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Have  you  ever  found  yourself  at  the  beginning  of  something  big,  and  not  realized  it

  un7l  later,  when  you  could  look  back?       I  am  lucky  enough  to  have  experienced  this  3  8mes.   First,  while  building  2  dental  prac8ces,  one  of  which  focused  on  the  mind/body   connec8on  for  behavior  change,     Second,  while  working  as  a  healthcare  analyst  on  Wall  Street  and,   Third,  most  recently,  when  I  became  a  digital  health  analyst  and  consultant       Beginning  in  2009,  my  curiosity  led  me  to  interview  over  100  experts  across  mul8ple   diverse  disciplines.   While  researching  “Mobile  Social  Games  for  Health,”  I  met  a  variety  of  academics,   hardware  and  soJware  engineers,  behavioral  and  cogni8ve  psychologists,  as  well  as   gaming  and  entertainment  professionals.     Next,  in  researching  “Big  Data  in  Healthcare  -­‐  Hype  and  Hope,”  I  met  technology   people  along  with  data  scien8sts  and  analy8c  experts.  Most  recently,  I  have  goMen  to   know  leaders  in  neurogaming,  as  well  as  those  in  cogni8ve  health  and  well-­‐being   communi8es.   It  is  no  secret  that  I  love  the  gaming  community;    who,  alongside  technologists,  have   reignited  sparks  of  crea8vity  that  have  become  dimmed  in  healthcare.    

My  Ahah  moment  in  my  original  research,  was  when  I  found  an  emerging  ecosystem  of   experimenters  trying  to  trigger  behavior  change  across  the  disease  spectrum-­‐  from  health  and   wellness  to  chronic  disease  and  addic7on    
 

Star8ng  at  your  leJ  at  the  Wellness  side  of  this  visual,    I  found  an  expanding  defini8on  of  health   to  include  life  balance  and  self-­‐improvement.     The  societal  shiJ  in  aQtudes  toward  health  and  wellness,  with  consumers  leading  the  way,  shows   in  the  rise  of  employer-­‐sponsored  employee  wellness  games.     •  Social  networking  can  bring  people  together  within  a  trusted  environment  to  share   informa8on  and  work  toward  common  goals.    Social  games  encourage  three  behaviors:   teamwork,  friendly  compe88on  and  accountability.     •  Brain  Games  is  an  exci8ng  applica8on  of  game  technology  that  takes  advantage  of  a   new  understanding  of  brain  plas8city.       •  Disease  Management:  Interes8ng  to  us  provider  types  is  whether  these  principles  will   work  in  chronic  disease  management.    Early  signs  are  posi8ve:     •  Mobile  games  are  finding  a  place  in  disease  management,  making  mundane  tasks  more   fun:  glucose  monitoring,  diet,  exercise,  insulin  and  other  drugs;  and  developing  a   support  network  of  like  people.    
 

Of  note,  back  in  2009  I  no8ced  an  expanding  defini8on  of  health  and  wellness,  which  included   habit  design  and  self-­‐care.    Remember  this  theme,  we  will  see  how  it  has  evolved.   2  

My  latest  research  tapped  into  a  fountain  of  innova7on  in  the  mobile  social  games  for  health   space.  WHY?                           A  convergence  of  many  factors:     • Ease  of  entry,  technology  advances,     • Recep8ve  end-­‐user  markets  (smart  phones,  ubiquitous  connec8vity),     • Access  to  capital  and  increasing  interest  from  healthcare  organiza8ons   The  gaming  market  has  grown,  especially  among  women  and  people  over  30  yrs  old  with  55   percent  of  gamers  playing  games  on  their  phones  or  hand-­‐held  devices.   Gamifica8on,  ini8ally  overhyped,  may  nevertheless  be  a  useful  engagement  tool.    According  to   a  Gigya  study  of  billions  of  user  ac8ons  with  partners  like  Pepsi,  Nike,  and  Dell,  adding  gamifica8on   to  your  site  boosts  engagement  by  almost  a  third.     Albeit  slowly,  I  think  we  are  beginning  to  see  a  societal  shiJ  in  the  importance  of  health  and   wellness  as  shown  by     1.  the  government’s  efforts  -­‐Mrs.  Obama’s  campaign,  Regina  Benjamin   2.   celebri8es  such  as  Sanjay  Gupta,  Dr.  Oz,  Deepak  Chopra  at  the  CES  are  trying  to  make   fitness  “cool.”     3.  more  self-­‐insured  employers  are  embracing  health  and  wellness  as  part  of  a  produc8ve   culture.      

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This  fountain  of  innova7on  has  fueled  wild  growth  in  our  ecosystem,  but  it  also  means  a  high  signal-­‐ to-­‐noise  ra8o  for  figuring  out  what  works.  
 

Our  new  ecosystem  has  many  more  companies.  Not  only  do  we  have  those  chasing  cogni8ve  health,   but  there  has  been  a  spurt  in  corporate  wellness  programs  using  social  games.    There  are  also  next-­‐ genera8on  companies  refining  their  approach  to  behavior  change.  
 

New  players  include:     •  Blue  Marble       •  Akili  Interac8ve   •   Cognifit   •   Fitocracy     •  Mango  Health,  Lark     •  Shapeup   •   Limeaide   •   Omada  Health  

 

I  set  the  results  bar  high  to  select  this  year’s  4  case  studies:   •   Lumosity   •  OneHealth    

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Let’s  step  back  and  examine  where  pockets  of  evidence  are  building:    
 

In    childhood  obesity  -­‐  Zamzee,  an  ac8vity  tracker  with  a  mo8va8onal  experience  wrapped   around  it,  did  12  studies  with  over  1000  kids  and  found  that  they  those  who  used  both  the   mo8va8onal  experience  and  the  accelerometer  moved  60%  more  over  a  6  month  period   than  those  who  just  had  the  accelerometer.      With  these  results,  the  program  is  now  being   used  as  a  tool  along  with  exis8ng  child  obesity  diet  programs  and  camps.    
 

In  corporate  wellness  -­‐  Shapeup-­‐  invested  in  research  early  on  -­‐  5  peer-­‐reviewed  ar8cles  in   scien8fic  journals  -­‐  with  more  in  the  pipeline.  Showing  that  using  teammates  and  social   compe88on  can  help  increase  physical  ac8vi8es  and  weight  loss.  
 

In  addic>on  relapse  -­‐  One  Recovery,  now  One  Health,  in  Pilot  with  a  Na8onal  Health  plan   they  found  a  58%  reduc8on  in  readmissions  and  a  $1.4  Million  in  cost  savings  
 

In  diabetes  preven>on-­‐  Omada’s  Prevent,  the  digital  version  of  a  2002  Diabetes  Preven8on   Program  known  as  DPP,  in  a  27-­‐center  study  with  over  3000  pa8ents-­‐  they  found  that  a   modest  weight  loss  of  5-­‐7%  could  reduce  type  2  diabetes  by  58%.      
 

All  of  the  companies  agree  that  their  established  evidence  base  has  been  invaluable  as  it  has   provided  them  instant  credibility  during  their  discussions  with  insurance  companies  and  self-­‐ insured  corpora8ons.     5  

One  strand  of  evidence  is  adop7on:  Who  is  using  these  tools?   I  would  have  guessed  that  most  of  the  apps  are  being  used  for  diet  and  exercise,  and   I  was  surprised  to  find  out  that,  according  to  a  recent  study  of  US  broadband   households  conducted  by  Park  and  Associates,  70%  are  using  these  tools  for  memory   training.      

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The  interest  in  memory  training  is  spurring  a  robust  ecosystem  of  brain  training  and   brain  fitness  companies  such  as:   •  Lumosity   •  Dakim   •  Posit   •  Cognifit   •  Brain  Science     •  Akili  Interac8ve     At  the  Consumer  Electronics  show  this  year,  I  began  to  think  that  consumer  interest   is  expanding  beyond  brain  games  and  brain  fitness  to  a  broader  context  of  the  mind/ body  connec8on  and  the  desire  to  pursue  cogni8ve  health  and  wellbeing.     I’m  s8ll  working  on  that  one,  so  stay  tuned  for  my  next  report.      

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 Lumosity  has  created  different  types  of  games  to  train  different  areas  of  brain   health,  including  problem-­‐solving,  memory,  and  brain  flexibility.   Lumosity  was  founded  in  2005,  raised  67.5  M,  and  is  using  the  proceeds  to  fuel  rapid   growth.  This  direct-­‐to-­‐consumer  brain  games  company  now  has  40M  users,  with  10   M  unique  visitors  a  month.     Click  above  to  enjoy  a  video  demo  of  their  3  new  games.     There  is  new  evidence  in  an  independent  study  of  “chemo  brain”  in  post   chemotherapy  breast  cancer  survivors,  that  showed  that  Lumosity’s  cogni8ve   training  led  to  significant  improvements  in  cogni8ve  flexibility,  verbal  fluency  and   processing  speed.      

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  Now  what  is  behavior  change  and  why  is  it  so  important?   Everyone  engaged  in  health  care  is  in  the  behavior  change  business:  we  are  nudged   to  eat  less  and  exercise  more,  follow  recommended  diagnos8c  screenings,  take  all   your  medicine  on  8me,  don’t  put  off  a  visit  to  inves8gate  suspicious  symptoms  and  of   course  floss  your  teeth  every  day.   As  shown  in  this  visual,  one  way  to  think  about  using  technology  tools  to  nudge   Behavior  Change  is  as  a  series  of  cumula8ve  small  feedback  loops.     A  simple  feedback  loop  can  be  described  as:  the  user  engages  with  the  mobile  tool,   data  is  captured,  feedback  is  created.  This  could  be  a  simple  reward  system  for   flossing  your  whole  mouth  one  8me  per  day.  More  complex  feedback  loops  involve   mul8ple  itera8ons  such  as  changing  your  sleeping  rou8ne  or  your  ea8ng  and  exercise   paMerns.     The  ul8mate  goal  is  to  foster  healthy  behavior,  but,  as  we  know,  changing  paMerns  of   behavior,  or  comfortable  rou8nes,  is  not  easy.    The  ques8on  of  using  tech  tools  to   nudge  behavior  change  has  recently  become  interes8ng  to  many  more  designers,  so   much  so  that  there  is  a  meet-­‐up  with  over  1000  members  called  Habit  Design.       Kudos  to  Michael  Kim  who  leads  this  group  of  imagina8ve  professionals.                      
 

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Now  that  we  have  thought  about  geNng  started  and  geNng  going,  we  are  now  set   to  explore  how  we  stay  on  track.     Many  of  us  think  that  social  networks-­‐-­‐peer  pressure  and  support-­‐-­‐plus  user  data   analy>cs,  could  help  us  stay  on  track.    Alcoholics  Anonymous  and  Weight  Watchers   have  been  helping  people  offline  for  decades,  with  real  success.     As  you  can  see  in  this  visual,  there  are  several  different  kinds  of  social  networks   which  offer  fluidity  and  flexibility  not  seen  in  the  offline  world   •  Informa8on  networks  such  as  Everyday  Health   •  Pa8ent  support  networks  Alliance  Health   •  Research  networks-­‐  PaCents  Like  Me  ,  Genomera   Yet,  people  are  complex,  and  influencing  everyday  choices  is  not  a  one-­‐size-­‐fits-­‐all   solu8on.    Just  as  social  networks  come  in  many  flavors  so  do  data  networks   For  some,  the  output  of  biometric  data,  data  coming  from  body  sensors,  will  help   them  to  find  their  way.    For  others  of  us,  large  sets  of  user  data  may  also  help   developers  understand  human  behavior  and  close  the  feedback  loop.   The  key  may  be  in  experimen8ng  with  peer  to  peer  support  networks  and  data   analy8cs  with  a  mix  and  match  approach-­‐  using  more  or  less  of  each  tool  as  needed   and  discovering  which  suite  of  tools  will  work  for  whom  and  when.  
 

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As  consumers  embrace  Lumosity’s  brain  games,  corpora7ons  are  embracing  games   to  spur  employee  wellness.     What  are  social  games  in  the  workplace?       Small  teams,  put  together  in  the  workplace  can  play  social  games  which  encourage   teamwork,  friendly  compe>>on  and  coopera>on.      Accountability  is  an  interes8ng   mo8vator,  because  people  feel  obligated  to  par8cipate  so  they  do  not  let  down  their   team  members.       Building  upon  basic  human  nature  desire  for  compe88on,  status  and  peer   recogni8on,  social  games  can  help  support  and  promote  a  posi8ve  collabora8ve   culture    

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Exemplifying  the  power  of  social  games,  Shapeup’s  par8cipants  have  collec8vely  lost   one  million  pounds!  
 

Click  on  the  link  above  to  watch  the  video  that  shows  how  their  programs  use  social   networking,  peer-­‐to-­‐peer  healthcare,  game  mechanics  and  behavioral  economics.  
 

As  far  as  using  social  games,  Shape-­‐up  is  one  of  the  oldest,  clinically-­‐proven,   technology-­‐based  social  wellness  companies  selling  to  large  employers  across  the   globe.    The  peer-­‐to-­‐peer  networks  form  a  grassroots  campaign  to  recruit  team   par8cipants,  using  social  support  and  group  mo8va8on  and  accountability  to  create   engagement.    Now  they  have  added  individual  and  team  coaching  to  their  suite  of   services.    
 

As  a  data  point  relevant  to  corporate  wellness,  Rhode  Island,  in  a  state-­‐wide  wellness   challenge,  over  the  past  seven  years,  found  that  more  than  70,000  Rhode  Islanders   have  par8cipated  in  their  programs-­‐  walking  millions  of  miles,  losing  thousands  of   pounds,  and  proving  that  teamwork  is  a  powerful  prescrip8on  for  taking  control  of   our  health.    
 

Shapeup  began  in  2006,  covers  more  than  2  million  lives  across  200  employers  and   health  plans,  raised  $5M  series  A  in  2010,  and  they  are  now  profitable.  

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When  I  asked  “What  is  working?”  Three  elements  emerged  in  common  across   companies  “EPI”-­‐  Engage,  Personalize  and  Iterate;    all  united  by  a  need  to   demonstrate  effec8veness  with  some  kind  of  evidence.  
 

First,  capture  people’s  interest  –  engage  them  with  the  use  of    gaming  elements  such   as  reward,  status,  achievement,  self-­‐expression,  compe88on  and  altruism.    Once   people  are  engaged,  it  is  cri8cal  to  create  evidence  that  the  tools  work.  
 

The  second  element,  is  personalize,  custom  approaches  are  essen8al  to  successful   behavior  change.    There  is  no  one  size  fits  all  in  behavior  change,  and  giving  people   what  they  need  at  the  8me  of  need  is  crucial  to  keeping  their  limited  aMen8on.  
 

The  third  element  is  iterate  and  experiment.    This  concept  is  also  well  known  in   consumer  products,  but  not  yet  much  recognized  in  healthcare  circles.    

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Pa7ent  engagement  has  been  a  popular  topic  of  late,  with  HIMMS  publishing  a  book   and  conduc8ng  a  Tweetup  on  the  subject,  Health  Affairs  devo8ng  its  en8re  February   issue  to  the  topic,  and  the  RWJ  Founda8on  and  others  sugges8ng  new  approaches.       Reflec8ng  upon  my  days  as  a  provider,  where  each  dental  pa8ent  had  a  different   view  of  their  needs,  it  is  not  surprising  to  me  that  the  defini8on  and  measurement  of   pa8ent-­‐engaged  care  differs  depending  on  context.       Now  that  the  discussion  has  moved  to  engagement,  evidence  of  effec8veness  seems   to  be  the  power  trigger.     Health  plans  are  demanding  mul8ple  pilots  to  prove  that  the  tools  will  get  pa8ents   engaged,  and  keep  them  ac8ve  in  treatment.    Companies  such  as  Shapeup,  One   Health  and  Omada  who  have  evidence,  can  grow  their  businesses  in  the  corporate   market  more  quickly.      

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To  get  engagement  and  behavior  change,  there  is  no  one  size  fits  all,  so   personaliza7on  is  essen7al.    Forms  of    personaliza7on  involve  using  incen7ves  as   well  as  data  analy7cs.   There  is  a  lot  of  experimenta8on  with  incen8ves,  such  as  money  or  premium   reduc8ons.    A  recent  survey  of  800  large  and  mid-­‐size  companies  with  more  than  7   Million  US  employees,  found  that  83%  offer  incen8ves  for  par8cipa8ng  in  programs   that  help  employees  become  more  aware  of  their  health  status.    Aon  HewiM's  survey   shows  almost  two-­‐thirds  (64  percent)  of  employers  offer  monetary  incen8ves  of   between  $50  and  $500,  and  nearly  one  in  five  (18  percent)  offer  monetary  incen8ves   of  more  than  $500.   Although  there  is  currently  a  lot  of  experimenta8on  with  extrinsic  rewards-­‐  such  as   money-­‐  the  literature  suggests  that  intrinsic  mo8va8on  is  superior.    This  is  an  area   that  is  s8ll  a  work  in  progress.     Analy8cs  is  another  important  element  of  personaliza8on.  In  brain  games,  Lumosity’s   machine-­‐learning  algorithms  customize  the  ques8ons-­‐  giving  the  player  the  right   amount  of  challenge  and  in  OneHealth,  they  use  data  to  be  beMer  informed  how  to   tweak  the  product  features.  
 

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All  of  our  case  studies  have  gone  through  mul7ple  itera7ons  of  their  product,     while  accumula8ng  data  used  to  both  iterate  the  product  and  improve  the   experience.       Onehealth,  which  began  as  OneRecovery,  focused  on  addic8on,  has  expanded  their   target  markets  to  include  people  with  mul8ple  chronic  condi8ons,  such  as  obese   diabe8cs.     Noteworthy,  Lumosity,  through  their  research,  called  “The  Human  Cogni8on”   project,  is  building  the  world’s  largest  database  on  human  cogni8on  to  con8nue  to   improve  and  personalize  their  games.     Shapeup  began  using  social  games  in  corporate  wellness  and  has  now  added   coaching       Omada’s  Prevent  spent  a  lot  of  8me  itera8ng  the  consumer’s  ini8al  product   experience,  because  they  learned  that  good  first  impressions  were  a  key  element  to   establishing  ongoing  trust.    

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Let’s  see  how  these  concepts  work  when  you  build  a  system  with  the  pa7ent  in  the   center.     OneHealth  uses  a  mix  of  game  mechanics  and  mul8ple  online  support  networks,   available  24/7.    As  we  will  see  in  the  demo,  game  mechanics  include  badges  to  mark   achievement  levels,  such  as  going  to  mee8ngs,  geQng  a  sponsor,  sharing  a  story,   journaling.    Emo8cons  help  us  share  emo8on  and  empathy.     For  social  support,  you  can  build  your  own  support  group  with  varying  levels  of   privacy,  customized  to  personal  needs  that  can  change  over  8me.    This  is  very   important  in  the  clinical  world,  where  many  people  suffer  from  mul8ple  diseases  -­‐   such  as  the  many  pa8ents  who  struggle  with  obesity,  depression  and  addic8on.   These  same  principles  have  been  applied  to  their  new  mobile  products.         One  Health  started  in  2007,  raised  16  M  dollars  to  date  with  a  7  M  dollar  series  A   followed  by  $9M  series  B.  

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What  if  these  tools  of  behavior  change  could  be  used  to  prevent  one  of  the  biggest   cost  drivers    in  healthcare?   As  shown  in  the  landmark  DPP  trial  back  in  2002,  pre-­‐diabetes  can  be  reversed   through  lifestyle  changes.    It  was  only  recently,  in  2011,  that  Omada  cleverly  figured   out  a  way  to  digi8ze  the  program  using  digital  tracking  tools  (e.g.  weight  scales,   pedometers),  personalized  coaching,  social  support,  and  an  interac8ve  web-­‐based   curriculum  to  mo8vate  healthy  exercise  and  ea8ng  behaviors.     Here  is  how  Omada’s,    16  week  course,  called  Prevent  works:   Upon  sign  up,  users  are  matched  into  small  groups  of  12  in  a  private  online   environment,  “based  on  age,  body  mass  index,  and  loca8on.”    They  are  then  sent  a   Path16  wireless  scale  that  requires  virtually  no  set-­‐up  and  automa8cally  syncs  to   Prevent,  allowing  them  to  transmit  daily  weigh-­‐ins  to  their  private  personal  profiles.       The  curriculum  -­‐  1x  per  week,  its  fun  ,  and  offers  some  interac8ve  elements,  with   mini  challenges  in  their  skill  center.    Important  aspects  of  the  program  include  the   peer-­‐to-­‐peer  support  from  the  group,  as  well  as  support  from  the  health  coach     Evidence  from  last  pilot  includes:   •  74%  completed  the  pilot  in  4  months   •  Mean  weight  loss  similar  to  DPP  -­‐  5-­‐7%  
 

•  40  of  the  230  par8cipants  have  applied  to  be  coaches    

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 A  handful  of  VCs    I  spoke  with  agree  that  it  is  s7ll  early  in  the  cycle  of  business   model  evolu7on,  however,  in  corporate  wellness,  we  see  2  different  approaches  to   revenue  models:   •  Shapeup  and  One  Health  charge  employers  per  member  per  month   •  Prevent  is  a  2-­‐8er  success-­‐based  approach,  where  there  is  one  payment   when  employees  complete  the  program  and  another  payment  when  they   meet  goals     On  the  consumer  side:    Lumosity  uses  a  monthly  fee  structure  for  consumers   Noteworthy,  Shapeup  and  Omada  are  profitable.     (Shapeup-­‐  started  in  2005  and  has  raised  $5  M  in  venture  capital  funding.   Omada-­‐  began  in  2011  and  has  raised  $5.5  M  in  seed  and  venture  funding)    

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As  you  can  see  in  these  graphs,  all  trends  are  posi8ve  showing  an  Increase  in  mobile   health  app  downloads,  global  revenues  and  venture  capital  funding.   For  Mobile  Health  app  downloads,  124  million  people  downloaded  a  mobile  health   app  in  2011  and  247  million  people  downloaded  one  in  2012.     In  global  revenue,  there  was  1.2  billion  dollar  global  revenue  from  mobile  healthcare   apps  in  2011  with  11.8  billion  dollars  expected  in  2018     For  VC  funding,  there  was  968  million  dollars  in  2011  and  1.4  billion  in  2012.      

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Reflec7ng  back  (in  hindsight)  this  has  been  a  year  of  rapid  innova7on,  so  let’s  see   the  up  and  comers  who  are  brave  enough  to  take  on  the  challenge         Up  and  comers  include:   •  Fitocracy-­‐  The  founders  are  gamers  turned  bodybuilders.    The  online   fitness  community  awards  you  with  points,  the  ability  to  level-­‐up,  badges   and  the  strong  social  component  has  created  community  support  with     over  1  m  downloads.   •  Mango  Health  using  game  design  to  help  consumers  mange  their  health  -­‐   earn    points  for  taking  medica8ons  safely  and  on  8me.  Points  can  be   redeemed  by  major  retailers  such  as  Target  or  by  making  charity  dona8ons     •  Lark  -­‐using  elements  of  game  mechanics  and  automated  posi8ve  coaching   (with  custom  algorithms)  to  make  sleep  tracking  more  fun-­‐  and  they  have   the  world’s  largest  sleep  database.   •  Akili  InteracCve-­‐combining  the  best  in  neuroscience,  with  the  best  of  video   games  to  create  a  new  kind  of  cogni8ve  ac8va8on,  beginning  in  the  area  of   execu8ve  func8on  
 

Who  would  have  guessed  that  game  developers,  once  considered  op8onal   consultants  in  health  related  products,  would  be  key  members  of  product   development  teams?    

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As  we  have  seen  in  our  4  case  studies  -­‐Lumosity,  OneHealth,  Shapeup,  Omada  -­‐  are   mixing  and  matching  elements  of  game  mechanics  and  peer  to-­‐peer  support  using  3   common  success  factors:  engage  the  user,  personalize  the  experience  and  iterate  the   product.     With  this  explosion  of  innova8on  plus  new  entrants  such  as  Fitocracy,  Mango  Health,   Lark,  Akili  Interac8ve,  these  are  exci8ng  8mes.     This  fan  represents  an  ongoing  trend  to  move  the  medical  system  from  sickness   interven8on  to  “preven8on”  or  “well  care.”      This  is  a  model  of  preven8on  based  on  a   con8nuing  convergence  of  data  analy8cs  and  ubiquitous  social  mobile  connec8vity.   This  convergence  is  enabling  people  to  proac8vely  drive  their  own  behavior  change   through  itera8ve,  personalized  engagement  rather  than  passive  par8cipa8on  in  data-­‐ driven  disease  preven8on.     This  is  an  extension  of  the  expanding  defini8on  of  health  and  wellness  that  we  first   no8ced  in  2009,  as  seen  in  our  first  ecosystem  visual.    But  this  concept  is  s8ll  so  new   that  we  don't  yet  have  a  word  that  replaces  "pa8ent"  to  describe  individuals  ac8vely   pursuing  beMer  health.    

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What  does  this  mean  for  the  future?   As  we  have  seen  in  our  4  case  studies,  in  our  4  up-­‐comers,  and  others,  with  gaming   and  compe88ons  taking  center  stage,  perhaps  it  is  8me  to  individually  and   collec8vely  think  BIG.      
 

Leave  it  to  Esther  Dyson  to  have  created  HICUUP  (Health  Interven8on  Coordina8ng   Council)  that  uses  community  wide  efforts  to  get  people  compe8ng  to  walk,  exercise   and  eat  beMer  across  ci8es  and  states.  The  council  is  spurring  popula8on  health    and   proving  the  financial  feasibility  of  preven8ve  health  on  a  larger  scale    

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I  am  grateful  to  the  100  plus  companies  and  the  25  plus  mee8ng  organizers  who  have   contributed  to  the  analysis  behind  this  presenta8on.         I  remain  ravenously  curious  to  see  what  will  be  next!    

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