The Digital Health Revolution

Kevin Pereau, Barry Lenson, Barry Lenson

• Editorial: TranscendIT Health
• Año: 2019
• ISBN:
  9780578431451
• Categoría: Medizin
• Categoría: Gesundheitswesen, Verwaltung & Pflege

Healthcare is evolving and our smart phones are driving that disruption, better connecting us with the stakeholders who help keep us happy and healthy. The Digital Health Revolution is the firstconsumerlook at how digital health technologies arehelping uscollect, analyze and take action on our personal healthcare data. We check in with30 of healthcare's top thought leaders to capture and share their insights. Whether you are managing a chronicalcondition or simply striving to stay healthy, plug in and catch up with the innovators driving disruption and delivering better value for us all.

CHAPTER ONE

OUR SYSTEM IS BROKEN, BUT WHO CARES?

Have you ever had a friend who constantly asked why things are done the way they are done? I was definitely that kid. When I first shifted my professional focus from technology and management consulting to health care, I was a nonstop “But Why?” machine.

I must have driven my poor wife crazy. She has logged more than 30 years in the health care industry, where she came up through the ranks. There isn’t an aspect of how insurers intersect with our lives that she can’t go into the weeds to discuss. She started in underwriting, later moved into account management, then did sales and before long, moved into management and was running regions. Okay, I glossed over quite a bit there because she is a woman and it took her twice as long and she had to work twice as hard as her male counterparts to finally become president of a multibillion-dollar region, and then CEO. If her name were Bob, we would probably be living on an island already. But you get the picture. She knows the health care industry backwards and forwards, inside and out. Forget the fact that she is only one of a handful of women in leadership roles. That is a story for another day. She has given me an insider’s perspective into all things health care and C-level connections any digital health startup would covet. From health care consumption to servicing, I have seen it all—and it isn’t always pretty.

AN EARLY VENTURE I MADE IN HEALTH CARE

When some former tech colleagues approached me about an idea they had about starting a health scoring company, I was intrigued. I had long asserted to my wife that one of the reasons we have such runaway costs in health care was that nobody measures anything.

How can you manage something you don’t measure? Seems like a logical question.

In coming up with a way to measure an individual’s health, we borrowed a concept from the financial industry and applied it to health care. We started with a simple score, something that anyone could track and understand. It was amazing how closely it tracked like a credit score. We used a sliding 0-1000 scale. At zero, well, you were probably dead. At 1000, you were taking the leading role in Superman movies. In between, anything above 600 was good; about 700, excellent; and above 800, exemplary. We put an arrow by your score to show whether you were trending up or down.

Yet there are some significant differences between your health and your credit score. For starters, your credit score only tells half the story. It shows how much you owe and how well you service your debt. It doesn’t list wholly owned assets or how much money you make. How do you account for similar factors when expressing the status of somebody’s health? We knew that would be challenging, and realized we had to get it right. After all, you aren’t automatically healthy the day after you quit smoking, just as you aren’t at risk for a heart attack or diabetes because you skipped a day of working out.

Starting in 2011, a cornucopia of data-collecting devices, ranging from the Fitbit to the Nike Fuelband, were already exploding onto the scene. Withings had introduced scales that could capture and store your weight, body fat and BMI for later analysis. Welcome to the Quantified Self movement. We decided to be agnostic about what devices we would use to fuel the data that would drive your score. Garmin, TomTom, even your phone, were just fine. Your score would reflect who you were, what you did, and how you felt. We measured incrementally how daily lifestyle choices affected overall health.

We were going to change health care. Measure it, manage it – thrive. Boy, did we have a lot to learn.

While we got much of it right, we didn’t see the incredible headwinds coming, coming from the entrenched incumbents who profited from fixing folk when they became broken. We quickly realized that not many in the industry were financially incented to keep people healthy. Sure, they talked a great game, but at the end of the day if we didn’t get sick, nobody made any money. Not the doctor anyways. How could we get their oars rowing in the same direction if it meant cannibalizing their core profit centers?

The first pushback from early innovators in digital health came from the insurers. When presented with a value proposition that engaging the consumer would alleviate strain on the entire system, they responded with a consensus . . .

“Good luck, we have tried. Consumers are the problem. They won’t engage, they won’t share, and they won’t take responsibility for their own health.”

That, I thought, was a total sack of hooey. With my typical energy and enthusiasm, I dove headfirst into fixing health care. We would show the world how to engage consumers, capture and analyze data to better understand what was really causing our health care problems. We were pioneers in the digital health movement.

We thought it all started by getting consumers to know their health score. If we could engage people and get them to sustain their interest in taking better care of themselves, we were on the right path.

We learned incredibly insight-filled lessons along the way. While it’s a fair call to say that all people are different, it is equally fair to say that there are many things we share. For sure, there will be a stubborn demographic that simply will not engage. No amount of coaxing seems to work—or does it?

One simple truth? We are all social, and we all seem to respond when gaming principles are properly applied.

ADDRESSING THE BIGGER ISSUES

Let’s focus on how to best leverage social principles first. When we first came to market, we were looking for any path to the consumer we could find. We thought selling through partnerships with insurance companies would accelerate our market adoption. Insurance companies would sell health scoring through their broker channel to employers who would provide it to their employees as a benefit.

A whole new lexicon developed around this very convoluted and, as it turned out, challenging route to market. The business-to-business-to-consumers model (B2B2C) meant our business would sell to your business, who in turn would provide it to the consumer. Per Employee Per Month pricing became the norm. What PEPM are you getting? Questions like that dominated the conversation at health care tradeshows.

A health score alone was never going to be compelling enough by itself to get anyone to bite, so we reinvented our messaging. Since we allowed our users to track more than 100 activities, we developed ways to create challenges around anything that can be tracked with a device.

We then fit into an emerging category called the “Wellness Market.” Our elevator pitch was now about a health score that utilized a B2B2C business model and heavily leveraged social and gaming principles to influence people toward healthier lifestyle choices—whew, what a mouthful! To our delight, it proved right on the money. Companies were biting. They were implementing our health score and developing corporate challenges for walking, running, cycling and burning the most Metabolic Equivalent of Task, or, METs, in a month. If you could track it, you could harness a rewards program to it.

While pretty exciting, I thought we could do better. Early push back from employees was, “Oh great, big brother is watching.” I realized that our co-workers might not be the best source of social agitation for keeping our interest and sustaining engagement. Maybe my co-worker doesn’t like me? Maybe she wants my job? Maybe he resents our VP of HR being able to look over his shoulder at his non-work activities as much as I do?

Maybe those employees weren’t accepting of our company’s intent to provide a tool that their employer could use to watch them at all times. Hey, argue all you want that it’s not fair, or that any company with enough forward-looking vision to be investing in you like this should be applauded. But I promise you that people are skeptical, and you can’t change human nature.

I thought back to some early lessons I had learned in the tech sector. At Cambridge Technology Partners, we did something innovative and daring. We created the Cambridge Information Network (CIN). It was a website created specifically and solely for CEOs and CIOs. We created something we didn’t expect—we created a sense of community. With that came incredible insight into how the executives we were selling management and technology consulting to thought about their problems. We never let our sales teams anywhere near the site, and we were always careful about applying lessons learned from what was shared on it. In other words, it wasn’t a lead-generation tactic.

We developed what we called a Lyceum Program around CIN, run by one of the tech sector’s consummate thought leaders, Thornton May. For one glorious summer, I got to work with him hosting lyceums all over the USA. For those of you who don’t speak Greek, lyceum is a place of learning. It was eye-popping. We never once presented those attending with corporate overviews or followed up about specific problems they had shared with us. Instead, we would pack the room with CEOs and CIOs who would bare their souls to one another about what was and wasn’t working in aligning technology with their corporate missions. I was flabbergasted. Here was the CIO of Praxair sharing with other executives the things I had flown about 1,000 miles to specifically discuss with him. In a safe environment, he was telling others about how he had failed, and was asking them for ideas on how to right his wrongs. His peers were doing the same. Collectively, they were banding together to solve the most difficult of their problems.

Poor Thornton probably put on about 40 pounds that summer zig-zagging across the USA, eating very bad chicken dinners while form-fitting his bottom into seat 4E on Delta. Why am I telling you about this? Because as you apply these lessons learned to digital health, you realize a couple of things.

One is that in a safe setting, people share. They open up. Maybe interacting with co-workers isn’t the best venue for helping people feel safe enough to share? As if my co-worker could secretly give a bloody rip about my blood pressure and body weight - who does? I’ll tell you who does care: your spouse cares, your children care, your family and friends care. If you only remember one thing, please let it be this. It is worth the price of admission. Whether you are managing a chronic condition or you are active and healthy, you can derive great benefit from tools that allow you to build your own social network.

I mentioned there were a couple of lessons learned. Here is the other one. People behave differently when they think someone is watching, and that is especially true if that someone is somebody they care about.

We developed a tagline, “It’s Better Together,” and used it in all our product messaging. Incredibly, the early blowback we got from employers was amazing. “We don’t want spouses involved in our employees’ health challenges,” they told us. “These are private challenges and outsiders aren’t eligible to participate.”

Really? We just showed you how to influence your employees to be more active, and now you don’t want to do it? Welcome to the early innovators’ dilemma. We had to do controlled pilots to demonstrate that employees would be more responsive to health care challenges when they were working with their spouses than they would be if they were working with their co-workers.

Spouses or co-workers—guess which group responded better? This is what I like to call the Cheers Bar principle in action. Blasphemous, I know, but you are more likely to show up and use a tool in a setting where everybody knows your name.

Another lesson learned had to do with gaming. We originally thought that to leverage gaming principles, we would constantly have to do challenges that offered rewards. There is nothing wrong with that. In fact, it helps keep things fresh.

My most memorable challenge was a walking challenge I entered. There were participants from Europe, Asia, South America and the United States. I targeted a goal of 1,200 miles walked for the year. That averaged out to about 100 miles a month. It was a bit aggressive, but I thought doable. I won the challenge but fell a little short of my goal. I think my total for the year was 1,143 miles walked on four continents. My nearest challenger was a 73-year-old professor from Switzerland who doesn’t like to finish second in anything. I realized when tabulating the results at year-end that a 60 year old and a 73 year old man finished first and second in the challenge. So much for our demographic not representing!

A couple of surprising things about being in this challenge remain with me. One was how supportive we old fellows were of one another. Judging from the smack talking from some of the women in the challenge and the younger fellows as well as the regional participants, this wasn’t uncommon. Support groups formed along natural lines and provided motivation to help us keep one another going. My nearest competitor would sometimes ping me when I was inactive, inquiring if all was well.

The subtler lesson was the effect our personal scores had on us as individuals. At a certain point in the challenge, it was clear that nobody was going to catch the 60 and 73 year old men that were leading. Yet, everyone stayed engaged. I circled back with some of the participants and found they all hated to see that dreaded down arrow show up next to their score. It meant they weren’t active and their score was trending down. They were competitive with themselves, and found they were striving to be the best version they could be.

I probably should have seen that coming. I have a buddy I golf with all the time and I realized, sure we enjoy bragging rights but more than anything else, we just want to beat the golf course. On any given day, one of us might play out of his mind and take home the trophy but over time, if we focused on becoming the best we could be, we were satisfied.

But with so much that is broken in the world of health care, where do you start? Let’s start by looking at how our health care system is oriented today . . .

And let’s next look at how the health care system will look like in the future:

Our current system is built like a solar system where the physician is at the center, with insurance companies occupying a close second place in the hierarchy. What is wrong with that? Consumer health care should occupy the central position. Health care payers, providers, insurance companies and the rest should revolve around the consumer.

Judging from the comments offered by many of the experts who contr...