Why Mint.com for Health Is a Terrible Idea, and How Keas Pivoted to the Fun Stuff

11/18/11Follow @wroush

If you’re a hammer, you just want to smash nails; if you’re a programmer, you just want to build features. But features do not a successful product make. This is the central myopia that eventually blinds even the most brilliant engineer-entrepreneurs, unless they’re smart enough to surround themselves with people who can check their bias.

If you want an interesting example of this phenomenon, look no further than Adam Bosworth, the co-founder and chief technology officer at San Francisco-based health gamification startup Keas. There’s no question about this guy’s brilliance. At Citicorp in the late 1970s, he invented an analytical processing system that helped the bank predict changes in inflation and exchange rates. At Borland, he built the Quattro spreadsheet, and at Microsoft, he built the Access database. He was one of the first to propose standards for XML—the foundation of most Web services today. At Google, he helped to develop Google Docs before moving on to start Google Health.

But as everyone knows, Google Health was a failure—and so was Bosworth’s next effort, Keas, at least until the venture-backed startup went through a dramatic pivot in 2010. How Bosworth figured out that his old approach wasn’t working, and how Keas reinvented itself as a provider of health-focused games for large employers, is the tale I want to tell you today.

It’s looking like there will be a happy ending: Keas (pronounced KEY-us) is bringing on 90,000 new users per quarter and has grown to 20 employees, thanks to continued backing from Atlas Venture in Cambridge, MA, and Ignition Partners in Bellevue, WA. But to hear Bosworth tell the story, things were touch and go for a while, and Keas didn’t really turn itself around until Bosworth stopped looking at his beautiful software code and his analytics dashboards and started listening to young psychology majors and game designers.

“Most software people don’t start by thinking about psychology,” Bosworth says. “Most software people think about features first, because they are concrete and they know how to implement them. They think, ‘I would want this, therefore my users would want this.’” But sometimes—perhaps most of the time, Bosworth argues—they’re dead wrong.

Keas CTO Adam Bosworth

Bosworth grew up in New York and graduated from Saint Ann’s, a private academy where his father, Stanley Bosworth, was the founding headmaster. He says he discovered early on that he is dyslexic, and that he learned to compensate by thinking in pictures. This gave him a talent, he says, for “basically taking Lego blocks for adults, and finding really simple ways to help people build solutions to hard problems.” Those skills enabled him to make breakthrough after breakthrough in the software world, and turned him into one of the hottest commodities in Silicon Valley—Bosworth has ducked recruiting attempts by Facebook’s Mark Zuckerberg, among others.

But it was during the Google Health project that the limitations of Bosworth’s data-centric point of view began to show through. The idea behind Google Health was to get millions of people to put their health records—medications, lab results, immunizations, chronic conditions, and the like—on the Web in a central, secure repository accessible to them and their caregivers. “The idea I had was that in order to help anyone be healthier, you would need their health data,” he says. “This was in 2006, when only 10 percent of doctors had access to electronic health records, and only 10 percent of them would share it with patients, meaning that 99 percent of people weren’t able to get their own health data electronically.”

At the same time, coincidentally, personal financial management startup Mint.com was getting off the ground. “I had in mind doing Mint.com for health,” says Bosworth. Mint had three features that Bosworth wanted to emulate: … Next Page »

Wade Roush is a contributing editor at Xconomy. Follow @wroush

Single Page Currently on Page: 1 2 3 4

By posting a comment, you agree to our terms and conditions.

  • http://www.quantifiedself.com Gary Wolf

    Thanks for this great report on Keas, the most detailed and useful I’ve seen. I’ll take issue with a couple of peripheral points, since Quantified Self is mentioned in passing as a stand in for the “dashboards are wonderful magic tools that will make everybody compliant” fallacy. I completely agree this is wrong, by the way; I only take issue with the assumption that this is the approach favored by people who have been collaborating and sharing their knowledge at Quantified Self.

    We are not software producers or app makers, nor should you look at us to do interface design, though many people who come and present have pretty good skills in these areas, and have made useful, popular apps. Rather, we are advanced users and tool makers. What can you learn from us? Collaborating and sharing knowledge among pioneering users in a new field allows you to explore future, still nascent use case, and to get a bigger view of the “possibility space” than is accessible from only reading start-up pitches and business reporting.

    For instance, and relevant to the Keas story: The likely failure of dashboards has been a steady topic of discussion at QS since 2009. Last year, we posted a touching reflection about the difficulties associated with dashboards for behavior change from Marc Hedlund, whose Mint competitor, Wesabe, failed. Marc pointed out that Mint’s success in selling to Intuit, an insecure legacy software maker with a need for web services components, does not testify to Mint’s power to change behavior, and the data he has from Wesabe suggests that this change is overblown.

    The current discussion on the Quantified Self scene, which is relevant to Keas, is how easy it is to get positive test data from a well made gamification platform that has social buy in from executives and team leaders. Weight loss data from gamified, but non-technological weight loss programs with a social component, like weight watchers, is also very good. But long term data is discouraging. This is not a diss against Keas… It’s a problem for everybody to be honest about. I’m giving it here just as a taste of the higher level of discussion among the leading tool makers at QS that I wouldn’t want people to miss, because they might think we’re dashboard morons.

    Thanks Wade – !

  • http://www.xconomy.com/author/wroush/ Wade Roush

    Hi Gary — thanks so much for your illuminating comment. I definitely didn’t intend to reduce your whole movement to dashboards, and I don’t think Adam would endorse that view either. Quantified Self is obviously fodder for a whole separate series of articles.

    I think the overall point Adam is making, which I tried to bring out in the piece, is that data-centric platforms will probably never be very effective for behavior change in the populations that need to be reached. I asked Adam what he thought about technologies like RunKeeper, Runmeter, Withings, Zeo, Massive Health’s apps, etc. His response (which I paraphrased in the article): “I am skeptical that the people we really need to reach are the people for whom this is optimal…most of this is going to appeal people who are either very fit or very analytical in nature…I think there is a significant number of people who are very fit and very conscious, and for them this is good stuff. The problem is those aren’t the people who are sick.”

  • https://twitter.com/#!/mishachellam Misha Chellam

    A couple quick points:

    1) I had always thought of Google Health as a platform without a killer app. Keas is attempting to build a killer app, but I certainly hope that they are not fully abandoning the platform dream, b/c whoever does one day succeed in on-boarding millions of users who actively contribute health data points won’t be able to write the complete universe of valuable apps by themselves.

    2) I agree with Gary’s skepticism on the long-term efficacy of “behavior change” programs (even the phrase “behavior change” is problematic). As Thomas Goetz pointed out, the gap between what we know we should do and what we do [akrasia] has vexed us for millennia.

    3) Adam Bosworth is obviously clear-eyed about these challenges, as he essentially says that he could build a giant business off making people happier – Zynga does the same thing

  • http://www.crunchbase.com/person/dave-chase/posts Dave Chase

    This is a great story of a company pivoting and finding something that resonates, however Adam espouses a common myth when he states “If you want to understand why we have twice the healthcare costs of other industrialized nations, some of it is due to inefficiencies and inequities in how we deliver care, but most of it is just due to the fact that we are fatter than anyone else.” Actually, a surprisingly small percentage is due to obesity (see Wa Post link below busting that myth). This isn’t to say that obesity isn’t an important issue to solve (and it sounds like Keas is making progress on that front) but there’s other bigger factors driving costs. I covered some of this in my TechCrunch posts on healthcare disruption (follow the link from my name if you are interested in those).

    Here’s the link to what is/isn’t driving why the U.S. spends so much more on healthcare
    http://www.washingtonpost.com/blogs/ezra-klein/post/why-american-health-care-costs-so-much-in-one-very-long-graphic/2011/05/09/AFjSRVbG_blog.html

  • https://twitter.com/#!/mishachellam Misha Chellam

    Thanks for this comment Dave, and the link to the Washington Post infographic. I’d missed this and have definitely been hearing the statement that obseity-related diseases are driving our cost problems, I will have to go back and read your TechCrunch posts in more detail!

  • http://www.xconomy.com/author/wroush/ Wade Roush

    Dave — Thanks for your comment, but I am pretty skeptical about the claims you cite.

    The infographic that you mention, which was republished by the Washington Post’s WonkBlog in May, does indeed claim that “Costs in the U.S. associated with disease, including obesity, total only $25 billion in extra health care spending, a tiny fraction of the overall costs.”

    However, I think you need to look into the provenance of that infographic. It was produced by a group calling itself MedicalBillingandCoding.org, and it apparently drew on a study of medical costs that was produced by McKinsey and cited in the Incidental Economist blog (http://theincidentaleconomist.com/wordpress/the-blame-du-jour).

    If you dig into the McKinsey study you will see that the angle offered by the Incidental Economist, MedicalBillingandCoding.org, and by association the Washington Post, is a misinterpretation of the original study. That study was actually a comparison of disease prevalance and healthcare costs across several industrialized nations (Japan, Germany, France, Italy, U.K., U.S., and Spain), and it concluded that obesity and other diseases that are more common in the U.S. than in other countries account for $25 billion in *extra* costs — meaning costs relative to the costs borne by the other countries in the comparison.

    I think it’s wrong to claim on the basis of this study, as MedicalBillingandCoding.org does, that most healthcare spending can’t be blamed on disease prevalence. Which is a pretty hard claim to swallow in the first place, if you step back and consider it. If healthcare costs don’t come from treating disease, then where do they come from? Certainly not from prevention, which is notoriously underfunded by the U.S. healthcare system.

    It is probably true that obesity is not one of the most expensive diseases to treat, but it’s linked to many other extremely expensive problems, foremost among them diabetes. It almost seems to me like there’s a willful effort underway in some quarters to play down the proportions of the obesity crisis.

  • http://www.avado.com Dave Chase (@chasedave)

    Wade – My gut sense is that obesity is the proverbial fat rat moving through the snake. I’d never argue that it’s not going to be a huge issue but I don’t think it’s the big cost driver…yet. However, my main point is that there are relatively low hanging fruit to tackle healthcare costs. The biggest thing that I have become a believer in is the Direct Primary Care model (and its counterpart Onsite Clinics) as they have shown the most impressive results at making huge impacts on downstream costs. For example, they have shown they can reduce the most expensive facets of healthcare 40-80%. These are things such as surgeries, specialist & ED visits. Led by IBM’s study of their $2B spent on health benefits, the results point to a surprisingly simple formula. More access to primary care = healthier population = less money spent.

    Both Direct Primary Care and Onsite Clinics reverse the damage that has been done to primary care models and make it economically viable and professionally desirable. See Wade – My gut sense is that obesity is the proverbial fat rat moving through the snake. I’d never argue that it’s not going to be a huge issue. However, my main point is that there are relatively low hanging fruit to tackle healthcare costs. The biggest thing that I have become a believer in is the Direct Primary Care model (and its counterpart Onsite Clinics) as they have shown the most impressive results at making huge impacts on downstream costs. For example, they have shown they can reduce the most expensive facets of healthcare 40-80%. These are things such as surgeries, specialist & ED visits. Led by IBM’s study of their $2B spent on health benefits, the results point to a surprisingly simple formula. More access to primary care = healthier population = less money spent.

    Both Direct Primary Care and Onsite Clinics reverse the damage that has been done to primary care models and make it economically viable and professionally desirable. See http://www.delicious.com/chasedave/DPCArticles for more on Direct Primary Care.

  • Pingback: Workplace wellness startup Keas raises $6.5M | mobihealthnews

  • Pingback: Why Mint.com for Health Is a Terrible Idea | The Health Care Blog

  • Pingback: Can Your Friends Bribe You to Get Healthy? Neuroscience Says Yes | Xconomy

  • Pingback: Gamification Hits Healthcare as Startups Vie for Cash and Partners | Xconomy

  • Pingback: Recommendation Algorithms + Humans: How Health Insurance Exchanges Should Work

  • Pingback: Get Employees Engaged, Then You Can Talk About Wellness, Says Keas | Xconomy

  • Pingback: Health Tech | Annotary

  • Pingback: Avado, NY Digital Health Grad, Snapped up by WebMD | Xconomy