Rewards for watching TV vs rewards for healthy behavior

By: Neil Versel | Feb 7, 2013        

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Neil_Versel_LargeHealth 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.

And despite what that specific commercial said, Viggle is not just for DirecTV subscribers.

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.

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?

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.

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.

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.

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.

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.

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.

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.

  • Cynical

    Well written. This is one of the few columns (or rants) that actually understands the reality of healthcare and digital health (attending any health care conference will also highlight this divide). What I am finding is two fold:

    1. The vast majority of these DTC products are created by people who have had success in other areas of “digital” – and therefore they build what they know – consumer facing apps / websites that just happen to be focused in health. They think that healthcare is huge ($$), broken, and therefore easily fixed using the same principals applied to music, banking, or finding a movie. But they have zero understanding of the “business of healthcare”, and as a result have no ability to actually sell their products into the health care industry – one of the slowest moving, convoluted, and cumbersome industries in the world.

    2. Almost none of these products have any clinical knowledge closely integrated – many have a doctor (entrepreneur) on the “advisory board”, but in most cases there are no actual practicing physicians involved (physician founders are often still in med school, only practiced for a limited time, or never at all). This results in two problems – one of which the author notes – no understanding of workflow; the other being no real clinical efficacy for the product – meaning, they do not actually improve health, improve efficiency, or lower cost. Any physician will be able to lament the issues of self-reported data…

    Instead of hanging out at gyms or restaurants building apps for diets or food I would recommend digital health entrepreneurs hang out in any casino in America around 1pm any day of the week – that is your audience. And until your product tests well with that group, you have no real shot.

  • http://twitter.com/drbetsyb Betsy Bennett, Ph.D.

    I agree with “Cynical” – great, great article. As a health psychologist with a lot of years in pharma and healthcare, I am continually frustrated with the hype that accompanies most “health apps”. Not everyone enjoys computer games, not everyone wants to “share” the issues they’re ashamed of with their “social network”, not everyone is interested in being a “quantified self”. This is not to say that digital health is futile or a bad idea. But if we took the time to understand why so many doctors hate EHRs and patients are not interested in paying to “manage their health information” (What does that mean, anyway?) we would come a long way towards finding digital interventions that people actually want to use.

  • http://ducknetweb.blogspot.com/ Medicalquack

    Here’s a video on gamificaiton and this is humor and satire but makes a point about games:) Funny thing about the video is it’s the developers themselves wanting to know if this has value:)

    http://ducknetweb.blogspot.com/2013/02/surgery-simulator-gamemaybe-not-one-of.html

    On a more serious point, I said two years ago, make apps that do more than “one thing”…I used to write some of those years ago in the old VB windows mobile days and we are so much further along today but why drown a good phone with apps, use the ones that have value. Also too on engaging consumers our government in HHS/ONC does a very poor job with role modeling and they still hang on to that old paradigm of “its for those guys over there”, and if they could only step outside themselves and see how they look maybe it would change, but being a role model and team member trumps the dated “expert” paradigm any day.

    I was helping a consumer friend the other day with some simple stuff and she said to me “people have to have a life too” and that came from frustration as she wanted to learn but again it’s not easy enough and there’s way too much garbage out there and I’ll go one more here too with start up and accelerators being a business plan now for corporate USA to get cheap code. They are all doing it and only 5% at best will make it as a stand alone company. Thats leaves 95% out there that don’t make it. What if they did something good, but no strong enough to stand on it’s own and not complete?

    This is where corporate USA comes and buys cheap code, those who sponsor these events, Verizon, GE, insurance companies and more…they get cheap code and the developer gets a few dollars and then goes on to work in yet another accelerator or start up? Not really good incentives there for developers and I’m trying to show both sides here and very few jobs are created. I’m sure this was not the intention with the incubators, but it is certainly how some of it is playing out. I call it code for cash and so much software, a lot of it like a “me too” gets thrown at consumers and they are overwhelmed.

    http://ducknetweb.blogspot.com/2013/01/verizon-latest-to-enter-code-for-cash.html

    If you want to make some sense of “context” watch this video from one my prized readers from NYU, “It’s all about context” and he’s right. The reason I recommend his presentation video at Google in New York as that a lot of the software on some of these apps lacks context too. It’s a good video for educating oneself any way you look at it as it will make you ask “is there value here”…in a little more stealth mode and asking does this have value or someone just wanting to make a buck, and we have both out there, the good and the bad.

    http://ducknetweb.blogspot.com/2012/01/context-is-everythingmore-about-dark.html

  • deetelecare

    Neil skillfully points out the ‘better mousetrap’ syndrome that most health tech companies have, which leads to failure because they believe their press releases and forget about their customers. Any experienced marketer could have told them that there are two markets for tech here: the ‘worried well’ who are the fitness freaks and obsessives (a/k/a the self-monitoring freaks) and those who need to manage an illness and are motivated to be ‘saved’ (from further deterioration, hospitalization etc.) Both are contiguous but not really overlapping. Fitness freaks/quant selfers will private pay (to a limit); those who need to manage an illness might shoulder some of the load but frankly feel that their health plan or Medicare should. (This last has haunted telecare and beyond PERS, sensor based in-home systems for monitoring older adults from the first.) And let’s face it–people get tired of games and social, and the older they are, the less this works. There are also limits to gamification (as Zynga is finding out to its loss–and Facebook is finding the point of wearout.)

    The problem is that these companies and their founders don’t involve marketers from the start to specifically kick holes in their propositions or do the market testing that’s needed. When they finally hire a marketer on board, they tell them not to question but get out that press release, pronto.

    Viggle and the lack of acceptance of telehealth points out the obvious (to a marketer): 1) Your customer has stamped on his/her forehead, “SO WHAT” and 2) People do things for their reasons, not yours. And checking into what I’m already watching, or might like to watch, and getting rewarded for it? What a no-brainer!

  • Tone Deaf

    Finally!! an honest and logical assessment of the over-hyped world of health apps. Well done! Add to the many variables swimming against the tide is the obsession with data and quantification which satisfies the needs of the inventors, the providers and the system, but often not the consumer who is dealing with managing a chronic disease like diabetes in their real world which requires a complicated dynamic of behavior change.

  • Jim_Bloedau

    Neil, great piece. Who likes consuming healthcare? Nobody. How many providers have you heard say they wish they could spend more time in the office? Never. Because of this, the industry’s growth has been predicated on the idea that somebody else will do it all for me – employers will provide insurance and pay for it, doctors will provide care. This is also the driver of the traditional business model for healthcare that many pundits label as a “dysfunctional healthcare system.” Actually, the business of healthcare has been optimized as it has been designed – as a volume based business and is working very well. Your prospective fit this well and is not cynical, just experienced. Keep it up.

  • Hugo

    Great, great insights.

  • http://twitter.com/ADeGheest Anne DeGheest

    Very nice
    article. Because of the “perceived” land grab, most of the new DTC
    startups are rushing into developing their product and getting it to the market
    quickly….and risk failure because they did not spend enough time defining the
    problems they are trying to solve and understanding the value proposition of
    ALL the players involved (including existing healthcare providers and
    payers)…therefore they encounter a value proposition and revenue model
    problem..in a very visible way.

  • civisisus

    love you, Versel, and good call on Massive Health’s massive fail, but this:

    “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…”

    needs more work.

    First, there is no “healthcare industry”. It’s a thousand (several thousand?) industries under a handy if relatively useless label – much like “the” tech industry. To do something useful, no one needs to “come to grips” with either.

    Second, PHRs do not need to “fit physician workflow”. to succeed. To succeed, they need to be useful for people. They are not “Physician” Health Records, they’re PERSONAL Health Records. j

    If anything, physicians need to provide data THEY trust TO PHRs, and PHRs should be ready to grapple with whatever output physician systems can manage (that they SHOULD be able to output – AND take in – useful data in practically any form, because there is no genuine technical barrier to doing so, we will save for another rant…).

    There are already fairly practical personal health information resources functioning, if not flourishing, not far beyond the glare of the spotlights on clown shows like Massive Health. People need to develop basic information habits, and to have basic information expectations to which the traditional, conventional, backwards, legacy health care services providers must eventually succumb. Developing those habits takes time and the availability of handy examples, and working models. Healthspek may not be “it”, but it might help move things closer to “it”, if for no other reason than that in it, people have another “it” to draw comparisons with – favorable or unfavorable.

  • D Zar

    Neil, a belated thank you for saying in public what I’ve been saying to anyone who will listen. There is a secondary problem, however; with all of the hype and land-grab going on, millions of investment dollars are going into consumer apps and not into truly revolutionary, or at lest evolutionary, medical products in the “digital health” landscape. I’m involved with, and friends with many other, companies who are really trying to do some interesting things, but since we’re not a consumer app to make people healthy, we get shut out of the funding. No matter that all are doing things with demonstrated clinical needs; since we sell to health professionals, we have a hard time convincing investors to give us a chance.

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  • anne weiler

    Hang in there. If you have customers who will pay you, that’s the most important thing.

  • anne weiler

    The problem with ‘gamification’ is that a lot of developers don’t understand that it’s mostly about good design that makes your app compelling and sticky. Badges as rewards only work for people who were in boy scouts.

  • anne weiler

    I’m surprised you didn’t mention FitBit. They seem to be successful with consumers and are making a move into corporate wellness programs (third-party payer).

  • http://www.innovationthrives.com innovationthrives

    Doesn’t seem like it gets much more simple than that. but in fact, it might. Change will likely arise much more swiftly with insurance exchanges, with uniform ways to pay, out will come the “consumerization” of health/sick products and services, bringing transparency to all facets, and a sweet spot will arise from the ashes like a phoenix, and it will come on the heels of being able to do exactly as you say, and the blue button was the first step.

  • STU LESSER MD

    I agree. Your comments are exactly right on, more realistic than cynical IMO.
    However, in the near future there will be great opportunity for those who can bridge the gap between truly clinically meaningful mobile apps and those accountable care organizations under Obamacare that desperately need them both for patient centricity and population based, data driven, cost reduction. Hang in there!

  • @BarbaraRapchak

    Thank you for this provocative piece. “Buzz” in the consumer world generally means a Silicon Valley rock star on board and more followers on Twitter. “Buzz” in the healthcare world means tinnitus, ICD-9-CM 388.30. We speak different languages. Or maybe we just use a different vernacular. Regardless, we desperately need your voice and insight. Please keep up the great work you are doing for all of us.

  • Rajiv

    Well written Neil. I have been in the Telehealth/Telemedicine and now mobile health domain for over 10 years and have never seen so much buzz as for the last 18 months. We get asked all the time, this market is flooded with so many developers who can write up some app over a weekend on a smartphone or a quick social networking web site and claim to be a healthcare domain expert. Well, the answer is to live through several years of experience connecting with care providers and their patients to clearly understand what they really want, what actually motivates them to change behavior to adopt new way to communicating with a mobile healthcare solution…then go and build it, pilot it, get feedback, enhance it and even then there is no guarantee that you will get the right model for commercialization.