Mobile Health and Mobile Incentives 10/4/12

I really like the idea of combining mobile finance and incentive with health services. Reading and discussing the potential of mobile phone credits — at least internationally — as a form of currency fascinates me.

What I love specifically about the concept of mobile incentives is that it’s just like cash, but you can give it to somebody who’s not standing in front of you. People always have their phones with them, so issuing a mobile phone credit or even a notification of a credit (I’ll expand on what I mean by credit later), can be linked directly to some action — refilling a med, reporting a glucose, showing up for an appointment, and so on.

It’s the ultimate way to tighten the feedback loop and drive towards behavior change at a large scale. Obviously you can send people auto-responses to the above actions in the form of SMS messages or Push notifications or badges or even e-mails, but money is big driver of behavior change.

I’ve always seen the applicability of mobile incentives overseas, but initially thought mobile incentives in the US would be limited to the minority of people who have prepaid (non-contract) plans. Interestingly, the proportion of prepaid users in the US is going up and now accounts for 25 percent of all mobile contracts. Even though it’s 25 percent, which really isn’t a small minority, it’s a target population that we don’t want to miss when it comes to using technology for health and engagement.

But beyond using mobile credits, which are being thoroughly investigated in a number of areas of health overseas, there are lots of opportunities in the US and other countries where mobile payments haven’t taken off to the same degree as places like Africa. I’ve seen several organizations exploring the use of various kinds of mobile credits, including iTunes credits, to motivate behavior change and adherence to health programs.

Bant is using iTunes credits with pediatrics diabetic patients. Zamzee (thank you Greg Weidener for sending me the Zamzee study after my last post) is using credits for movement, though the mobile part is more for activity tracking and incentives seem to be on the web. A program in Australia gives $20 mobile phone credits to teens that undergo a sexual health check . And startup GymPact is trying to do it for workouts.

The sky is the limit. I remember meeting with a hospital system and discussing giving iTunes credits to pregnant women to get them to tour the facilities, because the data showed that touring increased the odds of actually delivering there. Part of the appeal in this was giving them the credit before the tour was over so they’d get the warm, fuzzy feeling in the facility. I’m not entirely sure this is allowed, and it never went far enough to engage the legal department.

The really obvious choices for types of credits are mobile credits for prepaid customers (iTunes or other app marketplace credits) and gift cards, all of which can be sent to mobile devices. Gift cards can be basically anything if you count places like Amazon, and Ideally tailored to the patient or chosen by them. Whatever the form of mobile credit, the idea is to deliver the mobile incentive as close to the positive health behavior as possible.

One of the really cool things I discovered when I was working on an international mobile health startup was that there are lots of mobile phones overseas with multiple SIM cards. This enables you to issue a health-funded card that can be used for all health communications and can be recharged with good behavior (being adherent to TB treatment programs or clinical trials, for example). The second SIM also provides a dedicated connection for the organization in charge of treatment or the clinical trial. I don’t think there are many multi-SIM card phones in the US.

Last week at a meeting at RWJF, Don Jones of Qualcomm mentioned creating some form of common mobile currency for health, something that is transferrable and of value whether you have a mobile contract or not. If people are earning health awards, they could then transfer them to a new employer, payer, or carrier. It’s certainly an interesting concept, though you’d need somebody like RWJF to administer the program as a trusted third party, as Don pointed out at the meeting.

I imagine getting all the stakeholders to agree to this common currency would be the biggest challenge. I’ve read about creating exchanges to transfer mobile money between carriers in Africa, but my understanding is that it is not going to happen until the carriers are forced to do it. I have a hunch you’d encounter the same problems in the US.

The area made me wonder if any health systems, payers (especially public ones), or employers are trying to work with some of the prepaid carriers, like Cricket or US Cellular. I know AT&T, Sprint, and Qualcomm are aggressively looking to partner with heath companies or offer health services themselves, but what about the other carriers?

I’d love to learn more about what research, trials, pilots or anything else are being done with mobile credits or mobile incentives. I’m sure there is a lot happening that we don’t know about.

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Jose Angel Sanguino

     Excellent proposal

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