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Could Rewards Have Transformed Microsoft Healthvault To Greater Success? And Can We Learn Something We Can Apply to Wearables?

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Could Rewards Have Vaulted Microsoft HealthVault To Greater Success? And Can We Learn Something We Can Apply to Wearables?

I was recently conducting an interview with Gregg Masters and Dr. Phil Marshall from Health Tech Media about rewards for healthy behavior and made an off the cuff comment “Microsoft HealthVault should have worked but for some reason did not catch on with consumers. Perhaps rewards could have been the solution.” Peter Neupert of Microsoft and I actually had a brief conversation about the topic a few years ago. It got me thinking, would Microsoft HealthVault have caught on if consumers were rewarded for using it?

Microsoft HealthVault made complete sense. A single place where consumers could store all of their health information. After all, this is exactly what we do with online banking and travel applications where we store travel information.  Instead of our medical history being a random series of paper forms at different physician offices or the thought of a physician office administrator opening a file cabinet to pull paper files of our visits, we would simply have HealthVault.  Physician visits, hospitalizations, medication history, biometric data, x-rays, test results, surgeries, allergies and much more all in one place.  Maybe even for our entire family. Go to HealthVault, create an account, and one-stop storing would come to life.  We all understand the complexity of reimbursement and cooperation with insurance companies, but this just seemed to make sense for the consumer.

Launched in October 2007, Microsoft was described as a web-based platform to store and maintain health and fitness information. Here are some comments about HealthVault by Microsoft’s Peter Neupert on October 4, 2007:

On what consumers want. “They want an information system that puts them at the center, that makes it easy for them to manage their health, and their family, and their activities when they interact with the health system.”

On what HealthVault is. “HealthVault is three things. It’s a search experience, a new, private search experience designed to help the user navigate the rich and complete information that exists out there on the Web to help them find the info and the services that are relevant to them. Next, it’s a private, and secure shared data repository and online service for the family manager to collect, store, gather and share their health information. Last, it’s the HealthVault Connection Center. It’s a client application which enables a new set of personal home health devices to make a whole new important class of information, user generated information, information collected in the home and their activities in a plug and play simple way for them to collect, manage and share that information.”

On how it works. “So how do we get started? Well, people can type stuff in, they can fax stuff in, and they can start with a search tool, which enables them to learn more about what they should do. But, the real promise is can we connect all of the providers, all of the hospitals, all of the pharmacies, all of the imaging labs, so that it’s easy like today banking is easy. Ten years ago, in 1995-1996, when the Internet was starting it wasn’t easy to get your banking information. Today it is. Similarly, today we’re that much further ahead, and we can connect all of these providers. It is possible to make it easy for people to take their data from the source data providers, and put it in a simple area where they can manage it.”

Powerful value proposition.  We can certainly argue that HealthVault was an important step in creating a connected world of health information for the consumer.  But why was it not the breakout solution that many thought it would be, with millions of Americans taking advantage of a seemingly powerful value proposition.  Especially in light of the fact that we had just experienced Hurricane Katrina in 2005 in which most of the 1 million people displaced by the storm were left with no medical records — making it difficult, if not impossible, for doctors working to treat them.

So why was this not the rousing success that we might have predicted? Could rewards have made a difference? First, why did HealthVault not catch on with consumers?

  • It didn’t solve any pressing problems for consumers. Did it help them better manage their health and/or the health of a loved one? Did it help them make appointments? Did it save them money on their health insurance bill or their next doctor visit? Did it help them automatically get a prescription refill?  People don’t really want a place to store data, per se. They want to do something fun and engaging. If it’s not fun, if it’s not social, why would they do it? Yes, they want to be healthy, but they need more than that.
  • Security and privacy issues scared off users. Health information is too personal, too private and too valuable to be entrusted to any private corporation. Same old argument of the “evil corporation” that should not be trusted with personal data, especially health data. Proponents of this reason believe consumers are not willing to trust corporations like Microsoft with their personal health data.
  • It did not involve doctors. Dave Chase, founder of Microsoft’s health business and former CEO  of Avado (acquired by WebMD) wrote for TechCrunch: “As much as there’s a massive consumer-empowerment movement, in order to get ongoing and broad adoption of something in healthcare, one needs to lead with the clinicians. While consumers don’t trust social media companies or their health insurance company, they trust their doctor.  When consumers were asked whom they turn to for health advice, while only 13 percent said their employer and 18 percent said their health insurance company, but 72 percent said their physician.
  • PHRs had not caught on. A Wall Street Journal article in 2007 noted that PHRs, while a good idea in theory, had not caught on with the general public. Only 6 percent of consumers had used a Web-based program, or even PC-based software, to track health information, according to a Forrester Research survey. “Consumers are just not that excited about these services,” Elizabeth Boehm, an analyst at Forrester, told the Journal at the time.
  • It was too cumbersome to use:  The process for bringing data into HealthVault wasn’t simple. The patient doesn’t always get reliable information transferred to them. Also, many people simply don’t have the time or take the time needed to update the details of their healthcare. Third, the information complexity can become too unwieldy and complicated for most people to maintain on their own without professional input.

Perhaps Microsoft HealthVault was before its time. The question is could rewards have gotten it over the hump? Can we learn something that we can apply to healthcare and specifically to wearables to avoid the same fate? Recent data from consumers indicates perhaps we can. Consider these data points:

  • In a survey of 1,100 of social engagement platform users, 96% said they would change their health behavior if they were rewarded.
  • 75% would have their blood pressure checked (Health and Human Service Survey, 2013)
  • 73% of consumers would lose weight (Harris Interactive Survey, 2013)
  • 68% would have blood sugar or cholesterol checks (Harris Interactive Survey, 2013)
  • 51% would have their lifestyle choices scrutinized (Harris Interactive Survey, 2013)
  • 51% would use a regimen to lose weight or control diabetes (Harris Interactive Survey, 2013)
  • 38% would follow a diet to lower blood pressure or cholesterol (Harris Interactive Survey, 2013)
  • In a recent survey by Accenture, 65 % of consumers said the most important thing that a pharmaceutical company can provide to consumers is rewards.

Perhaps most interestingly, 49% percent said that they would not only undergo genetic test but would allow those results to be shared with their health plan for a reward.  Imagine that. We have come a long way from not trusting Microsoft with your health information to allowing a heath plan to have your personal genetic information in exchange for a reward.  Here’s the article about the survey:

It is also not uncommon for 50 percent of consumers to complete health risk assessments (which contain significant personal data) for their employer or health plan for a $50 reward or to undertake biometric testing and look to improve outcomes for a few hundred dollars.

Could we have designed a reward structure for Microsoft that looked something like:

  • $50 for creating an Microsoft HealthVault Account
  • $100 for uploading your basic health data and information
  • $50 for connecting your physician

While this is certainly Monday morning quarterbacking, it is another example in healthcare that “build it and they will come” rarely works. We have to realize that whether it is lack of information, complexity, lack of time, difficulty understanding, or the fact that consumers don’t trust health companies (only 7 percent of consumers trust their health plan, 6 percent trust social media companies, and 10 percent trust pharmaceutical companies), there are significant barriers to overcome.  In addition, we can never forget that 53 percent of consumers describe themselves as living “paycheck to paycheck.” So when we think of seemingly clear value propositions like HealthVault, we are swimming upstream.

Are we looking at the same challenge with health devices and wearables? There’s no arguing that the connected health movement has reached a tipping point – 52% of consumers are interested in buying wearable health trackers, according to the 2014 Accenture Digital Consumer Tech Survey. Unfortunately, Endeavour Partners’ research reveals that more than half of U.S. consumers who have owned a modern activity tracker no longer use it. A third of U.S. consumers who have owned one stopped using the device within six months of receiving it. Others say that 80% of health apps are abandoned within two weeks.  Here is another article that outlined the challenge of driving sustained usage of wearables:

The industry must find a way to truly engage users and create sustained healthy behaviors. It is not enough for consumers to simply wear these devices as accessories and log the results in a silo.  Rewards have the opportunity to learn from the past, as I outline in a recent publication.

From another perspective, a recent study of The Eatery’s 200,000 downloaders shows only 3 percent used it often enough to be considered active users, and of those, only about 10 percent showed an improvement in the health rating of their meals, according to a new study in JMIR. According to the JMIR study, 69 percent of people who downloaded the app didn’t take a single picture of food. Another 17 percent took only one picture. Of the remaining users, 11 percent were classified as semi-active: they took between 2 and 10 pictures and used the app for less than a week. Only 2.58 percent of users, or about 5,000 people, took 10 or more pictures and used the app for more than a week.  Here is the article:

Remember, consumers understand rewards from their non-health life. The average consumer is enrolled in seven different loyalty programs.   Imagine having a Fitbit, Jawbone, or a home monitoring device that monitors your diabetes compliance or other wearable or portable device or pilljogger monitoring medication adherence or Itriage steering you toward the lower cost and higher quality providers and being rewarded for usage and the right behaviors. Align rewards with the right behaviors that produce immediate, intermediate and long-term results and we may be onto something.

Microsoft Heathvault was a great learning experience.  At the time of its launch and the launch of Google Health, many felt if was just a matter of who would win with consumers – that one or more of these or similar solutions would be the beginning of integrated consumer health information. It feels the same way right now with wearables. Consumers are purchasing and using them more and more each day.  It feels like their consistent use should just catch on.  But let’s not forget that healthcare is a different animal and that getting behavior change in consumers – short or long term – is not easy. Think about it – almost 20 percent of pregnant women in the state of Florida in 2009 didn’t follow their pre-natal care.  Pregnant women!!!!

When we introduce wearables and other tools, let’s think about reward structures that make sense.  What activities, reward values and reward types align to the economics of the behaviors we can drive?  This is not always easy, but rest assured that if we ask people to change their behavior without rewards in the wearables market, we might just be reminded of Microsoft HealthVault.

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