Health Isn't Just About ROI

A familiar Einstein quote: "Not everything that counts can be measured. Not everything that can be measured counts."

W'ere trying to measure everything today in health care. We don't make a move unless the data is there to justify a positive "return on investment" (ROI) before we even start. We've reverted to use clinical and academic approaches to making decisions because we've been screwed so many times in the past. Data is safe. ROI is measurable. The way we make decisions today is justifiable in some cases and only holds us back in others.

Improving the health of our population is logical. When considering the costs of preventable chronic illnesses it only makes sense to help others change behaviors to prevent or minimize their effect- for the quality of life of the individual, and the costs associated with them. Yet, for any number of reasons, the health care system (employers, health plans, providers) continue to debate within itself with where the responsibility for "health and wellness" fits in the curative/sickness-focused model we have today. Who should pay for it? Will I get paid for doing this? Why should i keep someone healthy when they will only go to another employer or health plan when I'm done? What is the evidence and clinical model? With the costs of diabetes, obesity, hypertension, and other lifestyle-related chronic illnesses skyrocketing, a focus on creating a healthy population simply makes sense, we need to quit the debating, and begin to do something about it collectively.

An article in the December issue of the Harvard Business Review ("What's the Hard Return on Employee Wellness Programs?") further supports the value of wellness programs in the workplace. In typical academic fashion, the article identifies six "pillars" organizations included in the research used to create successful wellness programs in their organizations; Pillar 1: Multi-Level Leadership; Pillar 2: Alignment with organizational identities/aspirations; Pillar 3: Scope, Relevance, Quality; Pillar 4: Accessibility; Pillar 5: Partnerships; Pillar 6: Communication.

This isn't rocket-science.

I would argue these Pillars can and should be included underneath a more general platform of the need to create a "culture of health" that is trusted and embraced by the individual. The organizations included in the HBR article all had high "participation," positive ROIs, and focused approaches. But, all had also created a culture of health within their organizations that was a natural part of the organizational DNA. The health and wellness component was only an extension of the relationship these employers had created with their employees. It took time, and they all earned the trust of those participating with them.

Before relying on the 6 Pillars as the saving grace of what is required to create a healthy population of individuals we also need to focus on creating the culture of health throughout the landscape. This may take time and may not show a positive ROI for some time. Most individuals understandably do not trust the health care system we have today, some don't trust their employer relationship, and most certainly don't trust the health plans. Health care (providers, employers, health plans) need to build the trust and not simply rely on metrics or pillars to determine their success. They need to help individuals understand the relationships and provide the context they need to recognize they are part of the solution- and not simply a cog that is part of an external process. They need to be engaged.

To paraphrase Ghandi- "a (health care system's) culture resides in the hearts and soul of its people."

The culture is not determined just by the short-term ROI or other metrics that may or may not be important right now.