Neil Versal: Rewards for watching TV vs rewards for healthy behavior

Neil Versal: Rewards for watching TV vs rewards for healthy behavior

This interesting MobiHealthNews article by Neil Versal discusses some concerns about hype, mHealth and the challenges of doing new things. I thought it might be helpful to share some of my thoughts that a read of the article gave me:

Health gamification app developers, you may have met your match. You probably already knew the couch potato was your biggest challenge. But now the stakes have been raised. The other night, I was watching TV and this commercial came on: (Watch here). That’s right, there’s an app, called Viggle, that rewards people for sitting on their rear ends and “checking in” to their favorite shows. Users get bonus points for watching certain programs — including hugely popular ones like “Modern Family” and “Law and Order: Special Victims Unit,” as well as live sporting events. They then can redeem points for prizes, for example, a Papa John’s gift card, because nothing reinforces the sedentary lifestyle like free pizza

I think this is just touching on the manifest problems that exist today with regulators circling mHealth firms. The Viggle isn’t even the tip of the iceberg as there are plenty of far more powerful psychological stimulants emanating from a TV set than this (think ads for sugary drinks and unhealthy foods) and there are already examples that are much more unhealthy that are already commonplace and unaffected by regulators eg. kids watching 18+ age restricted content (alcohol ads on Facebook), location based Groupon ads that invite you to “eat as much as you possibly can for $10” in a restaurant 100 meters away, unregulated sellers using medical keyword ads, etc.

Trying to convince people to download and use mobile apps and gadgets to get active already has been a tough sell. Which is why I was underwhelmed by this week’s news that smartphone accessory maker Jawbone, producer of the failed – but later revived – UP sleep and activity tracker had acquired Massive Health, maker of, well, I’m still not exactly sure. Massive Health did come out with an “experiment” in 2011 called The Eatery that to me seems like the “Hot or Not” of food photos. There was another iPhone app for diabetes management supposedly called Penguine, but that never got a public release

This is sadly a fairly typical dismissive view of the work of software developers. Just because it’s sometimes hard to see what they “make” doesn’t of course mean that they don’t actually make anything eg. when Mark Zuckerberg put some code together with the intention of making a dating site for undergrads who was guessing that it would so radically change the way people interact with one another, brands and everyday experiences?

Business development chief Andrew Rosenthal once told MobiHealthNews that Massive Health’s differentiator was its user-centeredness. “Our approach has always been to focus on user engagement partly because no one else does. The more someone loves something, the more they use it, and the more opportunities we will have as a company to help them be healthy,” he said. Pardon my skepticism, but hasn’t everyone peddling a DTC health tool focused on user engagement? Isn’t that the point of all the gamification apps, widgets and gizmos?

While no one is questioning the value created and the advances in health when patients are engaged I’m amazed that as a journalist Neil’s hype filter isn’t a bit more tuned. Just because everyone tells you they are “peddling a DTC health tool focused on user engagement” doesn’t mean that any of these people actually know what patient engagement looks like, how to actually build it or have any real world experience effectively engaging with patients.

It’s quite obvious to me that established healthcare providers are greatly challenged by this as mobile communities have radically transformed the world and left them weighed down by entrenched self interests and uncertain of how to operate within the new status quo. It’s easy to spot in a study of the processes at any major healthcare provider (eg. while the NHS spends billions championing ideas around patient engagement and paperless futures it simultaneously outsources the way it communicates with patients – it’s “front door” styled website is run by a private company – and even the critical information that emergency room Doctors are providing to patients who have had a bang on the head is printed and wrapped in ads by medical negligence lawyers) which of course makes a market that is ripe for new market entrants with new perspectives.

I never was able to find anything unique about Massive Health, other than its Massive Hype. It had a high-minded business name, a Silicon Valley rock star on board — namely former Mozilla Firefox creative lead Asa Raskin — and a lot of buzz. But no real breakthroughs or much in the way of actual products

I’m not sure how Neil’s able to judge if any breakthroughs have been made but it amazes me that anyone who has chosen to report on the mHealth opportunity would find it so easy to simply dismiss as inconsequential the work that an entrepreneur has tried to do.

Perhaps it’s because we feel someone with a ‘Silicon Valley rock star’ background shouldn’t have the temerity to try and make a difference to something as complex as the healthcare industry? Perhaps it’s because it’s hard for us to imagine that it’s all too often those who try and fail that eventually go on to make the most disruptive changes?

Come to think of it, that’s not so unique, either. Revolution Health had a similar grandiose name and an even bigger IT rock star, Steve Case, behind it. Google Health had early XML developer and former Microsoft project leader Adam Bosworth, not to mention the Google name and reams of undeserved press. Both of those failed pretty miserably. Bosworth’s subsequent venture, Keas, just announced yet another change of direction this week

In a world where communities dominate brands I don’t think we can blame the private companies for hyping themselves just as it would be pointless to blame the media who so consistently reward it with reams of press coverage. While I don’t think Neil has himself written about these companies before himself it’s interesting to notice how much of this ‘undeserved’ press MobiHealthNews has itself has given to companies like Keas (Former Google Health head launches Keas, Keas: Build our iPhone app; SMS coming soon, Workplace wellness startup Keas raises $6.5M, Humana launches wellness platform Vitality, Keas inks Pfizer deal, Pedometer Plan: Keas partners with Partners HealthCare) or Massive Health (Massive Health to build apps that appreciate patients, A stealthy mobile-focused startup named Massive Health launched, Jawbone acquires Massive Health to improve UP, Massive Health’s first experiment: The Eatery app, TR also has a profile piece on Massive Health’s Aza Raskin).

What those projects all have in common is that they never figured out some of the basic realities of healthcare. Fitness and healthcare are distinct markets. The vast majority of healthcare spending comes not from workout freaks and the worried well, but from chronic diseases and acute care. Sure, you can prevent a lot of future ailments by promoting active lifestyles today, but you might not see a return on investment for decades

I find the idea that implying preventative health is the reserve of “workout freaks and the worried well” is a big mistake and we should be beyond thinking that it’s just about preventing “a lot of future ailments” but as an opportunity to turn around the onset of and reduce the impact of a lot of chronic disease.

I differ strikingly in my opinion from Neil as I see fitness and healthcare being inexplicably linked. I can only presume that someone who doesn’t share my opinion is unfamiliar with the work of dieticians or the stats surrounding the childhood obesity epidemic.

In my opinion it’s not the case that we’re going to have to wait decades for this to be measurable – it’s impacting total healthcare costs and workforce productivity today. FYI here’s a great video that helps explain the very basic issue that arises from the sedentary lifestyles modern societies offer.

Perhaps it’s that as digital migrants we don’t realise digital tracking is something that we’re already doing or that we just feel uncomfortable with it because it’s so unfamiliar for us to think that someone might be getting useful nudges from an electronic BP monitor or an activity/sleep monitoring app on their smartphone?

Another problem is that Massive Health, Google Health, Revolution Health and Keas never came to grips with the fact that healthcare is unlike any other industry. In the case of Google and every other “untethered” personal health record out there, it didn’t fit physician workflow. That’s why I was disheartened to learn this week that one of the first two development partners for Walgreens’ new API for prescription refills is a PHR startup called Healthspek. I hate to say it, but that is bound to fail unless Walgreens finds a way to populate Healthspek records with pharmacy and Take Care Health System clinic data

Wow. “Bound to fail” are pretty harsh words about a startup that’s trying to give patients access to their health information (particularly if you know about the pain this causes to patients and their carers in the USA). I think very differently, in my opinion Healthspek just by existing has already been an incredible success for Walgreens whichever way it pans out.

Walgreens get the mHealth opportunity and are making massive revenues from it already so if they see an opportunity in providing an API to the mHealth developer community the fact that two developers are already onboard it’s a very good sign and much better than just one.

If Walgreens are confident that their place is at the centre of future patient transactions and that they are in a position to collaborate with others (regardless of their corporate size) to ensure this can happen. IF Healthspek fails I don’t think there can’t be any doubt that it will be an incredibly valuable lesson for Walgreens in the same way that any failing app developer has been for Apple’s continually evolving Mobile App Store strategy.

In terms of cost it’s also of course likely to be a whole lot cheaper than Walgreen’s trying to innovate like this themselves and a lot less risky way to identify what works and what doesn’t (if Healthspek works I can’t imagine that Walgreens will waste anytime buying the company and bringing it’s talent onboard and mainstreaming it’s offering with their millions of customers).

Plus, doctors don’t trust patient-entered data and patients, for the most part, won’t bother to enter their own information in the first place. It’s like Quicken in the days before online banking let people download all their transactions. You need the interoperability first

These are generalisations that I don’t think are true. Here’s a video of one of the most highly regarded primary care Doctors in the USA talking about how his clinic at the Mayo Clinic readily accepts patient entered data all day everyday.

This isn’t new though eg. the Doctors who have been writing prescriptions online at firms such as KwikMed have also been trusting patient entered data for years and it’s even been proven that this information can in certain instances be more reliable than information that a Doctor can take from a patient.

The other thing working against the likes of some of these companies is the economics of healthcare. Third parties pick up most of the tab. People freak out when their health plans raise co-pays or employers ask them to cover more of their monthly premiums. Direct-to-consumer just doesn’t work. You have to go to those who pay the bills, namely insurers and employers. Keas did that in a previous refocusing, but I haven’t seen any evidence that Massive Health ever did

A statement like “Direct to consumer just doesn’t work” sounds to me like one of those things far too many in healthcare just accept as a reality. It always surprised me that so many think this despite the existence of a multi-billion dollar alternative health industry, and for anyone tracking the mHealth market how can you not be aware that patients are increasingly bringing their own devices.

As Verizon Wireless healthcare director John Maschenic wondered out loud in 2010, “I pay $18 a month for OnStar to manage the health of my car, but people aren’t willing to pay more than [$5 a month] to manage their own health information?” Yes, it’s true. And it doesn’t seem to be changing very fast

I’ve met John Maschenic and heard him sharing his passion for the idea he has of patients paying Verizon to manage their health information but I can’t help but feel he makes very little attempt to explain why patients would want to do this or how Verizon could possibly create the emotional connection with them that is required before they will be able to trust a telco with the supply of such a service.

I think it’s obvious that the only way Verizon’s going to get to this position is if they can succeed with the direct to consumer devices first. Consumers don’t buy Onstar because it’s provided by a mobile phone company (Verizon in the USA) but because it’s provided direct to consumer by the company that sells them their $XX,000 auto in an attempt to build value around it eg. cheaper insurance, lower maintenance costs, etc.

I’ve mentioned before of how many lessons I think the mobile market can draw from the auto industry when planning mHealth strategies but I really should have added some more comment on Onstar as while an auto manufacturer has created a system that enables emergency medical service personnel to be automatically notified with a “medical measure of the intensity” in the event of an accident, Verizon mobile hasn’t even started to begin adding value around the consumer health opportunities it could offer customers eg. imagine the potential for Verizon mobile subscribers to register important health information so that it can be shared with the Emergency Call Handler in the event that they ever need to make a call to 911.

Can you imagine how different a patient would feel about Verizon and their health information if it didn’t wait for the healthcare industry to wake up to mHealth but actually started expanding direct to consumer offerings that it could easily kick start by having a relationship retailing and supporting connected devices like smoke/co detectors, thermostats, front door locks, care/home security needs, wallets, etc.

Is Neil right? Do you also think the Direct-to-consumer route just doesn’t work?

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One Response to Neil Versal: Rewards for watching TV vs rewards for healthy behavior

  1. Pingback: Is it Hope? Hype? Or just the Same Old Struggle?

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