Efforts to educate Massachusetts residents about health-care reform took marketers to some interesting places – including out to the old ball game

Peanuts, hot dogs, beer…and health insurance? That was the pitch, so to speak, at Fenway Park in the spring of 2007. The Commonwealth of Massachusetts made news in April 2006 by becoming the first state in the nation to mandate nearly universal health insurance coverage. The new law required all citizens who could afford coverage to have health insurance by December 31, 2007, or forfeit a $219 personal tax credit. Skip health insurance in 2008 and the penalty increases drastically. Passing the legislation was extremely difficult for the state legislature, but it was still only the first step. Once the mandate became effective on July 1, 2007, the state had only a few months to create new programs and to figure out how to get hundreds of thousands of uninsured citizens to enroll. And that challenge led state officials to Fenway Park. It seemed like a logical destination to Joan Fallon, communications chief for the Massachusetts Health Connector, a state agency created to develop and implement new universal health-care policies and programs. Fallon and four other staffers were charged with reaching an estimated 372,000 to 619,000 uninsured Massachusetts residents, and helping them get coverage by the end of the year. Fallon’s entire marketing budget, which would fuel education and awareness from Cape Cod to the Berkshires and beyond, was $4 million. With health-care reform near the top of election-year campaign issues, the question isn’t just what to do about health care, but also how to conduct the massive communications campaigns vital to any such drastic change. For marketers, Massachusetts’ successful multichannel program — which helped cut the number of uninsured residents — serves as a solid model of how to inform and persuade a broad and diverse audience, offering lessons that apply not only to health-care reform but to any time- and resource-challenged campaign. Teaming Up As Fallon and her colleagues geared up to push statewide coverage, they found that the most difficult group to convince to purchase health insurance included many of the same people chomping ballpark franks and cheering from the bleachers. Research showed that the bulk of the uninsured were men in their 20s and 30s. Noticing this apparent overlap between their target audience and baseball fans, Fallon and Weber Shandwick, the Connector’s PR firm, approached Red Sox executives with an unusual request: Would the ball club join other groups in partnering with the state to convince young men to sign up for health insurance? The Sox jumped in wholeheartedly. The team ran ads on the local sports station that featured Red Sox “ambassadors,” young men and women who greet ticket-holders arriving at the park. The club broadcast interviews with healthcare advocates, staged press conferences and hosted an insurance sign-up booth at every home game. And they did it in inimitable baseball style: One public radio story caught a booth worker shouting, “get your health insurance here” with the same distinctive Fenway cadence with which thousands of hot dog vendors have landed wiener sales. “The signups in the park really complemented the ads,” says Adam Grossman, the team’s vice president of marketing. “If you were a Red Sox fan, you couldn’t miss the message.” But smart targeting had as much to do with the success of the promotion as its ubiquity. The Red Sox partnership illustrates that when you want to change the behavior of a diverse population, you must first identify the character traits of the people you’re trying to reach. Then, segment your audience accordingly — and go where they are. Experts praised Health Connector for developing such a far-reaching campaign in accordance with appropriate marketing best practices. In figuring out what was important to the audience, the organization was able to spot potential openings for its health-care pitches. Using the baseball park was hailed as a master stroke not only because of the high profile that the Red Sox enjoy or because many in the target audience congregate at Fenway. Rather, the ballpark was also, despite the action on the field, a place where targets could soak up some of the details of the Health Connector message. After all, baseball games allow fans a fair amount of free time — between innings, during offensive lulls, at the start of the seventh-inning stretch — much of which is spent in line for the bathroom or staking out the concession stands in hopes of scoring a frankfurter and a draft beer. But baseball fans weren’t the only group of people that Health Connector made efforts to reach out to. Indeed, there were numerous, widely divergent groups for the Connector to try to touch. Consider, for example, that Massachusetts residents speak at least 16 different languages. By themselves, Fallon and her small group of internal colleagues stood no chance of reaching all of their targets, so Fallon relied on other, lower-profile partnerships throughout the state to extend her group’s resources. Says Fallon, “We sat down and said, ‘Let’s think of all the ways that we can reach folks who need to be reached and get them to understand what they need to do and why it’s good for them.’” Recruiting More Players In addition to the Red Sox, the Connector worked with organizations ranging from huge health insurance providers and hospitals to tiny grass-roots community groups in towns and cities statewide. Grocery chains, drugstores and banks publicized the programs — generating publicity for more than 200 outreach sessions and educational forums that Fallon and her staff conducted. Fallon also teamed with the Greater Boston Interfaith Organization, whose members went door-to-door educating people and held enrollment sessions following services. The International Brotherhood of Electrical Workers put up signs on the Boston expressway. To reach college seniors, the Connector placed ads in university papers and asked schools to e-mail information about the effort to graduating students. And the Connector — through its partnership with other government agencies — mailed postcards to every state taxpayer to remind them of the new mandate. One mailing went out just before the mandate went into effect in July 2007, another prior to the New Year’s Eve deadline. “We tried to leave no stone unturned, be it direct mail or working with the churches,” says Fallon. “We’d work with anybody who wanted to work with us.” Working with grass-roots leaders was critical, says Brian Rosman, research director for HealthCare for All, which partnered with the Connector to spread word of the health-care rule. “We wanted to reach as many people as possible, if not every resident across the state,” Rosman says. “We felt that would be easier to do if we could connect to leaders in other communities, because those communities, quite frankly, have better trust in those leaders than we could expect to have. Nor could we [necessarily] speak the language.” From the Red Sox partnership to outreach sessions in far-flung towns, the partnerships accomplished their mission, observers say. In its first year, the campaign reduced the number of uninsured working-age adults from 13 percent of the population to 7 percent, according to research by the Urban Institute. By summer 2008, nearly three-quarters of previously uninsured Massachusetts residents were covered. Fallon gives no single effort the bulk of the credit for the outreach program’s success. “It takes a multifaceted campaign,” she says. “Focusing on one thing isn’t the way to go. It’s many different smaller campaigns that you have to put into place that bring together an overall public education campaign.” And, of course, it’s about reaching people where they live. Hot dog, anyone? Case Studies, Integrated Marketing, Large Business, Targeting