Who’s Buying Engagement?

It’s common for startups to pivot or change direction in both product and business models. Almost every early-stage investor will tell you they invest in teams and markets, realizing that the initial startup idea and plan will likely change. In healthcare, finding product-market fit can be hard since it’s a highly regulated industry full of entrenched players and multiple layers between buyers and sellers.

My favorite pivoter in health is probably Keas. I remember reading about Keas probably four or five years ago when it launched a care plan marketplace. I don’t even remember what Keas called it at the time, but I remember it as a marketplace for care plans. The former head of Google Health founded it. It allowed providers and content organizations like Healthwise to offer care plans direct to consumers. Consumers could browse and choose care plans, some free and some paid, to follow for different conditions. I think there was also a virtual care component to some plans, but I can’t really remember how that worked.

I thought it was a pretty cool concept, but I thought it was too early, and I felt targeting consumers directly was not the right route. A virtual workout plan marketplace more focused on motivated healthy people made more sense. I think a few companies are doing that now.

Apparently a care plan marketplace wasn’t something people wanted because Keas pivoted to become an employer wellness company not too long after. The focus then was on adding games and challenges to wellness programs to increase employee engagement in employer wellness programs. Then earlier this year, Keas expanded its offering to be more of a corporate wellness engagement platform, with more social features and less of a sole focus on games. At least that’s what I can gather from how Keas messages this. Just last week Keas announced another $8 million in funding, bringing the total funding to $26 million.

The evolution of Keas, seemingly inconsistent and definitely expensive for investors, makes a lot of sense. The goal was and still is to engage consumers in their health, first with care plans and connecting patients to doctors, then with games as part of corporate wellness programs, then finally with a broader social platform for corporate wellness. The interesting thing is where Keas ultimately landed.

There was another health IT startup pivot earlier this month that is related to Keas. Jiff is another company I’ve followed for a few years. Jiff started with JiffPad, an iPad application for providers to educate patients about conditions. I think providers could also e-mail links to multimedia education so patients could view it after the in-person encounter. I really liked JiffPad because it seemed like a great way for providers to engage patients.

Last year Jiff announced Circles of Health, which was basically a patient-centered social network. It was designed to unify records and connect providers and caregivers around patients. At that time, Jiff also raised $7.5 million.

Then, earlier this month, Jiff announced a new focus on integrating apps and data for corporate wellness programs. Part of the sell from Jiff is unifying different apps and another is on bringing consumer-type user experience to corporate wellness. But the real value Jiff is going after is engaging consumers in their health. It’s hoping that data integration tied to social tools will help corporate wellness programs effectively engage employees. There is a bit more to the platform according to the news, but the website and press release are a scant on details. There is also a potential sell to payers, but the focus is predominately on employers.

Why do I care that Keas and Jiff have pivoted a few times? What’s interesting to me is that the two companies, both seemingly trying to solve the same problem — engaging consumers and patients in their health — landed in the same place in employer wellness programs. Patient engagement holds tons of potential to improve overall health, reduce costs, and make the patient experience a more positive and happy one, but, we haven’t quite figured out how to do it effectively and at scale. Going direct to consumers would be great, but it’s not happening, or it’s not happening at a pace to satisfy investors and keep startups afloat. So we’re seeing engagement-focused companies bouncing around to find a fit and to find revenue.

If consumers aren’t buying engagement themselves, it begs the question of who is buying it? Health systems and ACOs are starting to think about it, but they are slower moving. Payers are an obvious choice, but many of the larger ones seem to be doing it themselves. As I was told recently by several third-party administrators (TPAs), all the big payers are building out engagement tools themselves and trying to keep the market locked down as much as possible when it comes to access to data. Companies like Keas and Jiff end up targeting self-insured employers.

I’ve had several recent conversations with investors who see the employer side of patient engagement very attractive. I can see it, too. Recent conversations we’ve had with large employers have been much different and much easier than talking to health systems about apps and engagement. Data, as long as you have a big enough employer and can get it, is easier to work with than trying to integrate with hospital systems.

I’m curious what others think or have experienced. What sectors of healthcare are going to drive engagement? In a funded startup, is the pressure to get to product-market fit and revenue too great to make it through sales cycles at health systems? Or are employers just the obvious choice because the pain, in dollars, is more evident to them?


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

  • Brad Levin

    Looks to me that the consumer engagement space is crowded. In addition to the companies you mentioned, there’s also Audax Health (http://www.audaxhealth.com) with their Zensey product, and at least one other early stage company that is about to launch that I am aware of. Like you mentioned, Audax pivoted their first gen efforts on their CareVerge product, rebranded as Zensey and are giving it a go. They’ve got a high powered board, including John Sculley, along with current/former C-level execs from Cigna and Aetna, respectively.

  • One of the biggest problems I see is the poor conceptualization of just exactly what those terms, “patient engagement” or “healthcare consumer engagement,” mean. Is it enough to provide a tool that people can use to get involved with their healthcare? Obviously not, as Google Health can attest. Does adding a social component – whether just sharing or creating a competitive gamesmanship space – drive consumer uptake? Sometimes, but only in certain areas and with some people, such as those motivated to keep fit. Obviously employers wield some power over employees to actuate their engagement, but that isn’t a model that can work for many smaller businesses and does nothing for the self-employed, jobless, etc.

    As with pretty much everything in healthcare, it’s often “all about the money.” But, that isn’t the full picture, either. (Again, Google Health comes to mind; they weren’t exactly cash-strapped.) I think the elephant in the room – that many people don’t even see – is the absence of true “engageability.”

    Hollywood, TV, game-makers, and sports ventures understand that consumers will pay to be entertained – and they’ll pay big. But, wimpy shows and poorly implemented games fail. The entertainment, the engageabiility, needs to be enticing and real.

    From what I’ve seen, most patient engagement tools still miss the mark on this. Even decent tools that provide a good UX do little to drive continuing return visits.

    Consider the tool, YouTube. It’s merely a platform for sharing media. If the content there was as boring as most “patient engagement” tools, how often would people re-engage with it?

    Honestly, for many people, perhaps the vast majority, healthcare is not something on which they want to spend their time. They want to be off living their lives and doing what interests them. Healthcare is often more of a necessary evil that gets in the way of family, friends, and fun. If we don’t make healthcare entertaining, it’ll be hard to ever drive health engagement beyond the health nuts and employer-enforced.

  • Audax is a great example. As you mentioned, it’s raised crazy money and brought in some very big names. Thanks for adding them to the list!

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