What do you get when you combine high-quality content with low registration fees, and add savvy marketing strategies? Pri-Med - a healthy, growing trade show for primary care physicians.

"I just hope Sen. Kennedy doesn't slam the pharmaceutical companies," says John Mooney, president of Hill, Holiday Exhibition Services, LLC, and creator of the Primary Medicine Today Conference & Exhibition (Pri-Med).

It's September 15th, the first morning of Pri-Med, at Boston's John B. Hynes Veterans Memorial Convention Center, and Mooney is concerned that the passionate and outspoken health care advocate might offend his exhibitors. But, then, he had asked Kennedy to deliver the keynote address. "We invited him six months [before the event], but he declined," Mooney recalls. "And then I got the call on Wednesday, 48 hours before the show. He's coming after all."

Mooney's show machine flew into high gear, making signage, mounting a last-minute e-mail campaign, printing inserts for programs, and figuring out the logistics of wedging an additional 30 minutes into a jam-packed conference and show.

Now, the senator is en route from Washington, and scheduled to speak at 1:30 p.m. At about noon, the on-site show office is humming. Mooney looks at his watch and yells out to anyone available: "Check the airport, see where he's at." No name necessary: Everyone knows who "he" is. Thunderstorms, nervous phone calls to Logan International Airport, and some hand-wringing notwithstanding, Kennedy arrives on time. And despite the last-minute publicity, attendees pack the 4,000-seat ballroom to hear him.

"The cost of medicine is going through the roof," Kennedy bellows to the crowd, "and it's time to shame America into taking some action. Right now, the only people assured of getting prescription drugs are those on Medicaid, and of the 39 million elderly Americans, fully one-third have no prescription drug coverage."

That's as far as Kennedy went in slamming the pharmaceutical companies. Standing off to the side, Mooney breathes a short sigh of relief.

Content First If Mooney was so concerned, why did he take the risk and invite Kennedy? "Pri-Med is an open forum," he answers, "and we don't mind anything being discussed."

It's that attitude about content that is one of the keys to Pri-Med's growth. After five years and 16 medical conferences throughout the country, Mooney has honed his formula for success. It's pretty simple: Give attendees high-quality content at a low cost.

The story begins in 1994, when Mooney, a new vice president with Hill, Holiday Exhibition Services LLC in Boston, and his partner Christine O'Connell, came up with the idea of launching a regional conference for primary care physicians, supported by regional HMOs. The debut show attracted 4,000 people. Now, there are four regional Pri-Med conferences and shows held throughout the country each year, drawing 5,000 to 7,000 attendees. But at first, no one believed the show could draw that many primary care doctors.

Suzanne W. Fletcher, MD, professor of ambulatory care and prevention, Harvard Medical School, was skeptical when Stephen E. Goldfinger, MD, faculty dean for CME, Harvard Medical School, asked her to create and organize education content for the first conference. When she heard that Mooney thought he could get 3,000 people to come, Fletcher says, "I laughed. We had a very successful CME program at Harvard and got about 500 at most, so I thought [Mooney's idea] was not very realistic."

Fletcher, who serves as chairwoman of Pri-Med's course development committee, thought her involvement would be a one-shot deal, but in the five years she has been associated with the conference, she sees content remaining true to its original mission - delivering clinical education to practicing physicians. One factor for success: The education committee can draw on virtually any of Harvard Medical School's 7,000 faculty members as presenters.

Another reason the Pri-Med model works so well, she believes, is that the course development committee is made up of practicing primary care doctors and nurses. "And they know what's on the minds of primary health care practitioners," Fletcher says. "It's important to have someone in the trenches get involved in the programming."

But, back to the Kennedy factor: Attendees not only come to Pri-Med for clinical education, they also come to reflect on trends in health care, notes Fletcher. "So you'll notice that each morning's keynote topic is not clinical, and that's on purpose. We've had talks on ethics, on patient-doctor relationships, on spirituality in medicine, on Renoir and his arthritis, anything that can relate to the world of health care."

Tech Trail Of course, medicine and technology is a topic of increasing importance for attendees. "You can't open up a magazine or newspaper today and not realize that the train has left the e-station," Mooney says, "and the Web is of major interest to physicians. We tested two two-hour courses in technology in Boston last year, and each had more than 1,000 registrants."

That's why, albeit on a small scale to start, Pri-Med debuted The Technology Pavilion, a cluster of about 30 high-tech exhibitors on the exhibit floor in Boston this year. Many of the technology exhibitors specialized in practice management.

Among the exhibitors were such firms as ComChart Medical Software, AllScripts Inc., and iMedica. "For the most part, the docs are drawn to these exhibitors just because technology and the Internet is becoming pervasive," says Mooney.

He also evaluated his competition. "Some of the fastest growing shows are technology-based, such as e-Health Care, so I thought, why not in my show, too? Eventually, the doctors will have an influence in buying the technology - or at least using these tools."

Pay Less, Get More Having the prestige of Harvard Medical School as education content provider for the mere cost of dinner at a local pub has doctors sit up and take notice - especially primary care doctors working in HMOs, who are often financially squeezed, says Mooney. When the show first launched, Mooney charged no registration fee. For the past three years, attendees have paid a token $35. The fee helps the show keep attendance numbers up. "We found we had high pre-registration numbers," Mooney explains, "but then by show time, we had a 30 percent drop-off. Even a little bit of money makes people more committed, and it gives us a much better handle on who's coming and who isn't."

Exhibitors, such as Blue Cross and Blue Shield of Massachusetts Inc., Harvard Pilgrim Health Care, Massachusetts Medical Society, and Partners Healthcare System, underwrite most of the show's cost.

How does he know the low fee is a crucial ingredient in the show's success? At the Boston show, sitting up front in the general session hall where Robert J. Blendon, professor of health policy and political analysis at both Harvard University School of Public Health and the John F. Kennedy School of Government, is about to talk on "Health Care and the Election," Mooney strikes up a conversation with a doctor sitting in front of him. This is his first Pri-Med conference and he came for one reason: the $35 registration fee.

The doctor tells Mooney he recently joined the staff of Massachusetts General Hospital. "Most conferences cost $1,000 to $1,500 and I can't afford it," he explains. "I'm at Mass General for the name and prestige, but I'm basically on a fixed income and Mass General pays for only one course a year."

Mooney, smiling, sits back and says, "That's why Pri-Med is so successful."

Marketing Mantra Another reason for Pri-Med's success is Mooney's marketing tactics. In 1995, when Mooney and O'Connell enlisted Harvard Medical School and Hill, Holiday client Harvard Community Health Care (which is now Harvard Pilgrim Health Care), one of Massachusetts' largest HMOs, the other HMOs followed suit. That access to PCPs through their HMO employers is the backbone of Pri-Med's marketing efforts.

"In that first year," says Mooney, "we sent letters to program directors at all the HMOs, and we haven't really changed tactics. We still work with the leading managed care organizations, state medical associations, and hospital networks in our given regions. We pay for all the mailings, but the physicians receive the mailings from their HMO along with a letter from their medical director."

Growing Pains But it wasn't always like this. Mooney winces when he recalls his biggest miscalculation - a "varsity mistake," as he put it - in 1996 when he launched Pri-Med Midwest in Chicago.

"It was a total disaster," says Mooney. "Chicago is a huge marketplace and we launched it with the same vim and vigor we did with Boston and Long Beach [Calif.], but at that time Illinois did not require CME for physician relicensure and we only got about 2,500 to register."

Pri-Med Midwest in Chicago was canceled. Since then, Illinois has adopted CME requirements and Mooney relaunched the Midwest show this year at the Rosemont (Ill.) Convention Center this June, attracting more than 5,000 doctors. Pri-Med Midwest is now a fixture in the regional rotation. (The fourth regional location is Fort Lauderdale, Fla.)

Filed under "Other Things I've Blown," Mooney counts abandoning a practice management track put on by Medical Economics in 1997. Pri-Med wasn't making any money in those first years, Mooney says, adding that the decision was no reflection on Medical Economics. "It was an economic decision and not a marketplace decision. To this day we still have attendees say that they enjoyed those courses. We'll be looking to Med Ec again for a practice management track in 2002."

Hampered at the Hynes Another illustration of Pri-Med's growing pains - it has clearly outgrown the Hynes Convention Center. "It's very difficult to get dates at the Hynes," Mooney explains. Housing is not typically an issue for Pri-Med - the shows are regional and very often many of the attendees drive to the event, Mooney explains.

This year, Pri-Med felt the space crunch with the new Technology Pavilion. It was located in a hall one level down from the main exhibit hall. Mooney's crew did their creative best with the floor plan. In the lower hall, at the back of the Technology Pavilion, a luncheon area was installed to direct attendees through the exhibits, and a refreshment vendor was placed at the front of the hall. A session room was also set up adjacent to the Technology Pavilion hall with an exit that spilled attendees onto the show floor. Plenty of signs and show staff were strategically stationed throughout the Hynes to herd the crowd to the lower hall. And although demonstrations of Star Trek - like chart management and prescription-writing tools wowed attendees, the challenge here for show organizers was keeping an even flow of crowds among the multi-levels.

Next year, Pri-Med East will be out of exhibit space in Boston. Pri-Med's promotion and marketing folks will also have to keep attendee numbers in check because there simply are not enough seats in the Hynes to accommodate more than 8,000. As he surveys the standing-room-only general session and meeting rooms, Mooney says, "The new convention center will be just extraordinary and will be perfect for us." Pri-Med East is holding dates there for 2003 and beyond, even though he realizes the new facility may not be ready by then.

Going Global Mexico, Canada, and Europe are the show's next frontiers. Geography, mandatory CME, and the fact that many Mexican doctors are U.S.-educated are Mooney's three top reasons for focusing south of the border. First contact with Mexico was made at Pri-Med East in Boston when Mooney met with Pedro Vera G., editorial director of Intermedica Inc., an international medical education service, of Darien, Conn. Both Mooney and Vera agreed that the Harvard Medical School name is Pri-Med's major selling point. Right now, Mooney is in discussion with a potential and undisclosed joint venture partner for a Mexico show. Similar talks in Canada are further along. "I wouldn't be surprised if there's a Pri-Med Canada, maybe in Toronto, by the end of 2001," Mooney hints. And he made a reconnaissance trip to Europe in October "to begin understanding the medical landscape."

Wherever Pri-Med goes, however, the same principles Mooney has learned over the past five years will apply. "We make sure the CME requirements are there," he says. "Then we put the doctors first, which is the real reason for our success."