The U.S. Centers for Medicare and Medicaid Services [3] (CMS), which greatly increased spending on private PR firms in 2003 [4], "is looking for at least three agencies that will be responsible for nearly all of its outreach programs over the next five years." CMS's current "preferred" firms - the only ones it solicits pitches from - are Ketchum [5], GCI Group, Ogilvy PR [6] and American Education Development. "Under the last umbrella contract," reports PR Week, "Ketchum led a $25 million integrated marketing campaign to drive people to the Medicare [7] (800) number and website." The new $17.25 million contract will involve "research, messaging, social marketing, education, training, and media relations." One priority will be "raising awareness of reforms mandated by the 2003 Medicare Modernization Act [8]," which Congress mandated additional funding for "education and enrollment efforts around."