Celebrating my 20th year in the health insurance business this year, I continue to marvel at how the more things change, the more they stay the same. It seems that every time there is a creative breakthrough in health plan design there is an escalation in treatment costs or a new therapy that devours any plan savings generated by aggressive measures. While we are overjoyed that a new treatment may have saved a life or offered the hope of a better quality of life for a member, we battle year after year to find a way to negate the cost of healthcare trending 5 times the rate of inflation. At the end of the day, we’re back to cost-shifting. “Here’s a little bit less coverage for a little bit more money.” Sound familiar?

I cannot help but notice that virtually every effort to control trend is focused on the “cost” of healthcare rather than the “cause” of it. By changing who pays the bill we may induce some consumerism and see people think twice before having a repeat MRI or X-Ray instead of driving to their other doctor and picking up a copy of the one done days before. Unfortunately, we may also see people decline services that are desperately needed. We read statistics that say “75% of every dollar spent on healthcare is spent treating conditions that are lifestyle related and largely preventable” yet we focus most energy on trying to get that dollar to buy more treatment instead of trying to improve lifestyles and decrease utilization. Perhaps it’s time for a new approach?

I vividly recall a meeting I had with a Human Resources Director and the CEO of a (150 employee) manufacturing company. As I explained the benefits of “results based wellness” supported by Bravo Wellness, the HR Director started to glaze over. I suggested they take advantage of recent federal legislation that allows them to charge more or reduce benefits for individuals who lead unhealthy lifestyles (obese, tobacco users etc.) that do not have a legitimate medical reason that prevents them from improving their health. I shared the statistics about obesity and tobacco use and our experience with seeing people change lifelong poor habits to avoid a cost increase, not to mention the expectation of 8 – 10% immediate net savings to the employer.

The HR Director gave me a motherly look and said: “You don’t understand our culture. We’re like a family here. We’re very paternal. We love our employees and could never do something like that.” Then the CEO spoke. He looked at her and said: “You have kids don’t you? Do you want them to smoke? Do you pack them a healthy lunch? What about this is not paternal?” Several weeks later when he helped announce the implementation of the plan to his employees, he shared: “This reminds me of when I kicked my 30 year old son out of the house. There is a time for “tough love” and we’re not doing you a favor by enabling the wrong behaviors.” Wow. The same message given with a different perspective made all the difference. Employees viewed this as a rally cry and embraced the movement.

Contrary to popular belief, employees are not pushing back at the idea of tying their lifestyle choices to their benefit plan. Even those who do not particularly like what the implications of such a design mean to them are really not saying that the plan isn’t fair. After all, poor drivers pay more for auto-insurance, good drivers get a discount, fire insurance cost less for brick homes than wooden structures, smokers pay more for life insurance, etc. etc.. Why shouldn’t there be a “good driver discount” for health insurance? Employers who are willing to show “tough love” will reap the rewards of a healthier workforce and lower claims. And just like that evicted 30 year old son, the message may be just the “kick in the pants” someone needs to save their own life.