Simply put, being sedentary is dangerous. An American Cancer Society study found that women who sat 6 hours or more and were otherwise physically inactive were 94% more likely to die during the 14-year study period than those we were physically active and sat for less than three hours per day.

Many of us believe that we can overcome the inertia of a sedentary day through daily bouts of exercise; indeed, this is in line with government guidance to exercise 30 minutes per day at least five times per week. Unfortunately only an estimated 17% of the population complies with these recommendations. Worse still, even these people may not be getting the benefits they expect.

Researchers have found that even among physically active individuals there is a strong association between extended periods of sitting and a reduction in life expectancy. The study concluded that extended sitting correlates with an increased incidence of cardiovascular disease.

Cardiovascular disease is the leading cause of death in the United States. Currently 1 in 3 Americans have some form of cardiovascular disease that will be life limiting. The cost of cardiovascular disease in terms of medical expenditures and lost productivity is projected to exceed $1 trillion dollars by 2030.

This enormous cost will serve as a yoke around the neck of our nation and our nation’s businesses. Worse still, the human cost of 116 million Americans suffering, including lives lost and impact on families, is impossible to calculate.

The good news is that we can extend our lives with “a single step” (multiple steps are even better). We simply need to avoid extended bouts of sitting. Even very brief bouts of activity such as walking short distances or transitioning from sitting to standing can have a positive impact on body composition and triglyceride (fat) levels in our blood.

At Healthrageous, one of our goals is to empower individuals to identify and make the small everyday changes necessary to reap great rewards in health and wellbeing. We approach this goal via education, feedback loops, and gaming mechanics. First, it is crucial to understand that some movement is better than none. Whether it be a walk to the water cooler, visiting a co-worker instead of sending an email, or taking the stairs instead of the elevator; such small changes have an impact greater than the number of calories burned. They signal to the body that you are on the move and it is time to wake up and start burning some fat.

Next, we give our participants a clear picture of their activity levels throughout their day. We present a tight feedback look that visually depicts hourly activity linked – with expert advice from our automated coach. This helps Healthrageous participants to understand their behavior and recognize opportunities to make small but meaningful changes.

Lastly, at Healthrageous we believe it always helps to make things fun. We have developed (and are continuing to expand) a whole series of game dynamics targeted toward developing healthy habits. Participants can join team or individual competitions, and earn rewards for achieving personal activity goals.

At a time when the economic viability of our businesses and our nation depends on reducing the prevalence of costly chronic diseases, we are proud to be developing science-based solutions that empower people to improve their own lives. By helping people to implement crucial small changes in behavior that produce large results, Healthrageous reduces disease, controls costs, and helps keep our individuals and businesses healthy.

The way Big Data works is elegantly simple; yet execution can be extremely challenging and difficult. Random data are collected in codified bits and bytes and run through large computing systems to generate meaningful information about the end user or target.

At Palantir Technologies, a firm engaged by the Pentagon to keep America safe from terrorists, their mission is described thusly: We live in a world in which data, technologies, humans and environments are linked, at massive scale, often in unseen ways. At Palantir, we build the software that makes these unseen connections visible and intelligible. We engineer so that the world works – with less risk, higher potential and greater good.

Those who are producing the dairy and beef for the insatiable American appetite (The US consumes twice as much beef per person as the next closest country), have typed each cow in the herd in order to personalize nutrient-rich feed bags to optimize beef yield or milk production. Information on each cow is collected, sorted, analyzed and parsed through massive algorithmic-intense databases, with intelligent software performing the challenging, but rewarding analytics.

Opower is a new customer engagement platform for the utility industry. It reinvents the way utilities interact with customers—from the quality of the information provided to the way it’s presented and delivered. It helps people use energy more efficiently and ultimately save money on their energy bills. 
And it vastly improves the overall customer experience by making energy use personally relevant.

Few don’t understand how Netflix’s Big Data play is to observe – through data crunching – each subscriber’s personal tastes in media viewing in order to better appreciate how to service that customer with recommended film options.

Which brings us to Healthrageous; the machine learning delegate of the health care industry. If the previous cited examples can better understand their customer/target (Palantir’s focus on terrorists hardly qualifies as a customer intimacy example), then it stands to reason that Healthrageous can use Big Data and algorithmic computations to discern what is the special sauce that motivates each consumer to pursue a life with glycemic control, or more activity, or managed blood pressure, or fewer calories.

Every person seeking to improve their own health has begun a journey unique from others. Granted, some may want to walk their daughter down the aisle on her wedding day, but the journey to achieve that end may be highly personalized around which flight of stairs to trudge up each morning and what kind of yogurt to snack on in the late afternoon.

Just as energy users, terrorists, cows, and DVD-viewers all have their own unique reasons for doing what they do, so too do Healthrageous participants who have decided to change the way they’ve been living and to experience a new adventure that will lead to a healthier, longer, more satisfying life.

They named the site the Habit Heroes attraction.  By featuring characters like Will Power and Callie Stenics taking on super-sized villains Snacker and Lead Bottom, the exhibit conveys a positive message about healthy lifestyles in a fun and empowering way.  It demonstrates how feeling healthy and trim actually leads to greater self-esteem and more energy.

It was shut down before its official March 5 opening because some parents called it “horrifying, stigmatizing and insensitive.”  What is insensitive are the adults who are subjecting their kids to a lifetime of pain and suffering due to the impact of excessive weight – potentially both physical and mental.

We once were a nation capable of getting a health hazard like tobacco appropriately labeled and drummed out of the lifestyles of ordinary Americans because we knew – in a public health advocacy role – what was best for our population.  Now however, we are unwilling to call foul when a very similar public health epidemic is compromising the health of not only our young people but everyone.  By not courageously addressing obesity we will continue impacting our economy through ever-soaring health care budgets.

Wouldn’t it be great if the Media focused attention on the laudable exercise habits of George W. Bush, Mr. and Mrs. Obama and Mitt Romney?  Instead, the Media highlights this, The National Association to Advance Fat Acceptance said: ‘It appears that Disney now believes that using the tool of shame, favored so much by today’s healthcare corporations, is the best way to communicate with children.”

A measurable goal, backed by the right program

TEP has bet its future on one key ingredient: teacher performance. It’s not about chasing a lofty but soft educational-improvement dream; rather, it’s about focusing on the specific ability of teachers to be captivating performers in the classroom. Teachers at TEP have perks: an annual salary of $125,000 for a full 12-month job. However, the promise of a good salary isn’t what makes teaching positions hard to come by; it’s that chance to work in a special environment that is showing real results that makes these jobs so coveted.

Perhaps you’re wondering what this has to do with Healthrageous and our goal of helping people improve their health? The teachers at TEP engage students, sustaining their attention and stoking their zeal for learning. Teachers are constantly evaluated on their ability to motivate, inspire, and improve their charges. At TEP, there is no one-size-fits-all model. Teachers are challenged to get intensely knowledgeable about each child in the classroom so that they can “dynamically personalize” the learning experience. This approach is quite similar to the Healthrageous model of treating everyone uniquely, with tailored engagement strategies that key off of the insights we’ve learned about those whom we serve.

Beyond education and health

The validity of tailoring engagements to individuals doesn’t just apply to education and health. For sports fans, we see the value of this approach during college basketball’s annual “March Madness” championship tournament. Coaches that are able to simultaneously inspire exceptional individual and team play from a group of young men with disparate backgrounds and life stories will be the ones that take their teams to the Final Four.

Engagement is all around us, and yet it rarely seems to be optimized. The limited results of these efforts are the proof of how inadequate engagement strategies fail to live up to promises. However, by tailoring engagement to the individual, tracking results, and rigorously adjusting actions and support; engagement-based activities can succeed. We see it at TEP, at Healthrageous, and on the college basketball courts.

I invite you to see how our outrageous engagement solution is working in improving people’s health.

Principles for successful incentive programs

There are four key design principles that will increase the effectiveness of incentive programs.

Principle No. 1: Reward behavior change and support continuous achievement

Taking an HRA survey is not in and of itself terribly beneficial to one’s health. Similarly, actions like making a single perfunctory call to a health coach or signing up for a program don’t constitute meaningful engagement. The key to real success is threefold:

1. Reward the behaviors, actions, and results you want individuals to achieve.
2. Address health issues that will generate the greatest return, such as tobacco cessation, blood pressure control, weight loss, and increased physical activity.
3. Spread out incentives so that rewards are delivered for both short- and long-term gains that will lead to permanent change.

Principle No. 2: Ensure objective validation

Measuring compliance or goal achievement represents one of the thornier problems with determining the effectiveness of incentive programs. Individuals are unlikely to remember or be bothered to track day-to-day data, not to forget the potential for inaccuracies associated with self-reported data. Biometric data collected through connected devices is the best way to ensure program valid data. Biometric data plotted over time and delivered to the individual also raises consciousness and self-awareness, leading to more accountable self-management.

Principle No. 3: Complement with intrinsic motivations

Motivating people to improve their health may require more than just extrinsic motivators, such as carrots (incentives) and sticks (penalties). These extrinsic motivators are often very good at increasing compliance and improving performance at simple, straightforward tasks; however, they often don’t work over the long term and may even inhibit performance on activities that require basic cognitive skills, such as creative thinking and digesting conceptual ideas. In his book “Drive,” Daniel Pink argues that many of us are driven by intrinsic motivators, such as:

• Autonomy: We desire to direct our own lives and feel that we are in control. Individual control is supported when a health management program focuses on empowering people to choose and control their activities while supporting personal preferences.
• Mastery: Some people desire to get better at things they love doing. A health management program can provide the initial impetus for someone to revitalize his/her body; ultimately the mastery of a specific activity such as yoga or resistance training will take over.
• Purpose: We yearn to do things in the service of something larger than ourselves. A health management program should tie outcomes to “lofty” goals, such as greater personal satisfaction, increased energy, more satisfying family life, an improved social life, and a greater ability to pursue personal goals and dreams.

Principle No. 4: Secure user input, evaluate, and change course as needed

Individuals gravitate toward different types of incentives. Some covet cash or cash equivalents, and others are motivated by a sense of collective purpose. Since they know their organizational culture best, company executives should start with something that they believe will resonate with individuals, or better yet, ask their employees or members what types of incentives will motivate them. Whatever path chosen, it is essential to evaluate the program and change course as needed.

How Healthrageous incorporates incentive design principles

The design principles outlined above are requirements for effective health management solutions. We built the Healthrageous platform with these principles in mind. For example, we:

• Support continuous achievements in a variety of ways, from helping companies promote the most beneficial health changes to distributing incentives over extended periods of time.
• Enable objective validation by working with a wide-range of biometric devices that automatically report their data to our system.
• Encourage intrinsic motivators by tying behavioral changes and health activities to the unique greater goals that matter to individuals.
• Require user input by having individuals select from a short list of effective paths.

For supporting scientific evidence, please refer to the Healthrageous white paper entitled, “Design Principles for Effective Health Incentives” located here.

What we have tried has not worked; we need a new solution. Current efforts in disease management and wellness have not made a significant, measurable impact on improving population health. We rely on once-per-year health risk appraisals, one-size-fits-all educational strategies, and expensive telephonic coaching. We have collectively achieved dismal engagement rates and only marginal improvement in population health outcomes.

What is needed is a new way to effectively engage individuals in health behavior for the long term – a way that understands and embraces the uniqueness of individuals in terms of their health, behavior, motivations, and needs, and one that delivers proven, effective action plans and support that will engage and enhance an individual in improving health in the short- and long-term.

Healthrageous understands and delivers the new way today. We have a proven way of changing health behavior. The solution is:

• Continuous: Automated quantitative and qualitative monitoring and simplified input
• Personalized: Plans and support are unique at the individual level
• Proven: It is a method with a proven clinical foundation and actual results from a randomized controlled trial
• Always available: Leverages smart phones and other always-on, always-available tools

The core of our solution is dynamic personalization and expert knowledge. Healthrageous is combining the kind of personalization technology used by successful companies like Amazon, Netflix, and Pandora with the best behavioral and consumer marketing science. We call this Dynamic Personalization. It is built upon our:

• Evidence-based understanding of people
• Vast scientific experience and effective treatment plan knowledge
• Technology expertise that allows us to integrate monitoring devices and personal devices, such as smart phones and personal computers
• Philosophy of continuous improvement and testing, meaning that each individual interaction gets better at engaging and supporting health behavior change over time
• Commitment to using sophisticated quantitative analysis, enabled by machine learning

Dynamic personalization is the future; Healthrageous is leading the way. We believe Dynamic Personalization is the solution for how we will finally crack the code on achieving outrageous engagement, measurable health improvement, and cost containment. Check out Healthrageous today! For more on the topic of Dynamic Personalization, please refer to our white paper on our Web site.

From clinical trials and work with our customers, we know that our vision of connected health is effective in improving health and reducing healthcare costs. This is accomplished by simultaneously supporting three components: personal devices that automatically monitor a user; a backend system with incredible expertise in effective treatment plans and wellness programs; and a continuous, personalized, and interactive experience for users.

As you can see from this vision, mHealth devices are critical for realizing the benefits of connected health. What most people don’t understand is that two types of devices are required to deliver and support true behavioral change.

Embracing two types of devices

So what mHealth devices are required for realizing connected health? First, there are the core monitoring devices, such as blood pressure cuffs, glucose monitors, and physical activity tracking gadgets. These devices increasingly incorporate wireless connectivity and leverage communication and data standards, allowing them to deliver personal data anytime and anywhere in a secure and unobtrusive manner.

The second class of device encompasses mobile phones. Some monitoring capability, such as a pedometer or rudimentary physical monitoring (through the use of accelerometers, gyroscopes, and other internal components) will be or have already been integrated. Undoubtedly, more such capabilities will roll out with new models, but the main advantage to smart phones is that they are essentially personal computers with amazing connectivity. Being computers, they can run sophisticated applications (or apps, as they are usually called). Being phones, they can always communicate with other devices as well as specialized systems, such as the software, servers, and expert databases that are at the heart of our solution.

The key to understanding how connected health will become a reality is by understanding the role of the smart phone, both technologically in how it can interact with monitoring devices, and personally in how it is and will be used by people. There is simply no other device that is as powerful, as connected, and as used by consumers as the mobile phone, and the smart phone only increases each of these attributes. In addition, future phones will only embed these devices deeper into the daily activities of more and more users.

The smart phone completes the connected health circuit

Smart phones, such as Apple’s iPhone and the Android-powered phones from various manufacturers, provide a series of critical capabilities that tie the three components of connected health together – in essence completing the circuit. These capabilities include:

• A wide range of communication capabilities to talk to everything, anytime. The basic wireless technology of a smart phone – beyond traditional voice and text messaging – enables it to communicate with external services, such as our solution. On top of that, other communication capabilities, such as Bluetooth and forthcoming NFC (near field communication) or ANT+, allow the phone to connect to monitoring devices, such as the blood pressure cuffs already mentioned.
• A platform for sophisticated applications and easy ways to get at them. With powerful processes, easy-to-access downloadable content, and simple-to-use interfaces, smart phones are hot beds of application development. Mobile solutions, such as our h!GO app, can capture, display, allow a user to interact with, and send and receive information. Rather than relying on a Web browser running on a desktop or notebook that may or may not be available, the smart phone is self-sufficient and always with a user. That means the ability to interact with a connected health solution is always available and always at hand.
• A screen, interfaces, and method of interactivity that makes them easy and fun to use. There were apps on feature phones in the old days, but no one used them or could find them. Now, smart phone apps and app stores are dead simple and everywhere. Whether it’s a $.99 game or a connected health app, finding, installing, and using complex software is now simple for even non-technical users. The result has been an explosion in use of apps, a growing interest in smart phones, and an expanding population of users that expect their personalized information and complex capabilities in their pocket.

The great news is that the smart phone is the last critical component of connected health, and consumers are investing in them in regardless of health issues. Sure, there will be some users that prefer a computer-based Web experience, and others will rely on simple text messaging – and they will see health results, too – but the smart phone makes getting and staying healthier easier. It makes the experience seamless, it makes everything available 24×7, and it delivers the personalized interactivity people have come to expect.

By convincing users with smart phones to use the other two components of connected health – monitoring devices and a powerful health and wellness solution like ours – employers and other health providers can realize true savings while watching the health of the targeted population rise.

And what’s more, as each component of the connected health circuit improves at its own pace – better, more capable monitors; continuously learning analytical and treatment solutions; and more advanced smart phones – the results skyrocket. And that’s good for everyone, whether you are hoping for better health or paying the bill for it.

Simple solutions aren’t working for complex problems

So what is the answer to improving individual health outcomes? It starts with embracing the complexity of the problem. As Simon Levin said in an Ecology for Bankers essay, “We can’t hope to manage or control systems that are 10s of 100s of times more complex than our conception of them.” With this premise accepted, the next step is designing solutions for healthcare organizations and individuals that are based on complex and expert adaptation. Complex adaptation, identified by Murray Gell-Mann (physicist), is resilience under extreme stress; expert adaptation learns from a proven model of how to tackle a serious problem.

To be truly successful, healthcare organizations not only must help individuals (and therefore populations) improve their health, but they must also help consumers learn and become adaptive health consumers.

An evolutionary journey to better health

Complex and expert adaptation in healthcare organizations and health improvement solutions will continue to evolve in the years ahead as we apply new technologies and models to the multitude of industry realities, such as:

• The escalating prevalence of chronic diseases
• Ongoing poor engagement by consumers in improving their health
• Pending shortages of doctors to treat increased levels of illness
• A growing percentage of the U.S. gross domestic product utilized for sick care (resulting in severely limited national economic health)

This is an onerous list, but the problems are not insurmountable. To overcome these obstacles, Healthrageous is integrating multiple pieces of science, technology, and evidence-based models to provide consumers with the expert adaptation tools and experience they need to live healthy lives. While the solution is resilient and complex, today’s technology and our understanding of consumer behavior allows us to shield the complexity from users and deliver effective, personalized support for improving and sustaining health.

It is a journey that some may be reluctant to embark upon, but we know it is one that healthcare providers and consumers will embrace as soon as they experience the benefits.

In a previous post, our CEO talked about why disease management (DM) wasn’t living up to its hype. Sure, it’s easy to critique what’s not meeting expectations, but what about delivering something better? We think we have done just that. Here are a few points to help you understand what we’re doing and why we believe we’ll succeed in our twin goals of improving health and lowering healthcare costs.

• Disease management, evolved. Many of us at Healthrageous have designed and delivered DM solutions or tried to make them work. We learned what was successful and what needed improvement. At Healthrageous, we kept what was working and added what was missing. You could call it DM 2.0, but we thought it deserved a new name, which we call personalized connected health. Sure it’s another buzzword, but it’s one that reflects where the industry needs to go.
• Addressing chronic diseases and wellness. Usually, a wellness program tries to help the self-starters improve their health and lifestyle while a chronic disease program tries to help people manage difficult, lifelong conditions like diabetes or hypertension. Our users can start from either point, but they’ll find that we deal with both. People can get on board to address one particular issue, but they’ll soon see that we can help them with many other health and wellness related challenges because they’re all inter-related.
• Continuous and real-time input and feedback. Most programs take one-time data or occasional inputs to create a user profile and then deliver advice for that static profile. The lack of updated information and delay in delivery of relevant advice limits what can be accomplished. We’ve designed a system that thrives on continuous real-time input of health information – from a variety of personal devices and subjective feedback – and continually tweaks and offers the best possible advice and experience for each individual. Nothing is stale. It’s real-time health for a real-time consumer.
• A dynamic personalized experience that grows in capability. With an expanding base of users, we know about the individual as well as the masses. Our platform will recognize patterns, understand individual preferences, and make predictions to serve up an experience that has led to success for people with similar profiles. The more an individual participates, the smarter the platform gets.
• A technology base that reflects the real, heterogeneous world. Being device agnostic, we can plug in most any device that employers or individuals want to use. On the other end, we deliver our programs according to what works for each individual – via web, smartphone, email, text, or all of the above. Users define the experience and can move seamlessly between interfaces.

So what does all this really mean? Imagine Healthrageous as an automated personal advisor and coach who never sleeps, who listens to you, who keeps your information private, and who knows what you need, when you need it, and how you need it. But don’t think that we’re all about computers and automation. We plug in real people, allowing individuals to create their own social networks including friends, groups, teams and broader communities. Together, the smarts of the dynamic platform; the real-time biometric data; the automated, personalized coaching; and the support of user-defined social networks deliver an experience that is capable of overcoming the obstacles to improving health.

It may sound like science fiction, but we have it today, and it will only get better with time. We’re confident. We didn’t pick a name like A Little Bit Better Health Services. We chose Healthrageous because we think the experience that we provide is how everyone will come to expect health in the future. Bold? Sure. Cocky? We don’t think so, as we built our system on clinical trials and years of experience. What we are is confident. Give us a call and we’ll let you see just what we are doing.

Not keeping up with the Joneses

Much happened in the intervening 15 years since DM burst upon the scene. The doctor/patient 1:1 paradigm that was common then shifted to today’s nurse call center model where one individual reaches out and connects with many. We also learned two important lessons from our work: 1) engagement has to be baked into the services in order to succeed; and 2) whether the messenger is a doctor or a nurse, the message has to be appealing to the target in order to achieve the desired results.

Obviously, something had to change.

Re-calibrating DM around wellness isn’t the answer

Many of the DM players that seeded the market years ago were the first to move away from targeting the diseased to going after “healthier” individuals. Wellness became DM’s central offering. While this shift allowed DM players to readjust the baseline, it further obfuscated ROI calculations. The shift also couldn’t prop up DM’s inherent systemic flaws. These include:

• One size doesn’t fit all – the non-personalized approach doesn’t work
• Doctor-, patient-, and coach–centric solutions focus on the wrong individual – the focus needs to be on the consumer … you and me
• Health solutions won’t win by default – people are initiating their own searches for health without third-party payers being the catalyst
• Traditional communication and interaction isn’t very effective–some people don’t talk on phones or open their snail mail
• Generic profiles of consumers and their needs aren’t enough – Madison Avenue knows more about people than doctors, nurses, or psychologists
• Many healthcare companies aren’t cutting edge anymore – one of the emerging healthcare companies in America today is Nike

Learning from DM, trying to do better

There are now 140 million Americans with one or more chronic diseases, so the need for a DM substitute persists. Something must meet the demand in terms of providing quality service, keeping costs reasonable, and helping people become healthier. Healthrageous is attempting to offer a bridge to those folks frustrated with DM while being ever mindful of the inherent flaws that brought down or stalled our predecessors. Let us know how we are doing.