Sometimes a realization hits you with such force that it totally alters the direction of your life. It is shocking when that realization turns out to be something you’ve known, at some level, all your life, but in this one blistering moment it becomes transformational in its clarity. Often this happens when the stakes are high and someone you love is involved. At least this was true in my case.

I spent two decades working as a strategist for health plans, developing products and programs and wrangling marketing issues. I got advanced degrees and a job with a benefits consulting firm to make me more competent in coping with employee benefit plans—especially health care. Eventually I knew, probably as well as anyone in the industry, how employers choose and administer benefits, and how health plan consultants and brokers work with them. Still, the pieces hadn’t formed the picture that would startle me into changing my entire professional life.

The thing that did it was when my elderly aunt’s health fell apart in ways that could have been easily prevented. Here was a woman who had diligently sought the very best health care and doctors all her adult life. Even with dream teams at her disposal, her health deteriorated almost daily. Here I was—her overeducated, highly knowledgeable niece—unable to lift a finger to change the quality of her next breath any more than the army of doctors and nurses could. On the other hand, there was my mom. Here was a woman who maybe should have deteriorating health, with fewer financial resources and no dream team of physicians—but in almost perfect health. What had made the difference? The answer was a wake-up call to me and became the focus of what I now teach.

Just before my aunt became very ill, I had decided to write a book for consumers (Surviving Healthcare, Chestnut Ridge Books 2004) to explain the hows and whys of managed care and the complexities of the types of health plans. My research for the book showed startling, overwhelming evidence of huge gaps in the quality of health care across the country. This evidence, compiled at the behest of Congress no less, included study results showing that the average person gets only 55% of the medical care they should be getting—even with good insurance and access to care. This was the case for BOTH my aunt AND my MOM! So, why did my Mom survive cancer and thrive while my aunt faded and suffered moment to moment? The key to it all was simple and plain.

Research by the Centers for Disease Control (CDC) shows that 50% of the average person’s health status is related to health HABITS and LIFESTYLE, and only 10% is related to medical CARE. The key is not to get the best FIXERS—it is to not get BROKEN to begin with. Yes, I know that sounds obvious. I had KNOWN this at the day-to-day level, it’s like my dentist friend who says I don’t have to floss all of my teeth—just the ones I want to keep. Now, here it was in a truth that I could not gloss over. My dear aunt was suffering, not because she had bad doctors, but because they had not advised her to do the SIMPLE things to take care of herself. My mom had much better advice, and she listened well.

We all know that we should improve our lifestyle habits, but we believe we can get away with continuing our unhealthy habits. We think the advice applies much more to “others” and not “me.” We believe that the medical system can save us in the end, but most often it can’t. The insurance and medical care system could improve upon health education, but such messages are not popular. Staying well requires us to have regular checkups and to change the behaviors that negatively affect our health. We know we should take care of ourselves, but without being held accountable, we just don’t. It takes education AND accountability. Where would the education come from?

My mom had a family doctor who advised her about things that would keep her out of his office. He was rare. Most doctors are too busy managing illness and have no financial incentive to emphasize wellness education. Moreover, most don’t see the patient until after damage has been done.

If this is true, where can the average person get the guidance and preventative information they need without filling their Tivo with episodes of the Oprah show?

One day, I realized the answer. Who would naturally benefit if an individual received good information about preventing illness? The individuals, of course, and—THEIR EMPLOYERS! With health care costs and decreased productivity directly affecting their bottom line, employers should be able to save by keeping employees healthy. Moreover, the employer is in the best position to provide education and to structure effective wellness incentives into their plans. However, employers don’t want to hold employees accountable for their personal wellness, as that is a bit uncomfortable. Still, offering large financial rewards for good management of measurable, controllable health risks (what I call ‘Accountable Wellness’) is the approach that I and others have proven works best in reducing absenteeism and other productivity challenges, reducing actual health care and insurance costs for both employers and employees, and in prolonging healthy, functional lives. Programs structured correctly maintain absolute personal privacy and do not punish those who cannot control their health risks for medical reasons. What could be more win/win than that?

It was a simple realization: do the right things for the body and keep it in good shape. Common sense. Very few listen. My aunt didn’t. Fewer do anything about it. My mom did. I am. Anyone can. Employers should. They just need to know how and believe that it will make a difference. It will. And, what a difference.