A startup health incentives app shows users the money

The human brain is a marvel, but it does a pretty lousy job of weighing long-term hazard avoidance versus immediate gratification. C’mon, if we were really thinking clearly about consequences, would anyone start smoking? Finish the entire bucket of Kentucky?

But what if someone gave you money to put down the cigarette?  Ah, that might change things.

Achievemint is betting on it. The startup app, part of a platform developed by Activity Exchange Inc., awards points for behaviors like a gym workout or nutritious food choice that can translate directly into merchandise or even cash. The platform has some 170,000 users. Achievemint gains by aggregating data anonymously for customers.

The company’s end target, though, is insurers, who stand to gain from improving preventive behaviors now that the Affordable Care Act put an end to pre-existing condition restrictions. In this scenario, users accrue discounts on their insurance premiums of up to 30 percent.

Mikki Nasch, Achievemint’s CEO, says most insurer wellness programs as yet have a poor track record of inspiring behavior change over the long run, with little research as to what actually motivates an audience and a general lack of truly targeted messaging. Instead, Achievemint aims to push age- and language-appropriate information relevant to a user, marketing health as a product one might actually like to buy.

Nasch dismisses gadgets and group competitions as interventions one might flirt with, but rarely marry.

“The whole notion of gamification and health undermines the intelligence of the consumer, to be frank. We don’t all rush to a reward portal every day to see how we’re doing against our five friends,” she says.

Money in one’s pocket is a different story.

“The way the ACA is written is very smart, because it incentives the payers to incentivize their populations. Regardless of what you want to do as a payer you’ve got to give those discounts intelligently, because if you discount the wrong 30 percent you’re going to lose your shorts,” Nasch says.

Patricia Meisner, co-founder and CEO of ActualMeds, also bemoans the difficulties of engaging patients.

“Today, there’s not a strong payment model or market model where consumers are used to paying for their own healthcare. They’ll buy their own running shoes but they won’t buy their own healthcare management tool,” she says.

Care managers, though, have all sorts of reasons to look for help, from avoiding risks to better outcomes and reduce costs. To those ends, ActualMeds is a web-based platform that helps them collect patient data and manage medications for those with chronic diseases. It provides medication reconciliation on demand at point of care and seamlessly combines medication information from the electronic health records, prescription claims, and structured patient interviews.

The company began life as NIH-funded research at the University of Connecticut, focusing on Medicare’s high-risk patients with seven or more medications to manage. Medicare’s way of helping ensure compliance involved matching patients with a random pharmacist for review, which brought in less than desirable results and low engagement rates.

“ActualMeds did not set out to disrupt that market model; we set out to change it entirely. You don’t need a clinical pharmacist to do all this. We can do a tool that aggregates the best possible medical history,” Meisner says.

ActualMeds also aims to provide a virtual safety net of reminders for areas that often escape attention, like over-the-counter meds.

“Acid inhibitors are powerful pharmacologic agents, as are antihistamines. And I want to go on records as saying statins will be next. People self medicate with these like crazy. Older patients will take things to help them sleep and they end up falling down. That’s the stuff no other claims database is going to give insight into,” Meisner says.

ActualMeds was part of the New York Digital Health Accelerator program (run by the New York eHealth Collaborative, another TEDMED 2013 Hive company), and recently won the 2014 Venture+Forum contest at the annual HIMSS conference. They’re currently working on a number of pilots on various facets of the platform, including testing its structured interviews for home visits and primary care, with results checked by case managers or clinical pharmacists.

Catalyst is an ongoing series about health innovation, focusing on companies from the TEDMED Hive.  For more information and to apply for the Hive 2014, click here.

Great American health startups, not from garages

Sure, a lot of great ideas came out of American garages, but with enough imagination, moxie and determination, they can be teased out of virtually every setting.

Take these products and projects from the TEDMED 2013 Hive companies, for example.

iMPaK Health makes an ultra low-energy Bluetooth enabled device, about the size of a credit card, supporting products that monitor medication adherence, pulmonary function, activity and sleep. Functions run the gamut from simple to complex – recording symptoms, measuring pulmonary function or analyzing a drop of blood. The company is an offshoot of Meridian Health, a not-for-profit hospital system based on New Jersey, which started developing the products after pondering how to help patients monitor their own conditions in ways that meshed with the workflow of the Meridian health system.

“We realized that the companies that were out there didn’t understand health care that well. They had no real idea of what health systems were looking for in terms of costs, return on investment, and ability to scale easily. They didn’t understand that patients don’t want to feel sick. A lot of the devices made to be placed in the home were modified hospital versions of existing technology,” says Meridian Health Director of Consumer Technology and Service Development, Sandra Elliott.

Screen Shot 2014-03-21 at 7.48.59 AMInstead, iMPak aims to increase patient engagement over time and to aid in prevention when possible with inexpensive, easy to use tools.

“How do we get people to own their health now, and at the same time take those patients who are at the ‘Oh, Crap’ moment in the hospitals, and put them back on a different track when they’re in the community? It’s not just about the tools and what the information is telling us; it’s about helping people change their behavior,” Elliott says.

Tiffany Wilson Karp, Executive Director of the non-profit Global Center for Medical Innovation (GCMI), works to help medical device innovations coming out of academic centers in the Southeast ramp up to market. Health devices are a tough field for a startup, not only with normal new business pressures but also with the mandates of prototypes and clearing FDA approvals.  A device can’t raise money until its proven clinically and commercially viable, and that can’t be proven until it’s manufactured in a cleanroom, an area designed to reduce environmental pollutants.

Project partners Georgia Tech, Piedmont Hospital, the Georgia Research Alliance and St. Joseph’s Translational Research Facility collaborated to open GCMI in 2012. It’s based in a 12,000-square-foot facility near Georgia Tech. The idea is to help innovators, from the Southeast at least initially, navigate what Karp calls the “little pockets and ecosystems” of the medical device commercialization process, and to gather the intelligence needed to see the process through.

“It takes a village to get something from a concept to the patient. It’s an intersection of science, engineering, business and law. Everybody speaks a different language, yet need to carefully coordinate to get something to market that’s safe,” Karp says.

The fine print is seen to by a network of intellectual property, regulatory and quality systems advisors, and the bottom line by investors already flocking to the center.

While products are of necessity hush-hush, Karp says results include supporting one company from going to a team of two to their FDA clearance and CE approval in about 18 months, a process that can take years.

“The medical device industry is hard, messy and expensive. The underlying reason that drives innovation is the patient. You ask anybody in this industry why they do it, and they say, ‘Every day when you go to work you’re working on something that’s going to affect somebody’s life and quality of care,” she says.

The positives of HIV testing: A tale of two cultures

Last week, we hosted a live online discussion about essential community building blocks for breaking the links between poverty and poor health outcomes. And the need to think creatively is perhaps strongest in local HIV/AIDS prevention initiatives. Cultural pressures, health myths, and access issues can hamper engagement and progress and yet, two campaigns are making strides.

The Many “Reasons” to Get Checked

Putting a positive spin on HIV testing for young men at high risk for the disease may be a daunting task, but culturally poignant messages may go a long way towards selling the value of getting checked.

Manuel Rodriguez manages the “Reasons” program for the non-profit development strategy organization FHI 360.  Reasons is a messaging campaign that aims to get Latino men who have sex with men to undergo testing for the HIV virus.  It comprises social media outreach, print, t.v. and online advertisements, and presence at gay pride events, and currently focuses on cities with many members of the target population, including Miami, Los Angeles and New York.


“We all have a reason for getting HIV tested,” the ads say, including words like love, life, family and pride.

Rodriguez says Reasons aims to touch on the strong sense of community in the Latino culture, which holds whether one is a first-generation immigrant or has lived in the U.S. for decades (Rodriguez was born in Caracas,Venezuela.).

“We incorporate family and friends, and the importance of protecting your partner. Mom is a very big figure in Latino culture, so some of the messages are, ‘I’ll do it for my mom to make sure I’m going to be there for her,” Rodriguez says.

Another hallmark of the effort is its positive, not punishing, slant.

“We see this as a new way to communicate because it comes from a positive and empowerment framework, instead of, ‘You must do this, because you do that.’ It’s more of a value-driven proposal.  ‘You can control it.  You can prevent it.’

“As a person, your value as a member of a family and your community is health. To be there for them is to take control of your health,” he says.

Rodriguez says impact of the year-old program is measured so far in the millions of online website views and by a big bump in social media interactions since the program launched. The program has conducted strategic online listening activities to fine-tune campaign messages. Some findings include that some Latino gay and bisexual men see testing as the right thing to do, and they go as far as to share Instagrams of their test results as a badge of honor — negative results, because a positive test result still carries a stigma in Latino culture; one that Rodriguez has worked to mitigate throughout his career in public health communication.

Though Reasons has a defined target audience, Rodriguez says that its themes may turn out to be not so specific after all:

“We think at the end of all these Pride events and local mobilization, we’re going to have a story to tell. And we’re going to find out that these will be universal themes that unite us all.”

Taking Pride in Resilience

Another FHI360-managed program, Testing Makes You Stronger, is aimed at African-American men with male partners. According to Cornelius Baker, Acting Director of the HIV/AIDS Unit, Testing reflects a common ethos in the black community of ‘that which doesn’t kill you, makes you stronger.’

“It’s the messages one gets by growing up in an African American family; that of resilience, that you can survive through tough things,” Baker says. “It’s also very much that sense of pride, of having a respect of agency for the community.  People want to live well; they want to survive.  What we have to do is create an environment of support for that, and give people the tools to be able to benefit themselves,” he says.

Baker says his organization gathered input from community leaders, advocates and the Testing target audience — more than 400 black men in five cities — before embarking on the campaign.  There is also a campaign for African-American women, Take Charge: Take the Test.

Both programs are funded by the Centers of Disease Control and Prevention, which also lends its scientific and technical expertise to governments and agencies worldwide to help stop the spread of HIV.  (For more on how global health strategies are applied locally, join TEDMED’s special World Health Day Google Hangout on April 7.)

BUSTED: What are the top five preventive health myths?

You can get the flu – or worse — from a vaccine. Only old folks get strokes and heart attacks. Calories in, calories out. X-rays cause cancer. Sleep eight hours a night and drink eight glasses of water a day. Skip the sunscreen on a cloudy day. Take a multivitamin every day, just to be on the safe side. An apple a day keeps the doctor away. Exercise more to lose weight.