Rewards for watching TV vs rewards for healthy behavior

By Neil Versel

Neil_Versel_LargeHealth gamification app developers, you may have met your match. You probably already knew the couch potato was your biggest challenge. But now the stakes have been raised.

The other night, I was watching TV and this commercial came on: (Watch here).

That's right, there's an app, called Viggle, that rewards people for sitting on their rear ends and "checking in" to their favorite shows. Users get bonus points for watching certain programs — including hugely popular ones like "Modern Family" and "Law and Order: Special Victims Unit," as well as live sporting events. They then can redeem points for prizes, for example, a Papa John's gift card, because nothing reinforces the sedentary lifestyle like free pizza.

And despite what that specific commercial said, Viggle is not just for DirecTV subscribers.

Trying to convince people to download and use mobile apps and gadgets to get active already has been a tough sell. Which is why I was underwhelmed by this week's news that smartphone accessory maker Jawbone, producer of the failed – but later revived – UP sleep and activity tracker had acquired Massive Health, maker of, well, I'm still not exactly sure.

Massive Health did come out with an "experiment" in 2011 called The Eatery that to me seems like the "Hot or Not" of food photos. There was another iPhone app for diabetes management supposedly called Penguine, but that never got a public release.

Business development chief Andrew Rosenthal once told MobiHealthNews that Massive Health's differentiator was its user-centeredness. "Our approach has always been to focus on user engagement partly because no one else does. The more someone loves something, the more they use it, and the more opportunities we will have as a company to help them be healthy," he said.

Pardon my skepticism, but hasn't everyone peddling a DTC health tool focused on user engagement? Isn't that the point of all the gamification apps, widgets and gizmos?

I never was able to find anything unique about Massive Health, other than its Massive Hype. It had a high-minded business name, a Silicon Valley rock star on board — namely former Mozilla Firefox creative lead Asa Raskin — and a lot of buzz. But no real breakthroughs or much in the way of actual products.

Come to think of it, that's not so unique, either. Revolution Health had a similar grandiose name and an even bigger IT rock star, Steve Case, behind it. Google Health had early XML developer and former Microsoft project leader Adam Bosworth, not to mention the Google name and reams of undeserved press. Both of those failed pretty miserably. Bosworth's subsequent venture, Keas, just announced yet another change of direction this week.

What those projects all have in common is that they never figured out some of the basic realities of healthcare. Fitness and healthcare are distinct markets. The vast majority of healthcare spending comes not from workout freaks and the worried well, but from chronic diseases and acute care. Sure, you can prevent a lot of future ailments by promoting active lifestyles today, but you might not see a return on investment for decades.

Another problem is that Massive Health, Google Health, Revolution Health and Keas never came to grips with the fact that healthcare is unlike any other industry.

In the case of Google and every other "untethered" personal health record out there, it didn't fit physician workflow. That's why I was disheartened to learn this week that one of the first two development partners for Walgreens' new API for prescription refills is a PHR startup called Healthspek. I hate to say it, but that is bound to fail unless Walgreens finds a way to populate Healthspek records with pharmacy and Take Care Health System clinic data.

Plus, doctors don't trust patient-entered data and patients, for the most part, won't bother to enter their own information in the first place. It's like Quicken in the days before online banking let people download all their transactions. You need the interoperability first.

The other thing working against the likes of some of these companies is the economics of healthcare. Third parties pick up most of the tab. People freak out when their health plans raise co-pays or employers ask them to cover more of their monthly premiums. Direct-to-consumer just doesn't work. You have to go to those who pay the bills, namely insurers and employers. Keas did that in a previous refocusing, but I haven't seen any evidence that Massive Health ever did.

As Verizon Wireless healthcare director John Maschenic wondered out loud in 2010, "I pay $18 a month for OnStar to manage the health of my car, but people aren't willing to pay more than [$5 a month] to manage their own health information?" Yes, it's true. And it doesn't seem to be changing very fast.