A brief history of workplace patient/consumer engagement/education

These topics continue to get a huge amount of attention…and have received tremendous attention since about 1980. Healthcare “experts” keep saying that we need patients to be better educated about their health and more “engaged”. There is nothing new in any of these ideas.

Let’s review a little history.

Around 1975 healthcare spending and insurance premiums started surging about 12%-15% per year. Those spending increases spurred the development of HMOs, PPOs, and other forms of managed care. A common word to describe those spending increases was “skyrocketing”.

Along the way “experts” thought that better educated consumers would help contain rising costs. Starting about 1980 companies started flooding their employees with brochures, information packets of various levels of glossiness, paycheck stuffers, break-room posters, table tents, meetings, health fairs, etc..  Employees didn’t get much use out of that education (read ignored it) and it certainly was not effective in changing consumer speeding habits. 

Starting in the 1990’s companies additionally set up or “rented” websites, both intranet and internet, where employees could access health information. Problem is employees rarely accessed them.

In the 2000’s companies started setting up special internet sites for employees, ones that included employees’ personal health information. Sounds terrific, right? Just what the doctor ordered, right? The problem was few employees used such sites, and then usually not more than once or twice. Some were very expensive, but only about one in a hundred workers or fewer ever used them, and even fewer used them more than once.

The truth is that employees have never trusted their employer or its agents or insurers for health information. Where do they want to get health information? From their doctors, of course.

Wellness became popular as a way to drive consumer education and “engagement” (whatever the term “engagement” means).  When employers began to realize that was not working, they typically changed wellness vendors.  When that predictably failed, employers tried to incentivize employees to become educated and “engaged”.  Failure again led to the latest iteration:  coercive wellness and education programs.  If all the other iterations of wellness-style employee education worked so well, why coerce employees?

My prediction: when it comes to coercing employees to become better educated health care consumers, the end is near. Coercion in the form of big penalties to improve employee “engagement”? Gimme a break? Coercion leads to more distrust, lampooning, disloyalty, unionization, etc. Look a the mess Penn State created, or CVS.

What were they thinking?  Perhaps this: The beatings (read coercion) will continue until morale improves. Or, as Al Lewis and Vik Khanna say in Surviving Workplace Wellness, employers are going to make their employees happy whether they like it or not.

Why am I writing this now?  Alas, lately I’m seeing a resurgence in 1) the notion of flogging employees until “engagement” improves and 2) a new concentration on more gimmicks to educate consumers/patients.

Using coercion to improve employee engagement?  Have HR executives gone off the deep end? Hmm. Makes you wonder.


Tom Emerick

Cracking Health Costs, the book, an Amazon best seller, is available on Amazon at a deeply discounted price.  Click here:  Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of Edison Health. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.




  1. Al Lewis says:

    Great history. It happens so many times, so predictably, that it could really be called: “Deja vu all over again, again.”

  2. Absolutely refreshing Tom as it is absolutely true. Well said and well done. People beg then – what is the answer to it all – however most people and businesses are too selfish to actually get to the complex answer it takes to get to a better working model – and the answer is NOT single payor.

  3. Jeff says:

    Hey Tom,

    I’m trying to get your blog to show up on my Feedly account, but it appears your RSS link doesn’t work. Does it appear to be fine from your end/am I screwing something up?

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