Predictions are something I make often in my line of work. As someone who has been making healthcare predictions for more than 2 decades – and keeping score of how often they come true – I admit it is a humbling pursuit. Some predictions end up being flat out wrong. Others turn out to be right, sometimes with a significant twist. For example, although many of us predicted in the mid 90s that video communication with patients would someday become ubiquitous, I daresay missed the power of the smart phone as a game changing device. I just re-watched the early 80s film Blade Runner (the action takes place in 2019) and chuckled at the scene where Harrison Ford’s character does a video conference with another character, but through a device that looks suspiciously like a pay phone!
When a prediction comes true, it is worth writing about. For several years now we’ve talked about the power of wearables to generate feedback loops. In some cases, those feedback loops can induce behavior change (the individual must be self-motivated and will use the feedback loop to measure progress). Often, some other motivational force must be applied to induce behavior change. For instance, many people will set up competitions with a friend or loved one. In any event, the sine qua non for a wearable is the feedback loop.
Another important principle is that shared data provides a window into the tracked individual’s habits and lifestyle, particularly about their technological engagement level and their ability to achieve personalized tracking goals. Humans apply filters and biases when they estimate about themselves. I’m no different. When my doctor asks me each year how much I exercise, I always reply, “Twice a week.” What I neglect to add is “…on a good week.” I’m not trying to deceive him, but that’s just how the answer always comes out. Now imagine how different that conversation would be if the dialogue were about total active minutes and he had access to my Fitbit data.
This realization sparks debate about both privacy and consternation about being held accountable for targets – and punishment for missing them. “Will my employer fire me for not walking enough?” “Will my insurer charge me more?” “This all sounds very creepy.” These are some oft repeated refrains.
A few years ago, I suggested people would be given wearables by their insurers and there would be some contract with the insurer around the monetary value of achieving certain health targets. At that time, Progressive Auto was already doing this in the auto insurance industry. I thought, “Why not?” This vision is even vividly laid out in the first chapter of The Internet of Healthy Things, where Sam the virtual assistant guides me toward better health in exchange for lower health insurance premiums.
The debate has become one about carrots versus sticks. Will we ever reach the time when an individual who ignores healthy lifestyle cues as measured by one or more of these devices is penalized in terms of covering his or her healthcare costs? I’m not sure. But what I am sure about is the world of rewards is here. Here are two exciting examples of this phenomenon – one from the health plan world and one from the retail pharmacy world. (There is a third from a company called Vitality whose services are embedded in Humana’s portfolio. I don’t know as much about them so I am not reporting on their work here.)
In 2014, Walgreens introduced a program called Balance Rewards for Healthy Choices. Members earn points, redeemable for store purchases, by making healthy choices like tracking exercise, body weight, blood pressure and glucose, connecting health devices and apps, quitting tobacco, and setting and achieving goals for behavioral health risks modification and chronic conditions management. If you own a tracker relevant to any of these goals, you can connect that device to your Walgreens app and accrue points for improved health. In 2016, at the Academy of Managed Care Pharmacy annual meeting, data on the program from nearly 7,000 participants showed participating individuals significantly improved adherence to anti-hypertensives, anti-diabetic meds, and cholesterol medications. Pretty impressive achievement with no directed involvement from the patient’s doctors!
United Health Group recently launched a program called Motion. They released their own proprietary wearable and challenged enrollees to meet three types of daily activity goals (as measured by the tracker). They are: frequency (300 steps in 5 minutes at least 6 times/day), intensity (one 30-minute walk of 3,000 steps/day), and tenacity (10,000 steps per day). Enrollees who meet these goals receive up to $4/day deposited into their health savings account. As with any health insurer model, this is done in collaboration with the enrollee’s employer. Employers can achieve a goal of a 6% premium cap if they achieve 60% compliance across all three goals among their employees. (Which reminds me of another prediction. In 2008 I visited a number of Boston-based large employers pitching the idea of using wearables to track various fitness parameters. Although there was a mix of enthusiasm and skepticism, one of the skeptics said, “If this is so great, why doesn’t my health insurer offer it to me?” Eight years hence, we are there!) Although the program is new enough that they don’t have outcomes just yet, some of the plan sponsors are quoting engagement rates of 85%.
The lessons here are not about who makes the most accurate predictions or whether or not they ever end up coming true. For me, three insights stand out.
- Wearables offer the opportunity to quantify important health-related information and mobile connectivity makes it easy to share that information. First we shared with ourselves, then with friends and loved ones. The next phase seems to be sharing with commercial entities in exchange for some value (not unlike when a retail outlet exchanges a coupon for your feedback on a new product). Many would like to share with their doctor, but doctors are befuddled right now, worried about liability and data overload. Let’s work together to build that future.
- With heightened fear and loathing surrounding things like data breaches and identity theft, people will share personal information when they see value in exchange. Most of us have been sharing intimate details for years with Google, because we get so much “for free” in return. Health information is different, yes, but perhaps the old adage, “Everyone has their price,” directly applies here.
- The world of connected health offers great opportunity for new ways of providing healthcare. Would you have predicted that a retail pharmacy chain would be competing with a health plan to encourage you to increase your activity level? That is a prediction I did not make! And we will nonetheless only continue making new healthcare predictions together in the years to come.