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.

Can Independent Health Advisors Help Consumers Make Better Decisions?

I attended a presentation this past week discussing health plan reactions to reform. One of my key takeaways was how new consumer attitudes and beliefs were driving change in the industry. A man-on-the-street video highlighted, among other topics, the diverse views around selecting health insurance and the trade-off between quality and price. While there was no consensus around what plans should specifically do, it was clear that consumers yearn for more empowerment as they make decisions about their health.

One of the new solutions described was deploying insurance-backed advisors to help patients choose the right coverage, especially in exchange markets. I think this is a good idea – having a representative walk consumers through the wide range of products can help match a person’s needs to the right product.

However, I’m not sure this model will work for all consumers, especially younger patients. The Internet has created savvy consumers, and any whiff of bias could turn these people off. I like the concept, but I think it could be taken a step further by creating health advisors independent of the industry.

I see this working like financial advisors today (or even rolled into existing financial services). These people would answer basic health questions and help improve health care literacy, whether it’s selecting the right insurance, settling a hospital bill, or understanding preventative medicine. While this could range in engagement (from an annual “checkup” to a 24/7 concierge service), the main focus would be to make healthcare understandable, especially the financial side that is rarely discussed.

The challenge is the business model. A fee-for-service model seems most logical, but could put this out of reach for many Americans. Any sort of rebates or kickback from insurers defeats the purpose and savings calculations, whether it’s vs. their previous plans or vs. expected medical costs, seem complex. Regardless of how this makes money, I think this hands-on service is the right way to customize healthcare to the individual and provide the empowerment consumers are looking for.

What Does The Weather Teach Us About Improving Health?

It was a beautiful day in Chicago and running outside this afternoon reminded me how much weather can impact health. As I observed people walking around, it struck me that this phenomenon is probably motivated by a few things:

- After being cooped up indoors all winter, people are anxious to get outside and change their routine

- Nicer weather leads to shorts and t-shirts, meaning people need to look better as they start to shed the bulky coats

- Sun provides vitamins that folks have been deprived of during the cold winter

Obviously the combination of these factors creates a perfect storm to motivate people to run or bike outside, but there may be lessons health companies can take from this. For example, gyms could have special events that change up routines, encourage people to try a new type of exercise, and even tap into that summer anticipation to reinvigorate folks. Similarly, health insurers could host exercise or social events to get people moving during the winter by encouraging them to prepare for the event by taking steps to look good around others. Finally, providing support for Seasonal Affective Disorder (e.g., having sun light therapy at gyms) could be a differentiator and contribute to improved mental health.

Do Consumers Lose Out If Healthcare Companies Don’t Speak Plain English?

A recent article in BenefitsPro discusses how the current administration may reverse course on a popular provision in the Affordable Care Act. The requirement forces healthplans to simplify plan language and give examples of coverage options by this fall. I imagine this will resemble credit card offers that have a table highlighting key components (e.g., APR) and put everything into plain English.

However, insurance companies are pushing back, saying that this would be expensive – a trade group puts the cost at $382 million over the first two years. The author contends the White House may buckle under this pressure, hoping to appear business friendly heading into the November elections.

Overall, I disagree with the insurance trade group assessment. There will definitely be an upfront cost, but they don’t talk about the potential benefits from this transparency. For example, this education may allow the customer to choose a more efficient plan that puts limits on coverage or helps them understand those limits better, both of which help healthcare dollars be spent more efficiently and lower costs.

While I think transparency benefits the system by helping consumers make better decisions, my faith was shaken by a Freakonomics podcast that discussed financial literacy education. One of the guests argued against this (there’s a great debate in the middle of the podcast), saying that a little education…

1) …can give consumers overconfidence that leads to more reckless behavior – a healthcare analogy is a patient who visits a doctor armed with online research that complicates the diagnosis and treatment options

2) …shows no evidence of positive behavior change. She says that studies show people like learning about finance, but didn’t necessarily change their habits

3) …isn’t sufficient to address the complex financial products available - healthcare insurance definitely has a similar complexity

This isn’t a perfect comparison and educating people on their plan options, not how to use the plan, are two different processes. Nevertheless, while I support greater transparency and providing greater consumer choice, the outcome of this regulation, if it survives, could be a little more uncertain.

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.

Should Patients Be Rewarded For Visiting A Hospital?

In my past life as a consultant, I was a slave to reward points. I would make every effort to fly a certain airline or stay at a particular hotel, even if it was completely illogical.

This is why my ears perked up when NPR highlighted efforts by hospitals to reward frequent customers. The article describes how these hospitals provide valued customers with perks ranging from free parking to gift shop discounts to exclusive classes on healthy living.

Their efforts seem well meaning. In an environment where hospitals are fighting to fill beds, it makes sense to build loyalty and relationships with people who they frequently see. The “rewards” themselves also sound worthwhile – educational programs and social events can be positive reinforcements for this at-risk population.

Despite these benefits, something doesn’t sit right with me. It is one thing to reward people for choosing to use a certain product or fly a particular airline, but it’s another to reward them for something they have limited control over. Patients want to avoid the hospital as much as possible, but these programs send mixed signals, i.e., we’ll teach you how to avoid hospitals, but when you need one, come to us (almost like the ‘Most Interesting Man in the World’ commercials – “I don’t drink beer, but when I do…”).

On top of that, I’m not sure how much choice a patient has in where they can be treated – the patient may be limited by either geography or insurance. Maybe this is a differentiator that can be applied to highly competitive geographies, but I see limited real-world application for this type of program.