Self-proclaimed tech nerd Adam Bosworth has spent more than two decades building software and databases. Before becoming VP of product management at Google, he’d done stints in management positions at BEA Systems and Microsoft. He’s been a key player in the development of Google Health, Google Docs and Microsoft Internet Explorer.
But in his newest role, Bosworth is transferring the knowledge about changing consumer behavior gleaned from a long career in tech and applying it to helping people change how they take care of their health. He co-founded Keas in 2008 and since then has raised $17.5 million in institutional funding and launched a corporate wellness program that uses gaming, team dynamics and web and mobile technology.
Bosworth talked with MedCity News about what he’s learned along the way.
Your background is so tech-heavy. Why was healthcare the next step for you?
In 2002 my mother was ill. In 2003, my daughter was ill. I got to watch our healthcare system at its best and at its worst simultaneously. It was pretty illuminating. By 2003, most industries had started to revolutionize the way they dealt with their customers, to give them transparency into what was going on and ongoing information and support. Clearly that was not happening in the healthcare community, and it wasn’t obvious why.
I thought, maybe these guys just don’t know how to use IT, and maybe I could do something.
You’ve said that the reason Google Health failed was because it wasn’t social. Are there certain lessons from Google Health that you carried over to your new company, Keas?
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When I was at Google, I did what I normally do when I get into a new field: I wander around asking a bunch of dumb questions for three months, trying to make sure I understand what’s really going on. So I talked to hospitals and physicians and other firms about healthcare in 2006, and three things became quickly apparent. One was that the payment model was fundamentally broken, and there were a huge number of problems stemming from this, because we were paying for procedures and drugs and not prevention.
The second thing that became very clear was that a really large amount of the disease that we suffer from that is curable or preventable comes from lifestyle choices. The third thing that became apparent to me was that the so-called personalized medicine trend that was all the rage in the valley at that point, based on genomics, was not going to yield any early fruit. There were very few people whose lives were going to be saved or improved from this compared to the number of people whose lives could be changed based on intervening with them before they got really sick.
How has the vision for Keas changed since its conception?
We originally were looking at things like Mint.com, and we built this very fancy engine that took all of your lab data and health statistics […] We had a deal with Quest Diagnostics so that patients could send the data directly from Quest to Keas and we could start giving you personalized content. That sounds good, but turns out it doesn’t work at all.
We stopped and asked ourselves, why is this not working? We’re giving these people great content, and we’re giving them good advice, but they’re not following it. And we asked ourselves the question we should have asked in the first place, which is why are we like this? If you’re obese, you’re somewhere between 40 and 140 pounds overweight. You’re pretty aware. It’s not that they don’t know it; it’s that they’re coping with stress. […] They’re tired because of the way that they’re coping, and food makes them feel better in the short term. It’s the same reason you sometimes see nurses smoking outside the cancer hospital. And if you sit there and lecture these people, that’s the last thing they need.
So we took a completely different approach. We said, what are the things people really like to do? The first thing is people like to have fun. They like to play games. They like to be rewarded. There used to be this belief that games were only played by 20-somethings and teens. By this time Zynga had come out and done well and Farmville was being used by a lot of people. What most people don’t know is that the average Farmville user is a 43-year-old woman. They’re basically in their 30s, 40s and 50s, and that was really interesting. Facebook had also come out […] and it had shown that people’s desire to be socially connected was very high. That combination of things led to what we do today in Keas.
Tell me about Keas.
We started with this premise that if you want people to do something good, don’t tell them that they’re in trouble. They already know they’re in trouble; they don’t want to hear about it. Data is not something people want when the data is bad. By and large, we’ve got half our population for whom the data is not going to make them feel good.
Fun turns out to be huge. If you make it a game and the game rewards you, that is pure operant conditioning. That is basically – do the right thing, you get points, you get acknowledgement, you get badges, your friends online are telling you what a great job you’re doing – all of that is positive stimulus. So suddenly, eating the healthy lunch is not something that you dread; it’s something that cheers you up. Even then, one of the other things I learned from the Google Health experience is that very few people are going to exercise their way from where they are today to where they should be. So the other thing that became clear was that you have to have a holistic program.
How it’s different form other workplace wellness programs?
When we rolled out Keas we were focused on three things: Start by making it fun and making it social. And that was the big downfall of every wellness product out there. No one wanted to do them. These are people who are looking for things to make them feel better. The second thing we focused on was team dynamics. Pretty much everyone who’s in the process of trying to be healthier is going to fall off the wagon […] while they’re developing their new habits. But if it’s a team of co-workers and that team depends on them, you get about six times the level of sustained engagement you’ll get otherwise.
We also focused a lot on achievable things. It doesn’t do anyone any good to tell them they need to lose 30 pounds. It doesn’t seem achievable, and when they think about what they actually have to do it seems even less achievable. We focus on a day at a time, a week at a time. That was the third thing we focused on – actually making the game so it’s easier if you do the same thing over and over again in the first 100 days than not. Pushing a car from a standstill is a lot of work. Getting a car that’s actually moving to keep moving is a lot less work. Our health habits are very much the same. Lastly, we focused on making this something you could do anytime, anywhere.
Why go through employers?
One reason is that employers will pay for it. Employers are already paying, twice, for the sickness of their employees. They’re paying once in terms of increased healthcare costs, and that’s the hardest thing to monetize, but they’re also paying highly in terms of tired and occasionally absent workers.
The second reason is that if you’re talking about your health, and the entire employee group is engaged on a quest to be healthier, there’s something very non-judgmental and at the same time very social about the process that makes it natural that you reach out to your friends. […] The way Keas works, is any time you do anything that earns you points, you do it in a public place. So now your corporate reputation is at stake. This is a big win in rolling out to employers versus going after the consumer space.
The third reason is it turned out there were some serendipitous benefits to Keas that employers were even more interested in. We’re fundamentally teaching teamwork and improving morale. We’re giving them something fun and playful and social that they’re actually allowed to do at work.
What has the response been?
We’re starting to move upmarket a little bit. For example, we rolled out to 19 companies and about 100,000 people a couple weeks ago. We rolled out another 18 companies this week. A lot of the traction has been historically in 1,000 to 4,000-person companies. But we’re starting to move up. We’ve just done our first half million dollar deal, and we have a bunch of million dollar deals in the works. Like all B2B enterprise sales, it’s a steady growth.
We think we will make a much bigger dent in the healthcare costs in this country with what we’re doing than almost any of the other things we’ve heard being discussed, because a lot of the things that are being discussed right now are given that people are already sick […] how do I at least make sure I’m cost effectively treating them? And that’s good […] but still that’s way more expensive than making sure they didn’t get there in the first place.
The real savings are going to be shifting back the healthcare in this country to where it was in 1995 far more than tuning the healthcare costs of those people who are already very ill, particularly given the entitlement most people feel toward unlimited healthcare.
*Editor’s note: This interview has been shortened.
