Should Healthcare Run More Like Airlines?

While most people dread flying during the holidays, it’s hard to ignore how efficiently the airlines are able to move millions of people across the country.  While we tend to dramatize issues with flying, today I want to appreciate the tremendous job the industry has done to create an effective (and dare I say friendly?) member experience that healthcare could learn from.

Flight Purchasing

How The Airlines Do It: How do you like to buy plane tickets?  Some people use a travel agent, some people call the airline, others buy online (either directly from the airline or from flight comparison websites).  Airlines give customers several channels to buy tickets by creating their own infrastructure, but also opening up their data for other companies to use.  Freeing up their data also creates price transparency, leading to greater competition and lower prices.  While everybody hates the new fees airlines tack on, decoupling extras (e.g., checked luggage) can also lower costs or keep them steady since only the people who use these services are paying for them.  Finally, customers can also get lower prices through group buying, using companies like Egencia that exchange volume for price.

What Healthcare Can Learn: Right now, you have very few choices about how you can pay for healthcare – given the high cost, insurance is the only route for most people, and that’s often tied to your employer.  This may change with the individual exchanges, as employers may drop coverage and folks will get to choose which plan is best.  As a result, insurance companies will need to create more customer-friendly plans and interfaces to help customers understand their choices in a much more competitive market. 

While healthcare is mostly fee-for-service (i.e., you’re only charged for what you use), there remains a lack of price transparency – do you know how much your x-ray costs?  While new startups have emerged to address this (e.g., Change Health, Healthcare BlueBook), we need to continue to create easier tools and better incentives for people make the right treatment decisions.  Finally, group buying has existed in groups such as Pharmacy Benefit Managers, but newer incentive-based models (e.g., ACOs) have the opportunity to be scaled up.

Pre-Flight Experience

How The Airlines Do It: Airlines have embraced technology to make the pre-flight experience better.  First, airlines use code sharing agreements to fill less crowded flights on other airlines or transfer frequent flyer points across multiple carriers, completely blind to the customer.  Second, airlines have embraced newer consumer technologies – for example, United and American are two of the first businesses to work closely with Apple to integrate their apps with their mobile payment service, Passbook.  Finally, security, one of the most important parts of the operation, is handled by a centralized agency, the Transportation Security Administration, meaning airlines can focus on what they’re good at rather than the complexities of security.

What Healthcare Can Learn: The code sharing agreements are akin to hospitals and doctors seamlessly transmitting patient information across systems.  While hospital systems do this today, it needs to be more portable and touch more patients, possibly through larger alliances that cover more health systems using the same technology.  I also like how airlines are working closely with mobile companies on cutting edge consumer technology – major health systems may benefit from tighter alliances with those major tech companies.  Finally, ceding certain activities to a single group takes healthcare companies out of what their bad at (e.g., data management).  EHRs may be a good example – does it make sense for the industry to name a single standard, and then allow health systems to outsource the work to dedicated vendors?

In-Flight Experience

How The Airlines Do It: Sure, the seats are cramped and the food is mediocre (when there’s food at all), but airlines have done some things right.  First, any in-flight purchases are cash-free, limiting the payment options, but simplifying the process to make things more efficient.  Next, airlines have created partnerships with movie and television studios to present current entertainment options or started handing out tablets to personalize the experience.  Finally, frequent flyers are often rewarded in-flight through a variety of special perks (e.g., free checked bags, automatic upgrades).

What Healthcare Can Learn: Efficiencies gained through limited payment systems would be a clear benefit to healthcare (i.e., eliminating the complexities of the fragmented insurance system means less admin headaches for providers).  The entertainment partnerships are vaguely similar to ACO’s, where there’s an incentive to produce and deliver high quality products – in this case, the airline benefits from having an engaged, happy flyers, and the studios have a captive audience to pitch their best shows.  Finally, I’ve written about “frequent flyer” healthcare programs in the past – integrating something like this into a hospital system could be an effective way to gain loyalty with select consumer segments.

These are certainly pipedreams with a multitude of complexities and challenges, but after flying this past week, I’ve come to appreciate what the airlines have done in the face of tremendous challenges and I’m hopeful healthcare can do the same.

What Are Some New, Exciting Technologies With Potential Healthcare Applications?

For anybody with an interest in retail, I’d encourage you to check out PSFK’s Future of Retail Report, which has a lot of great quick hits on retail strategies.  One technology that I was particularly interested in was an app from Neiman Marcus that alerts sales associates when a customer visits a store.  The associate then has access to sales history and customer preferences, while the customer can access product information at their fingertips.

Let’s apply this to healthcare, where a patient might be able to broadcast medical history or preferences to different stakeholders.  At one end of the spectrum, a patient could list their health-related questions or ask for assistance through an app at a pharmacy or health provider, creating a better, more personalized experience.  At the other end, an electronic health record could be built into a phone and be able to be broadcast to or downloaded via secure line at a hospital when the patient enters.  Biggest hurdle is security and privacy, but could be overcome in the future.

The second technology, also via PSFK, is an extension of my fridge magnet idea from a previous post.  The Virtual Fridge Lock attaches to a refrigerator and monitors when a person opens it.  If that person uses it during an unauthorized time, the fridge sends a message to their social networks and gives friends the chance to comment (with either encouragement, similar to the Nike+ running app, or criticism).

This idea uses all the great elements of gamefication and social motivation, although I wonder how many people will invite this self-induced criticism.  Given that people use social networks more than ever to shape their personal image, will they be willing to admit weight is a problem and shame themselves to lose a few pounds?

Why Isn’t Everyone Talking To Their Doctors On The Phone?

Imagine being sprawled across your bed with a cold compress to relieve your throbbing headache.  You haven’t eaten for days and every muscle in your body feels like it’s been through a heavyweight bout.  You know you should see a doctor, but that requires energy that you can’t muster up.

This is the dream scenario for Ringadoc, a startup I recently ran across that lets you call a doctor to diagnose your issue for a flat fee.  Telemedicine has the potential to play a significant role healthcare delivery, filling a gap in primary care that may not be covered through general practitioners and retail clinics.  But despite the explosion of smartphones and tablets, why don’t I know anybody who has used or considered this type of service?  There are a few hurdles for the industry:

1) Accurate Diagnosis and Patient Trust: My wife recently had a skin issue and, because of her busy schedule, was only able to talk with several doctors over the phone.  They recommended some topical solutions and suggested she needed to reduce her stress.  After three weeks it was clear that wasn’t working, so we went to a retail clinic where she was diagnosed immediately, given antibiotics, and felt better in a few days.

Medical diagnosis is a very intimate process and often requires more than just descriptions or pictures to be accurate.  I think the public recognizes this, which is why many folks may feel uncomfortable with this process.  Until telemedicine provides and communicates accurate diagnoses on a regular basis, the public may be reluctant to give it a go.

2) Seamless Technology: To assist in these diagnoses, doctors may also require data such as blood pressure, glucose level, etc.  While the technology to do this over your smartphone exists, it would require a whole other set of devices for the patient to own, be accessible, and be able to use correctly.

On top of that, in order for telemedicine to provide significant value, there needs to be greater connectivity.  For example, if my wife had been accurately diagnosed over the phone, she still would have needed medication, requiring the doctor to send a prescription to the pharmacy.  I’m unclear on whether this connection or the ability to pass along data to specialists or a hosipital exists, but I suspect it’s several years out. 

3) Cost: Of course, looming above everything else is cost.  Telemedicine solutions can range anywhere from multimillion dollar, state-of-the-art labs (as I Simon Cowell plunked down for his tour bus) to Ringadoc’s $40 per call model.  However, until this is promoted or supported through insurance, likely reducing costs and giving the industry more credibility, I’m not sure we’ll see stronger adoption.

That’s not to say the industry isn’t looking at this.  Recently, my company has thought about virtual pharmacies, complete with live connections to pharmacists over video.  While this solution has been well-received, it will be years before we roll this out due to the scale and complexity.

Like the newer retail clinic model, I see a lot of potential for telemedicine to play a larger role in healthcare delivery.  However, there are still several fundamental patient issues to work out before it’s normal to talk with your doctor on your bed.

How Can Facebook Use Its Resources To Improve Public Health?

This past month, the big news out of Silicon Valley was the Facebook IPO, when they agreed to trade more access to capital for more public responsibility and scrutiny.  While most of this responsibility is financial, it’s hard to ignore the opportunities to improve social welfare.  Given how much data they collect and how many people they influence, it’s fair to ask if they should use that information to benefit health causes.

Facebook has already taken a first step with their organ donor initiative, which gives users the ability to sign up to become a donor and share their decision online.  In the first day, state registries saw nearly 15 times more people enroll than on a typical day and over 33k new members registered in the first week.

While some people may question the effectiveness and ethics of this, I think it’s a good illustration of how massive tech companies such as Facebook and Google can use the core foundation of their products (users and data) to benefit healthcare.  Broader opportunities for Facebook may fall into a few categories:

1) Resource Portal: With a dizzying array of healthcare non-profits, for-profits, government agencies, and homegrown support groups, Facebook could act as a curator for indexing user resources.  While this idea is very Web 1.0, having a personal improvement / health portal could spark greater awareness by promoting these links rather than relying on users to find them using Facebook’s clunky search tool

2) Personal Data Management and Analysis: Given the wealth of user data, Facebook could act as an aggregator of personal health information and predict future outcomes.  Privacy concerns aside, algorithms could analyze changes in behaviors based on posts or user-generated data and provide advice if that person was looking to change health behavior.  Google tried to collect digital health records with Google Health, but it required active management by the user.  By making it passive (i.e., collecting data already entered into the system), Facebook could build a large user base that might gain traction

3) Engagement Support for Healthcare Companies: Facebook is just beginning to realize its potential as an effective outreach tool, but there are some basics that healthcare companies need to understand to be effective.  As a public service, Facebook could offer free courses on the best way to utilize their tools to more effectively engage users

Obviously there are concerns and issues with each of these ideas and a strong business case against pursuing them.  But as their influence and scope grows, and as the healthcare landscape evolves, it will become more critical to harness their product to influence health changes

What Can Employers Do To Encourage Healthy Behavior?

While traditional wellness programs are firmly embedded in corporate culture, a couple articles reminded me there are still a lot of innovative ideas for supercharging health in the workplace:

1) The Wall Street Journal spotlighted the gamefication of wellness program from companies such as UHG, Humana, and Aetna.  As I’ve discussed in the past, the ability to quantify and track progress to a goal, while wrapping in social communities, can make fitness fun. 

However, I’m still not convinced these are good investments.  First, as the article states, the research on these games is thin.  While anecdotes suggest they are successful, we can’t say with certainty if they drive better behavior, especially for people who need it most and may not be participating.

What I find more challenging is the incentive structure.  While a lot of people participate to improve their health, others are drawn in by the giveaways and prizes.  Arguably, the bigger the incentive, the more people who will participate, which is how employers will generate the most savings.  But a bigger prize also means more people may try to game the system (most of these programs are self-reported) or be less than honest about their progress.  The article mentions some programs require special equipment (e.g., a pedometer), but that may dissuade employees, especially those on the fringes, from participating. 

I’d be interested to see a business case comparing the value of the prize to the number of people participating and their average health improvements.  I would be curious to see if there is some prize level that encourages so many people to participate that their benefits, no matter how small, outweigh the costs of others trying to outwit the system.

2) Another article via PSFK highlighted a meeting table withbicycle pedals attached, allowing employees to exercise and generate electricity.  Similar to the hotel concept I previously discussed, I love this idea for a few reasons.

First, it brings fitness into the everyday work environment, but is less awkward than some solutions (e.g., standing treadmill desks), and offers the benefits to a wider range of employees.  Second, it brings a little green energy into the office and encourages environmental conservation.  Finally, from a more practical standpoint, it can cut down on meeting times, which has its own benefits for employees.  In fact, I’ve heard of one other company that has been successful by having only standing tables in meeting rooms. 

Sure, there are some practical concerns to implementing these bikes (e.g., price, worker buy-in, hygiene), but I could see employees of all shapes and sizes using this for the novelty and health benefits.

Can Technology Help Us Shop For Cheaper Healthcare?

Medical cost transparency is the holy grail for keeping our system in balance.  Any high school econ class will teach you that a market functions best with data, so it’s easy to understand why healthcare has continued to be inefficient – it keeps its customers in the dark about prices.  There are products today that force consumers to think more about costs and potentially shop around (i.e., individual health accounts like HRAs and FSAs), but without knowing how much they’re going to spend for treatments, people still can’t make the best decisions.

In light of this, I applaud the Castlight Health and their new app that gives consumers healthcare pricing and quality info on their phone.  By collecting claims data, negotiated rates, and quality metrics, the app and accompanying website show information about doctors in the area and expected costs for services.  The article highlights how the app is especially good for travelers, which help them make on-the-go decisions.

While I love the service, I struggle with the bigger question of how to change mindsets and encourage people to take price into consideration when working with a doctor.  This is especially challenging for patients who have seen the same physician for a long time.  Not only will they be reluctant to talk about prices, but they will also resist building a relationship with a new doctor who, at a lower cost, might be viewed as lower quality (even if data says different).

However, if we’re to rein in costs, patients shouldn’t blindly stick with one physician, or accept their prices, if there are others nearby that provide good quality at a lower cost.  Like any negotiation, the patient needs to be willing to walk away, but this can be a hard mindset to take when this is new territory for patients.

Maybe this will be solved as this generation, which is more comfortable with shopping around for price and understands the healthcare crisis, makes up the bulk of the patients.  I’d also be interested in seeing what Castlight is doing (e.g., member education and communications) to encourage customers to seek lower cost physicians.  Regardless, they have fired the first shot against healthcare price opacity, and I’m excited to see how this plays out.

Can A Fridge Magnet Promote Better Health Behavior?

One challenge healthcare providers face is cutting through the clutter to deliver targeted messages. I’ve talked about dedicated healthcare devices, so I was intrigued by a fridge magnet from a restaurant in Dubai. Red Tomato provides this Bluetooth-enabled device that connects wirelessly with a customer’s smartphone and allows them to easily order a pizza.

Obviously this is great branding, positioning the company as cutting edge and convenient, while building awareness through this unique product. However, I’m more interested in the technology, specifically syncing this device to provide a service. I could see a few applications in healthcare:

- A direct application of this technology would be a device that, at the push of a button, can call a doctor or emergency vehicle – think Life Alert without working through their call center

- This type of device could also collect and display information, connecting with a website or app and transmitting medical information to promote optimal behavior. For example, after entering medication information into your computer, this device could alert you when you need to take your drugs or when to get a refill. Similarly, after entering the dates when you last visited the doctor, the device could alert you when to schedule a new appointment

- Following the fridge magnet approach, this device could be a dedicated food tracking device and barcode scanner. There are lots of smartphone apps that allow you to track calories, but making it convenient by keeping the device close to where you eat and more accurate by scanning barcodes could drive more adoption and interest

There are plenty of challenges. First, this would appeal to tech savvy consumers who aren’t the people who may need this information the most. Second, the device itself would be challenging to create – it would need to be easy to use, have a long battery life, be inexpensive to produce, and address privacy concerns. Finally, there’s the issue of who pays for this – consumers, healthcare providers, or another third-party? If someone is able to solve these issues, I believe this could be a game-changing device that makes healthcare as easy as ordering a pizza.

How Can The Government Improve Smartphone Health Apps?

Every week I see a flood of new smartphone apps hitting the market that help users make better health decisions. And every week there are some great ideas I want to write about, but I’m dissuaded by two things:

1) The apps are usually micro-targeted towards a certain consumer and do very specific things

2) I’m overwhelmed by the number of apps and how many of them feel like clones of each other

This is why I’m intrigued by a new program from the UK’s National Health Service, which is recommending 500 apps and tools for doctors to prescribe to patients. As I mentioned in my last post, we need more health curators to guide us to the best solutions. While you can argue whether or not the government should be recommending services (although, at 500, it’s tough to say there’s any conflict of interest or they’re limiting choices), they have two big advantages that can improve public health:

1) Scope: Unlike other public health organizations, the government can reach all doctors and patients

2) Credibility: The government seal-of-approval gives users confidence that these apps have been vetted by health experts and are provide value

Now, I’m not advocating the government go into the app business - attempts by our government can be mixed at best (see TSA app – functional, but not innovative) and they’re served best by leaving development up to private companies.

But they can play a powerful role by leading people to the most promising solutions. By highlighting the most functional products, these apps may build a user base and encourage their designers to continue innovating. It would also be great to see the government providing small grants or awards to select companies to help fund this expansion.

Ultimately, I think the industry needs to consolidate so smart engineers and health professionals can concentrate efforts on the apps that work. One day, I hope I don’t have as many choices because a smaller number of apps provide the range of services I need and do it best. And I think government can help catalyze this process through similar recommendations.

How Can People Learn About Health Through Pictures?

At my current company, we spend a lot of time analyzing how to communicate with members. Typically, this means sending letters to patients reminding them to stay on their medications or highlighting savings if they switch treatments. Two innovators are taking a different approach to member education by literally illustrating their messages.

The first company, theVisualMD, recently introduced "The 9 Visual Rules of Wellness", a website that uses video and interactive displays to deliver wellness education. Each of the rules has a set of chapters that guide the audience through what healthy behaviors are and how to achieve them. As opposed to dull wellness sites that just tell you what to do, theVisualMD encourages better behavior by developing a narrative around what it takes to stay health and creating an interactive environment akin to walking through a museum (which isn’t all good – the website can feel academic at times). I like this conversational approach and can see user experience improvements making this more appealing in the future.

The second innovator is an MIT economist that wrote a graphic novel eschewing superheroes for healthcare reform. The book breaks down the major provisions of the Affordable Care Act into easy-to-digest pieces and eliminates some of the complexity around this policy. The author’s goal was to provide an honest assessment of the bill and help readers understand what it is and what it isn’t. I haven’t read the book, but I like the concept since learning about policy can feel overwhelming. By breaking it down into this format, people may be more willing to invest the time to understand this bill.

My struggle with these innovations is that they appeal to a narrow audience. theVisualMD requires time and commitment to scroll through the various chapters and, while the website is well constructed, it can feel too much like a textbook and turn people off. The graphic novel, while much more effective in communicating complex policy, runs the risk of oversimplifying the issue and turning people off with the format (i.e., will people take you seriously if you say you learned about the ACA through a comic book?). While both are very niche, I like the project goals – taking steps to simplify and demystify healthcare through a more visual experience. The question is how do we scale these ideas up to appeal to a wider audience?

What Challenges Do New Healthcare Delivery Startups Face?

Last week I was confronted several times by new ideas for healthcare advice and service delivery. First, I read about a service in NYC that gives patients access to healthcare professionals 24/7 and helps them navigate the New York medical system (hence the name Sherpaa). There were also a couple articles on The Health Care Blog - one described a number of online health communities, while another questioned the viability of the doctor-patient forum HealthTap. Finally, I heard a speech from Dr. Andy Sussman, President of MinuteClinic, who described the strategy and expansion plans for CVS’ onsite clinics.

I’m encouraged by these developments. The shortage of primary care physicians over the next decade is well documented and it’s great to see solutions helping fill that void. While they may not replace the existing medical establishment, they can serve as a safety valve for our growing healthcare demand.

I’m intrigued by how people will respond to these tools and if they’ll be widely adopted. Right now, I think these companies face two obstacles before these services reach their tipping point: trust and scale.

First, these new tools need to make patients feel like they’re getting quality advice and treatment, then deliver on that promise. Unlike other online forums or retailers, healthcare services require a much higher level of trust from a consumer before they’re willing to try something new. Even if a company gets that trust, one wrong move and they lose all credibility (e.g., imagine the backlash if HealthTap gave advice that kills a member). However, once that trust is established, that patient will likely be very loyal.

Second, I think these tools need much greater scale to be effective. While the internet enables folks to create niche communities, I think patients would benefit more from the resources and reach of larger, brand name enterprises. For example, I think of all the smaller social networks vs. Facebook – while the startups provide great new features, none of them can match the user experience and development opportunities that Facebook provides. The market is so fragmented right now that most solutions, no matter how great they are, will never get significant traction and may ultimately leave the people they serve behind.

Don’t get me wrong – I’m really hopeful that these solutions can address our growing medical needs. What will separate the successes and failures are their ability to confront these two challenges.

Can Groupon Replace Health Insurance?

A recent article by BenefitsPro highlighted the growing trend of uninsured using daily deal sites for healthcare. You don’t need an article to know that this is on the rise – my inbox is regularly flooded with dental offers, skin care regiments, and other health services. In fact, the article says nearly 10% of daily deals last November were health or medical related.

There are certainly benefits to these deals. Consumers, especially those without insurance, have access to common healthcare procedures at a lower cost. As with any daily deal, businesses also benefit by using this as a platform to find and retain new customers.

Unfortunately, I see plenty of disadvantages that could hurt the customer in the long run. First, while customers clearly benefit from lower cost preventative services, many of the deals are for more expensive treatments or cosmetic procedures (e.g., laser eye surgery). These may require the customer to have screenings and a full understanding of the treatment. But with a ticking clock urging them to buy before the deal expires, some customers may make impulse decisions. Best case, they’re out several hundred dollars. Worst case, they put their health at serious risk.

Second, a doctor or center that agrees to discount services may not have a high degree of quality or experience. Clearly customers need to have the right expectations for what they’re getting, but there’s also a moral question of whether deal sites have the responsibility ensure their products meet certain standards.

Third, one benefit of insurance is that the provider can use data from doctors to track a patient’s health and proactively screen for any issues. When a consumer relies on Groupon, they are bypassing this system by running from doctor to doctor. Obviously this is tricky as is with the uninsured, but could be more so with these price sensitive customers.

That said, I think the daily deal model could work under the right circumstances. I could see something like this being valuable for the individual exchanges that will be created through the Affordable Care Act. Customers going through these exchanges will already be cost conscious, and, if the individual mandate stands, they will be forced to purchase insurance. A provider could partner with a daily deal site and promote offers targeted to its members that go above and beyond their coverage, providing more value to the customer. This type of arrangement could provide the oversight and quality assurance missing from daily deals today while not eliminating any of the benefits.

How Can Sex Games Lead To Safer Sex?

A recent ad campaign in Sweden managed to shatter a stigma by tapping into the male competitive spirit. To promote safe sex, an ad agency handed out 50k condoms, each with a QR code that installed an app to measure how good you are in bed. After instructing the user to put on the condom, the app measured various factors (e.g., sound, duration, rhythm), then uploaded the data to a central server. Users could then see their own performance and compare with others across the country.

You can call this crude or tacky (especially if you were an unwilling partner), but I think it’s brilliant. This ad agency was able to reach a captive audience by helping users to quantify something every guy wants to brag about, then giving them a semi-voyeuristic view into where they stack. Enabled by technology to collect and share this information, this campaign allowed the agency to attach a relevant message regarding safe sex and address a social issue.

Are there other groups of people or conditions that could benefit from a similar program? Could diabetics monitor how stable their glucose levels are then compare with other users? How about tracking Facebook or general computer usage to highlight behavior traits (e.g., user spends 30 mins per day updating statuses, 45 mins per day viewing friend profiles) and discourage people from spending so much time in front of the monitor?

How Can Fantasy Football Create Healthier Lifestyles?

A friend recently told me about a Biggest Loser-type challenge that he started with his family. They were inspired by his father, who recently had heart issues, and saw this as a way to collectively support his new health routine. Although it was spawned by an unfavorable situation, this is a great example of how group challenges can be used to change behavior:

1) Rallying Cause: Experiencing a powerful event or situation can provide the catalyst to start and maintain a healthier routine. In addition to triggering the new behavior, this story can help publicize the cause and reinforce the goal, similar to people who shave their head in solidarity with a cancer-stricken family member. Unfortunately, the majority of these triggers are negative events – are there positive motivators that can create the same sense of urgency?

2) Competition: Adding competitive elements keeps people motivated to stay on course and outperform. As much as I hate recent gamefacation trends, these social motivators can be valuable as long as the goals remain realistic and no one person gets too far ahead or behind to be a disincentive

3) Measurement: Like the Biggest Loser, my friend’s challenge is measured using weight loss. Having an easily quantifiable goal gives each of the participants a simple way to gauge their progress

The bigger question is how to scale these types of challenges up. The most successful model could be to align people with similar goals into small group challenges. A fantasy football model could work – a person can join a private or public challenge that is moderated by an individual, who puts various rules and tracking metrics in place. Tracking could be done by the individual or integrated with other existing apps (e.g., Nike+, Runkeeper) based on the challenge, and could include a reward system (e.g., Nexercise app). The best example of this model currently in development is Keas, a social health and wellness network, which is a little broader and primarily aligned with employers and employees.

Can the Healthcare Industry Improve New Year’s Resolutions?

The New Year brings an opportunity to reflect on the past 12 months and set goals for self-improvement. Most of us will dust off old resolutions given that most end in failure (almost 90% according to one study). Considering half of people will make a health resolution this year, there is a huge opportunity for healthcare companies to engage an unusually captive audience to keep them on the right path. I believe they can get involved in three ways:

1) Goal Setting: Using industry research or proprietary data, healthcare companies may be able to identify improvement areas, provide specific guidelines to set realistic targets, and clearly illustrate how achieving the goal will improve the consumer's life. For example, a health insurance company may use data to identify specific risk factors and potential behavior changes for a member (e.g., Patient X needs to lose weight based on BMI). Based on their research and Patient X’s profile, they can calculate the optimal amount of weight Patient X should lose over a year. Finally, by demonstrating the insurance premium savings and added life expectancy, Patient X may feel motivated to set these goals

2) Program Development: Users need to develop a realistic action plan and healthcare companies can help users create a timeline and provide advice. For example, after Patient X decides to lose weight, milestones can be set throughout the year (e.g., how much weight should be lost each month) and the company can provide advice on steps to take each month. While Patient X’s insurance company may not provide the services it recommends (e.g., gym memberships, health food providers), the company could partner and offer discounts with other suppliers

3) Program Tracking: Users also need an easy, unobtrusive way to track their progress. This tracking could be through a smart phone app or website, but would ideally be linked to the custom timeline and provide reminders / motivation to the user

The challenge with these solutions is that they require significant infrastructure and data, and ROI could be difficult to calculate. If this is appealing, however, a company could start with program tracking – there are some apps and websites dedicated to monitoring progress (e.g., Big Change). By partnering with one of these developers, a company could start helping customers achieve their existing goals and gradually roll out other features over time.

Do We Need More Dedicated Health Devices?

A lot has been made of product convergence with smartphones becoming more powerful and ubiquitous. Cramming more features into a single device allows the user to do more without sacrificing comfort or accessibility. However, it's a very passive experience and, for all the badges and alerts a program may provide, the user still needs to be motivated to visit the app or access the features. This becomes even more difficult as more information gets packed on these devices.

That's why the Jawbone Up catches my attention. Despite the bad reviews, we may be reaching a tipping point where people revisit the value of dedicated devices. Up could be successful because, by decoupling the device from the phone (since smartphones arguably have the same features), it's a constant reminder that you're being monitored, and may motivate someone to make better health decisions (e.g., walk more, sleep at the appropriate times). Similar to a Prius, Jawbone may also be banking on the social signal component - wearing this demonstrates how much you care about your health.

With that being said, there are some adoption challenges. Right now, this will only appeal to the health conscious who arguably benefit less. However, if the type of technology becomes cheap enough, I could also see widespread use by insurance companies to motivate and monitor, similar to the Progressive Insurance Snapshot program. There are clearly privacy and social issues, so we'll have to see how successful their program is.

However, the idea of dedicated devices has always interested me. For example, instead of being cluttered with other smartphone apps, could insurance companies distribute a flexible e-ink card that explains benefits and provides tips for healthy behavior?

How Can New LivingSocial Service Be Applied to Healthcare?

LivingSocial is testing two new services that would bring more of the restaurant experience to your doorstep. One of these services, LivingSocial Room Service, features food from higher end restaurants and complements them with top-notch service and amenities. It's an interesting way to differentiate from other delivery sites (e.g., GrubHub, Seamless), while tapping into their deep user base that, presumably, includes some affluent diners or users who want a four-star experience at a two-star price.

There are several principles that could be applied to healthcare:

1) There is a market for urgent care / retail clinics and a market for long-term home care, but how about on-call home clinics? Can you create a network of nurse practitioners that could be deployed via app / phone? Barring any legal challenges, can a volunteer corp be used for a similar purpose? How can this be monetized?

2) Can the discount / group buying model be applied to general practitioners? Obviously group buying has been applied to the drug industry and there are economies of scale across medical groups, but can a company create its own network to reduce costs for urgent care services?

3) There are several segments that LivingSocial is targeting here - presently affluent, future affluent (which will grow as the recession eases), and aspirational diners. The first group is already accounted for in healthcare - I think of older patients that have access to various services through their existing plans. The other two groups would be our targets, but given their profiles, could require more targeted services (e.g., preventative care education)