drive awareness of its key features and benefits, and associate long-acting as a positive, relevant patient end-benefit. “But how do marketers credibly and authoritatively make long-acting the new and standard measure for disease management?” Dr. Teper asks. “The confluence marketing lens identifies the advocacy community as the integral part of the redefinition process. Confluence marketing would prescribe bringing together thought leaders, specialists, pediatricians, parents, and teachers from across the globe into a steering committee that would follow a step-by-step process to precisely redefine treatment endpoints at the confluence of interests of all constituencies involved.” Using the new pediatric treatment as an example, to achieve this goal the confluence committee should: • Champion the desire for an alternative to existing options; • Offer a broader and more-inclusive perception of the condition that calls for a long-acting treatment; • Bolster physician and nonphysician thought leader support for a long-acting treatment; • Develop diagnostic and measurement tools to support the long-acting effects; • Ensure that the tools are accepted as the new gold standard to create best-practice guidelines; • Address concerns about the redefinition; • Increase patient/consumer awareness of the reformulated definition and need for treatment based on the new definition; and • Provide an assortment of public-image opportunities, including media attention. “Only with this level of interaction across many discrete interests can a fundamental, sustainable, and universally applicable sea change in how a condition gets treated be implemented,” Dr. Teper says. Compliance Programs are Confluence Marketing “As a marketer, you may be one of the lucky ones who has responsibility for continuity,” Dr. Teper says. “Just to make it interesting, let’s say the product’s target audience is teenagers, and it competes in a market rampant with switching; teens are not, by nature, loyal. So you determine that you need a compliance or relationship-marketing program. Teens are motivated by engagement, fun, affinities, and what’s cool. Imagine, for a second, the fertility and richness in the creative brief for this very creative assignment. “Confluence marketing would tell us a different story,” he says. “Physicians have to prescribe the product and are therefore potentially the most effective channel to bring teenagers into the program. But cool does not always resonate with physicians when it comes to teen health, especially if the cool packaging is too frivolous or too bulky. And parents are decision makers too, and they trust the physician’s product choice as the most clinically sound option for their child. After that, they care about convenience and price.” In this scenario, marketers want large signage for the product and program, sales reps worry about the limited capacity in the trunk of their car, managed-care marketers are attuned to the backlash of a cool program, and distributors know that independent mail-order programs are really where ongoing product is sourced. “Somewhere in this account, there is a confluence, but it is not at cool,” Dr. Teper says. “The creative brief must be rewritten.” The Economic Story in Confluence Marketing “Years of a successful track record in brand management have taught us to focus on clinical and other product features, customer benefits, and emotional resonance when creating a brand,” Dr. Teper says. “All marketing programs reflect these agonized-over principles. But somewhere in a parallel universe sit the market access, pricing and reimbursement, and pharmacoeconomic folks, who undertake a different kind of research to develop an economic story for a different buyer.” This story follows a course independent from what is traditionally viewed as marketing and gets implemented in its own set of tactics: white papers, slide presentations, and formulary kits. Dr. Teper outlines how confluence marketing identifies the issues in this approach. • The economic advantages of the product may not be reflected in the brand commitment and personality and, in fact, may not even align with the brand personality. • The economic messages are developed with only one audience in mind and, as such, may be dissonant with other messages of clinical superiority or patient convenience and preference. • The economic story is disseminated to a limited audience (i.e., payers and employers) rather than being interwoven into the communications to all relevant audiences: KOLs, physicians, patients, media, sales reps, and the financial community. “In this system, no one benefits from the whole brand story,” he says. “Bolt-on approaches or after-thoughts rarely realize their potential. Confluence marketing advocates involving clinical, customer, and economic marketers to conduct a total brand value analysis, using market research and brand audits with economic and clinical buyers as well as customers. Together, the group reviews quality vs. price and the trade offs as they vary from one segment to the other.” According to Dr. Teper, the confluence of quality and price becomes the essence of the brand. Once this is solved, the group develops brand strategy and seamless messaging to drive the brand’s marketing plan. Having worked together, the marketing team is aligned, and no one doubts or questions the strategy. Resulting tactics reflect the unified story and have convergent messaging. “Certainly, select aspects can be dialed up for different audiences, but overall, consistency generates frequency of message consumption, and a surround-sound effect, magnifying the total effectiveness of each individual tactic,” he says. “With confluence marketing, inclusiveness drives the brand’s agenda.” Welcome Diversity of Input Examples of potential applications of confluence marketing abound. For instance, Dr. Teper says, the field of biotechnology bridges science, industry, and the public. Key public influencers include advocacy groups, religion, and the media. Public opinion, in turn, influences regulators who in turn influence investors, governing what gets funded. The biotech industry has assembled these various constituencies, but has not yet uncovered their confluence. “Corporate communications teams need to recognize the confluence of the financial community, R&D, and the government,” he says. “Confluence marketing may sound unwieldy, but it’s not. It is just a change in philosophy, with some facilitation attached.” For more information or to contact Dr. Teper, visit energyandco.com. PharmaVOICE welcomes comments about this article. E-mail us at feedback@pharmavoice.com. In an exclusive to PharmaVOICE, Daniel Teper, Pharm.D., MBA, CEO, of Energy & Company, a strategic communications company, discusses why it’s important for the various stakeholders in healthcare to come together for a shared agenda. Confluence marketing is a dialogue between the different customer groups and stakeholders with the objective of moving toward either a common agenda or at least a common understanding of a particular issue.

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