Why employers are recruiting strong public health communicators

We spend the majority of our waking hours at work, so there’s no doubt that employers have a major role to play when it comes to healthy behaviors. And yet, that’s far easier said than done. U.S. employers provide health care for more than half of Americans and have invested heavily in providing a suite of behavioral health, chronic disease, women’s health, primary care and other health benefits, as well as workplace wellness initiatives. But at a macro level, the population is not getting any healthier. Rates of chronic disease are continuing to tick up, cancer is increasingly getting diagnosed in younger individuals, and life spans in the U.S. aren’t all that impressive relative to other high-income nations. 

So what’s not working? And what steps can employers take to get their populations to make better health decisions in 2025? All of this is even more complex against such a difficult backdrop. Healthcare costs for employer-sponsored benefits are set to increase this year by double digits for the third year in a row, and it’s creating massive tension between HR and benefits teams, and the chief financial officer.

Furthermore, it’s worth pointing out that employers are not all the same – some retain their employees for years and have high-margin business lines – while others are in high-churn environments where margins are extremely thin. But what most have in common these days is they’re looking for ways to engage people in preventive strategies that are known to work – flu shots, cancer screenings, primary care visits – and are struggling to do so. 2024 was a bad year for flu and COVID vaccines; and other forms of prevention, like cancer screenings, have not recovered since COVID in many states. Meanwhile, millennials and Gen Z seem to be opting out of primary care at extremely high rates.

As I’ve spoken to employers and other health benefits experts for this piece, the first problem they pinpointed loud and clear is related to challenges with marketing and member awareness. Employers are offering benefits that their populations don’t even know exist – and even if they do, they are too out of sight and mind to be used at the moment of need. This is a huge missed opportunity. “I don’t know anyone more trusted than employers when it comes to health information because they provide benefits to 60% of working age adults,” said Dr. Vin Gupta, a pulmonologist, the former chief medical officer of Amazon Pharmacy and a public health communications expert with Manatt who advises employers and sports teams. Gupta said it’s not uncommon to hear from employers where close to half of their members don’t take advantage of a single healthcare benefit. For that reason, he is seeing an increasing interest amongst employers in recruiting chief medical or health officers, who excel at communicating - and not just at dispensing medical advice. One notable example of that is Dr. David Stark at Morgan Stanley, who both runs the HR and benefits function and is a strong physician communicator. Prior to joining Morgan Stanley, he ran one of the earliest digital biometrics and health screening labs at Mount Sinai. 

The second major problem is that the healthcare industry is not set up for prevention; it is a “sick care” system at its core. What our system can do reasonably well is treat the already chronically or acutely ill populations, versus staving off disease before it becomes highly expensive and complex. With very few payers incentivized to care about their members’ long-term health needs, it becomes very challenging for any companies in the health prevention space to breakthrough. 

Even in cases where employers are prioritizing prevention, there’s also the challenge of managing increasingly diverse populations, particularly given that many companies are still fully remote post pandemic. I spoke with Personify Health, the sponsor of this piece, about this problem as Personify has relationships with dozens of the largest U.S. employers via its health platform that includes wellbeing, health plan administration and member-focused navigation. Chief Medical Officer Dr. Jeff Jacques described the period we’re living in as an extended “post COVID hangover.” Jacques said that in the pandemic, people avoided the healthcare system for reasons of their own safety – including delaying elective procedures including colonoscopies, surgeries or radiology scans, as well as annual physicals or dental check-ups. Some individuals may have gotten used to the idea that non-emergent healthcare can be kicked down the road. While these decisions were deemed appropriate by public health leaders to keep people safe during the pandemic, it also may have given off the impression that it was possible to delay care – both in terms of procedures and in prevention. “We spent a few decades building up these learned behaviors,” he explained. “We destroyed a lot of the framework for those habits in just a few years.” 

Related to remote and hybrid work, another problem that we’ll discuss in more detail is the value of convenience. Companies without physical offices, or with highly geographically diverse teams, are less well set up to do things like bringing a nurse to the office to vaccinate a few hundred employees in a single day or setting up a primary care clinic within walking distance of the office. Most of the employers I spoke with described these types of convenient offerings as very popular with their employees and highly successful. 

There’s not yet substantial research on the long-term effects of the pandemic on health care outcomes. But we do know that investing in prevention is meaningful, and that it can lead to long-term cost savings for payers. Anecdotally, one impact employers are already starting to see involves rising incidences of serious disease, notably cancer. We know that we would detect cancer earlier with more effective screening and early detection approaches. Worldwide, rates of cancer screening plummeted during COVID. And at the same time, cancer has only become more expensive to treat. “If cancer wasn’t a big problem for employers pre-COVID, it is now,” said Jen Nishio, a health solutions practice leader for Aon, who works with companies based out of the Northwest. “It is fast becoming the number one cost driver for employers.”

The path forward

I spoke to a dozen experts in doing research for this piece, ranging from employers to vendors and physicians to better understand the problem. Just a few of the questions I asked: What would it take to get employees to re-engage in the benefits that are on offer? And what are some of the right ways to make prevention and public health relevant to people, especially at a time when trust in medical experts is at an all-time low? 

Here’s a few of the points I consistently heard, which would take us from talking about the problem to implementing a solution. 

Aligning incentives

I write about this topic on Second Opinion non-stop because it’s THE problem. Most people don’t stick around at jobs anymore for more than three or four years, with the exception of certain industries like law and finance. So it leaves payers with far less incentive to cover prevention, as it’s usually the next payer (the competition) that will reap the benefits when an individual does not get sick or gets far less sick down the line.

That’s also one of the reasons why I remain intrigued by ICHRA, because it provides a path for individuals to keep their health plan – although that assumes that their next employer (if they have one) will also offer ICHRA as an option. ICHRA is another topic I’ve been covering regularly, and if you’re not familiar, it essentially is a tax-advantaged health benefit that reimburses employees for health care costs. Employers can then go pick their own health plan on or off the individual marketplace. 

This is a systemic problem that isn’t going to be solved overnight - but it’s worth pointing out in any overview of employer benefits. It’s the reason why some employers will provide a lot more preventative health services than others. Some employers are also more inclined to pay to keep their employees loyal and happy, and that will also inform their strategy on health-related benefits. 

I’m confident the opportunity to better align incentives involves aligning the patient, the provider to share the risk in the long-term. That is the best way to ensure that preventative strategies that we know work from a public health perspective get the support they need – both in terms of reimbursement and in making it a priority to reach patients with information about these programs. 

The power of communication 

In Gupta’s view, another potential solution involves bringing in strong health communicators to design content and programming that people will actually consume. Can employers do a better job meeting people where they are? I spend a lot of time thinking about how the various longevity and direct-to-consumer health companies have convinced people to pay cash for their services – and yet, payers are struggling to recruit patients to do things that are offered completely for free. In many ways, companies like Function Health, Superpower and Lifeforce have replaced the annual physical (although, I will acknowledge that most of the longevity players offer a far greater breadth of testing with its lab work than is typically covered by insurance).

One key problem is that the bulk of benefits information today is still buried on Intranets, generic email marketing campaigns, or in paper brochures that get lost on orientation day. Gupta, who’s a medical contributor to MSNBC and a managing director at Manatt, is a big believer in speaking to people in a language they’ll understand, rather than scientific or medical jargon, and also through accessible mediums and formats. I have yet to see any employers embrace social media platforms all that much, as one example. Yes, of course, there’s privacy considerations so we shouldn’t use Facebook messenger to DM someone their STD results. But there’s plenty that can be done without jeopardizing anyone’s privacy. And considering that the average adult spends about 2.5 hours on Facebook, Instagram, LinkedIn, YouTube and other apps per day, there’s a real opportunity there. For instance, why couldn’t an employer sponsor a health and wellness influencer to take over TikTok to explain to people how HSAs work? Or an influencer could be sponsored to talk employees through their health plan options, and which ones might be the best to pick based on their individual circumstances? 

“I think a lot about how to create social media content that is accessible and yet both rigorously evaluated and clinically checked,” said Chris Michalak, executive chairman of Personify Health. “Getting the right balance is key, but I believe it’s possible.”

Getting more personalized 

Another problem is the lack of “personalization,” a term that’s used so much that it’s become jargon. When I use it in this context, what I really mean is targeting. At previous employers, I’ve received countless emails inviting me to enroll in diabetes programs, when I have extremely low levels of cardiovascular risk. Granted 1 in 3 people have prediabetes so it’s not a bad strategy to mass market to everyone, but there could be some basic targeting to get better results without breaching confidentiality or protected health information. I remember when I was working in my prior venture fund meeting a company that built health care for LGBTQ populations. How did they reach those audiences? Not just by emailing everyone, but by connecting specifically with people who had self-selected as belonging to the LGBTQ community, such as going through Pride-focused Employee Resource Groups (ERGs). 

“I think platforms that navigate individuals to benefits that don’t use predictive analytics and machine learning are missing the mark,” said Jacques. “You’ll see that in low engagement numbers at a membership level.”

Make health care cool

Hot take: Let’s bring back the executive physical but with a new spin. The longevity sector has proven that people are willing to pay to learn new things about their health in order to optimize their sleep, energy levels and productivity. How might companies get involved in that trend? Could a subset of employees volunteer to get involved in a longevity program, and report back their learnings to others at the company in order to inspire others? And then, how might some of those ideas get incorporated into company culture? For instance, could there be all hands meetings where employees are encouraged to walk on a treadmill while they tune in, or could there be a culture of walking one-on-ones? I hear from employees all the time that the vague “be healthy” content coming from the employer doesn’t resonate when they’re expected to sit on Zoom all day long (and that’s part of the culture), or commute to the office, sit in meetings, and return to a commute. 

On a personal note, I have a few friends who are often on the Peloton treadmill or bike going at a slow pace while we chat, and I have to say I’m a fan. I regularly take phone calls instead of Zoom meetings, and my fellow attendees seem stoked about the excuse to walk outside while we talk. That said, this needs to be baked into company culture - it’s not enough for a few rogue employees to start doing it. I find that if leadership sets the tone, it has a trickle-down effect. And as Jacques, who’s a primary care physician by training, suggests, companies might also want to consider subsidizing the cost of an under-the-desk treadmill – it’s only about $200 and there’s known health benefits to daily activity. He points out that companies can also make use of gamification, where employees earn points for healthy actions that they can then convert to rewards or gift cards for things like walking pads.

Bring back convenience 

Self-insured employers are the payer. So they get to make (at least some of) the rules. And that might include creative ways of reaching people with health care, including asynchronous care, on-site or near-site care, accessible content, and more. Sometimes it’s appropriate to call a doctor’s office, book an appointment, take off a few hours to travel there, and get care in person. But oftentimes, that’s the least convenient way to do something that could be done via video or even with an asynchronous messaging service. Likewise, when care is available within a few minutes’ walk - on-site or nearby the office, people are more likely to use it. 

“I do think something on demand is very attractive for employees,” said Nishio from Aon. 

Younger populations, in particular, want digital solutions and they want convenience. Gen Z, which is the largest population in history, is now entering the workforce. These employees are not going to access healthcare in the way that it’s administered today, and we shouldn’t miss out on an opportunity to engage and educate them with early intervention – even though they may be relatively young and healthy today. 

But the problem is that the newest entrants to the workforce appear to be the least informed about their workplace benefits.

All of this brings me back to a fundamental point: We need to move away from the top-down messaging that feels paternalistic to employees and get a lot more creative. There may also be value in learning from the consumer health industry, which has created such compelling branding campaigns that people are even willing to pay out-of-pocket. 

 “We have an aspirational way of talking about health, whereby getting a colonoscopy at 40 is part of you managing your longevity – and it’s a discussion on a podcast, not a postcard in the mail from United Healthcare,” said Dugal Bain-Kim, CEO of the company Lifeforce, which provides a service for people to measure biomarkers and access both clinical support and health coaching. “It just hits differently.”

Bain-Kim said it’s also important to give people “agency,” such as credits to spend on health and wellness, versus company-wide strategies that see low utilization. 

“People are feeling distracted and anxious right now, and employers do have an opportunity to step into the void when it comes to public health messaging, but they need to do that in a different way to get people’s attention,” he explained. “And then couple it with a new approach that feels a lot more individualized and personal.”

Dr. Emily Maxson, the former chief medical officer with Aledade and a partner at the venture firm Despierta, agrees that employers have a tough task on their hands, given eroding trust in medical experts. 

“They [employers] need to mount a prevention PR campaign, hopefully backed by some reputable medical societies, highlighting evidence-based preventive measures and what happens if they are neglected,” she told me. Maxson noted that employers can leverage behavioral economics to incentivize the activities they wish to see, like a financial reward for acing a preventative scorecard, and they might also experience success with “scare tactics” like what might happen when they neglect seeking care. The carrot or the stick could both be effective. 

But Maxson feels that these efforts will be most effective when paired with primary care, and this isn’t easy to find for patients given long waitlists and provider shortages. “Employers with high density geographical presence should consider relationships with local PCPs to ease the path for employees who can be convinced to leverage the healthcare benefits on the table,” she explained. 

Ultimately for Maxson - the lesson here is that it’s no longer enough for employers to pay for healthcare. It’s not an easy job going into 2025. “They must also ease the path to realizing these benefits,” she said.