The Department of Defense in 1999 launched a congressionally mandated, three-year health care demonstration project in eight geographic areas across the United States, open to 66,000 uniformed services retirees and their families.  In 2000, the Department increased the number of locations to 10 – more than doubling the number of potentially eligible participants (146,000) – and partnered with Fleishman-Hillard to increase participation throughout the system, from California to Puerto Rico, from Texas to Delaware.  The Department’s responsible agency, the TRICARE Management Activity (TMA), and Fleishman-Hillard planned and executed a sophisticated, multifaceted outreach campaign to enhance the image of the benefit and increase enrollment.  The effort generated significant interest among the eligible population and more than tripled previous participation.


There were several challenges to increasing this demonstration project’s enrollment.  The health care project involves a complex set of benefits and exclusions that are difficult for many military retirees to understand.  Additionally, the demonstration areas are spread across virtually the entire United States and Puerto Rico.  Third, enrollment is restricted to a single annual four-week period.  Fourth, enrollment during the program’s initial phase was below expectations (just 500); when the enrollment period was extended, total participation increased to 2,500, still fewer than Department officials originally anticipated.  Lastly, the program had to be introduced at the two new demonstration sites:  the areas in and around Adair County, Iowa, and Coffee County, Georgia.

However, the project does offer comprehensive health care coverage, which at that time was not available outside Medicare to the majority of military retirees age 65 and over.


The campaign objective was simple:  Introduce the benefit and encourage participation in the two new geographic areas, and increase enrollment overall in the pilot health care project.

In a January 2000 survey of eligible residents, conducted just after the first-year enrollment period, respondents revealed that they thought the project was complicated and difficult to understand.  Few said they grasped the potential cost savings over their existing Medicare supplemental insurance.  Also, many expressed fear of joining a health care project that could end in just two years.

The planning process also included soliciting feedback from a focus group of military retirees on the proposed campaign structure, messaging, materials design and content delivery.


The campaign was designed to build momentum and enthusiasm, to improve the project’s image among the target audience, and to lead potential participants through a sea of technical information.  The strategic approach was to communicate with eligible retirees incrementally, repeatedly and in surround sound via direct mail and in person.  Each tactic was designed to increase participant comfort levels and present project components in a simple, palatable format.  Using the research results and Congressional testimony from an April 2000 hearing, multiple tactics were devised to inform, educate, and persuade through a variety of formats (i.e., written and in person; postcards, bulletins, handbooks, local media, Web site and group education sessions; English and Spanish languages).

While content was explained succinctly in bite-sized, digestible increments, overarching program elements were linked as a progressive and unified whole.  The outreach campaign was launched in July, four months prior to the designated enrollment period.  Each successive mailing built upon the previous one, leading up to a post-Labor Day series of on-site education sessions led by a TRICARE representative.  The outreach campaign culminated with the mailing of a comprehensive handbook at the start of the November/December 2000 enrollment period.


Every written material sent to potential participants in Puerto Rico was translated into and produced in Spanish.  For two tactical elements – the education session invitation and the site-specific bulletin – 10 different versions were produced, each tailored to a particular demonstration area.  The following tactical elements were executed on a strict timeline:

Campaign Launch Postcard (July) – The launch postcard briefly announced upcoming enrollment for the project’s second year. Its look-and-feel set a tone for the campaign – classy, cordial and upbeat.  The postcards (and subsequent mailings) were sent directly to all 146,000 eligible beneficiaries; a Spanish version of each was sent to Puerto Rico eligible participants.

Premier Bulletin (early August) – The premier bulletin provided “the basics” of the project, as well as some clear, contextual information about Medigap and Medicare.  This mailing was designed to clear up the confusion about the program that beneficiaries had expressed in the January survey.

Invitation to Education Sessions (mid-August through early October) – Designed to convey a solid, dignified, dependable benefit program, each of the 10 versions of this gold-framed card provided tailored logistical information for local education session options.  Each site’s invitation was sent two to three weeks ahead of time.

Site-Specific Bulletins (late August through mid-October) – Primarily intended to reinforce the education session invitation as well as provide additional program information, each site-specific bulletin included that area’s map and a corresponding list of ZIP codes that designated eligibility for the program.  Each bulletin was mailed at least a week before that area’s education sessions.

Press Release (late August) – To reinforce the direct mailings, an August press release announced the upcoming education sessions and was distributed through the Pentagon’s public affairs channels.

Education Sessions (September/October) – Facilitated by TRICARE representatives, the 90 education sessions held throughout each of the 10 test sites were designed to present information clearly and succinctly, to resolve any confusing issues, and to allow for questions both as a group and one on one.

National Handbook (November) – The campaign’s final piece was designed to present the overall benefit, as well as to address larger questions about Medicare and other insurance that had perplexed beneficiaries surveyed earlier in the year.

Web Site – The TRICARE Web site ( displayed comprehensive project information to complement the direct mailings, including national as well as site-specific information.

Enrollment has more than tripled since the campaign’s July launch: As of January 5, 2001, 7,751 eligible test site residents were pilot project participants.  And during the Fall 2000 four-week enrollment period, more than 5,200 people joined the demonstration project – many times the number that signed on during the same period the previous year (the Fall 1999 open season).  Additionally, 17,519 attended this fall’s 90 education sessions – an average of nearly 200 per session, which was a significant increase over last year’s series attendance.