Can Your Friends Bribe You to Get Healthy? Neuroscience Says Yes
HealthRally is a company that Paul McCartney would understand well. It’s all about getting a little help from your friends.
A little help making health-related changes, that is—like quitting smoking, losing weight, or adhering to an exercise program. There’s plenty of science to suggest that these goals are easier to achieve when a person has close friends and family supporting them—and even easier when there’s money on the line. HealthRally lets a group of friends or family members organize around someone who’s trying to achieve a goal, such as “run a 5K” or “lose 15 pounds before the wedding,” by contributing to a financial reward that’s only handed out if and when the goal is met. Through the startup’s website, strivers get carefully timed motivational messages, while supporters get updates about their loved one’s progress.
Lurking right behind HealthRally’s cheerful Web interface, there’s a complex recipe that draws on lessons from neuroscience and behavioral economics to keep users and their teams of supporters inspired. The co-founder of the company is Zack Lynch, who’s something of a celebrity in the world of business and neuroscience; he’s the executive director of a Washington, D.C. lobbying group called the Neurotechnology Industry Organization, the co-founder of a market research firm called Neuroinsights, and the co-author of The Neuro Revolution, a book about advances in brain science and their implications for law, economics, marketing, art, religion, and even warfare. Lynch says he co-founded HealthRally with Peter Kaminski, the co-founder and former chief technology officer of enterprise software company Socialtext, because he didn’t see anybody using the latest insights from brain science to help consumers beat common problems like obesity and addiction.
“The cutting edge of neuroscience is behavior change,” Lynch argues. Indeed, studies prove people will go out of their way to earn modest rewards. One 2009 study reported in the New England Journal of Medicine, for example, showed that a $750 reward was enough to increase smoking cessation rates by a factor of three (15 percent of people in the reward group were still non-smokers after a year, compared with 5 percent in a control group). At HealthReally, which earns money by keeping a 7 percent slice of each reward administered through the site, Lynch and Kaminski are betting that they can translate such science into profits.
HealthRally debuted last fall with $400,000 in seed funding from Esther Dyson, Ty Danco, and other prominent angel investors. This spring the company went through the incubator program at Rock Health, the San Francisco-based haven for healthcare technology startups, which held its latest demo day this week. In a pair of interviews with me—one held before the company entered Rock Health, and one after it finished—Lynch shared the story behind the startup’s founding, as well as some thoughts about how HealthRally is different from Keas and other companies applying “gamification” principles to health. He says the startup is gaining users fast, and is now in talks with venture firms, software companies, and other potential strategic investors about raising Series A financing. The edited transcript below captures our conversations.
Wade Roush: Where did the idea for HealthRally come from?
Zack Lynch: It was through writing the book that a couple of things came to me. One was that the cutting edge of neuroscience is behavior change. The time to develop treatments for new brain illnesses is long and costly; it takes hundreds of millions of dollars if not billions to develop central nervous system drugs. But within the software world I saw an emerging segment that I call neurosoftware—taking the basic principles of neuroscience and applying them to software. Some of the early companies are developing cognitive-fitness apps to slow memory decline. Others are focused on cognitive behavioral therapy for depression. There was no one really focused on leveraging the cutting edge of behavioral economics and neuroscience and applying them to obesity and addiction, which are the two largest markets of all. It was the meshing of those things, as well as some personal experiences, that helped me come to the “aha” moment that was HealthRally.
WR: What sorts of personal experiences?
ZL: My brother was a smoker. He lives in Seattle, is an avid photographer, and is chief strategy officer of his own biotech startup. We wanted to support and inspire him to quit smoking—“we” being his family and some of his friends. I said I’d put in $100, and each of them said they’d put in some money. That grew pretty soon to $500, but I realized that the money wasn’t enough. There needed to be a way for us to stay in close contact and support him socially in the morning and the evening for the first couple of months while he was quitting.
In behavioral economics, the research shows that a couple of hundred dollars as a reward can triple one’s success rate in quitting smoking and quintuple success rates in losing weight. That meshed with emerging social health science research that shows that when you bring friends and family together, that’s your best motivator. They can hold you accountable, and that improves your success rate.
WR: Okay, so walk me through how the service works and how people are using it.
ZL: HealthRally lets friends and family—and soon brands and companies and health plans—pledge money to support, inspire, and motivate someone to achieve a health goal, whether that’s losing 30 pounds or going to yoga three days a week or taking a diabetes medication. You can use it in two ways.
One is to take charge of your own health; you know what you want to achieve so you pull in your friends. But unlike Facebook, this is a private social network—you are bringing in the four to 30 people that you would really tell the truth with. You choose a reward that will inspire and motivate you. Maybe it’s cash, maybe it’s an iPad, maybe it’s a day at the spa with your girlfriends, or maybe you’re raising money for charity. You launch your rally, and it’s three to six months long, and your friends inspire you through a private activity feed. It’s like a Kickstarter for health. What we are seeing in the initial user base is that rallies are either radically funded, or not at all.
The other way people use it is when your friends and family decide whether you reached the goal. There is a social verification process, so you don’t just get the money. It’s only if they declare you succeeded. That amplifies the level of social support, because you have accountability. If your aunt puts in $50 and you have mom puts in $30 and your five friends put in $20 then you have $180 on the line to lose 15 pounds in three months, and those people are checking in with you. We also have an internal artificial-intelligence engine called Rally Coach that monitors the motivation levels of the rally. If you haven’t updated HealthRally in a couple of days, we ping you or a random supporter and say, Hey, check in on them.
With my brother, he was psyched. He said, “This is great, I have tried to quit smoking three times and I didn’t have any help. You’re giving me a kicker? I’ll take the challenge.”
WR: What’s the neuroscience behind all this? In what way does the design of HealthRally’s rallies reflect what we know about how the brain deals with rewards?
ZL: What we know is that an uncertain reward keeps people interested and involved, and when that reward is provided it spikes your dopamine [a neurotransmitter associated with reward-based learning]. So you are going to stay involved, because your brain wants that dopamine spike. But that is only half the game. The second half is the social support, which increases your serotonin levels and boosts immune health and makes it possible to achieve more difficult goals. If you’re going to get off the couch and run that 5K, it’s going to require your whole brain system to be involved.
WR: There are several companies that administer rewards-based programs for large companies to help them incentivize their employees to make healthier choices, with the goal of lowering the employers’ healthcare costs in the long run. You aren’t going after that market, at least not yet. Why not?
ZL: You do have enterprise-to-employee programs out there, and they are not effective because when your coworkers get involved, that’s cute and interesting but those are not the people you are really accountable to. There are also some systems out there that are nice form the perspective of badges and levels, which are also commendable approaches to motivating people to achieve goals, but they will run their course. From what we can tell from the data, it’s getting loved ones involved that is the real accelerator.
WR: So you’re not a big fan of “gamification” in health.
ZL: It’s cute and it will work for some people, but the middle of the bell curve is not going to be driven to substantial behavior changes by badges and levels. It’s a big world out there and change is hard. The beauty of having your close, authentic social network as your motivational team is that they are basically gaming you all the time already. That is the game mechanics you want—the real humans involved in your true life experience.
WR: What do you think of Keas, here in San Francisco? They’re one of the leading companies organizing health-focused competitions within companies.
ZL: They have a fine approach. There is an incentive ecosystem emerging. It’s a huge space, because we’ve got to figure out how to motivate people to be healthy. I think the core philosophical difference between our approaches is that when you have friends and family pledging for you to do better, it’s real money coming out of their pockets. Would you rather earn $50 from a friend or $50 from your company? There is a different valence to the money and what it means. There is a sense of moral obligation that comes along with money from friends and family.
WR: Personally, I’m not sure that HealthRally is something I’d want to use to achieve a goal. When I set a goal, I usually just try to go do it. I don’t necessarily want all my friends and family looking over my shoulder.
ZL: It’s really interesting pitching the HealthRally idea to people in the Bay Area versus people in the South or the Midwest. Everyone is into fitness here. It’s all about the quantitative self—“How does this help me track myself better.” You guys are data junkies. That is not the middle of the bell curve. The middle of the bell curve is the real America. Ground zero for our product would be a place like Atlanta, where people are obese and smoking, but still connected.
WR: Can you talk about your experiences as part of the Rock Health accelerator this spring?
ZL: For a company like ours it was a fantastic experience. Learning alongside the other digital entrepreneurs in the health-tech space was not only joyful, in that we were all trying to do new stuff in different ways, but it was also valuable from the perspective of all the new relationships that were instantly made possible by their network. Getting together with the folks from Procter & Gamble to explain our grand strategy—that’s a meeting that might have taken me two months to set up on my own, but at Rock Health it happened the next day. Ditto for Mohr Davidow, and for relationships with health plans like UnitedHealth Group. Conversations like that are dramatically accelerated by being part of Rock Health.
WR: How did the product or your business strategy evolve while you were in the program?
ZL: One of the things that we have been focusing on since we joined is the design of the Rally Coach experience and really optimizing our AI engine to learn how to appropriately nudge people, and when not to nudge, and how to nudge—which messages get people to move and which don’t. Cooper Design, a design firm that supports Rock Health, basically offered free time with some of their best designers to walk us through some of the user experience issues they’ve seen, from having done this a bunch, and get their feedback. We worked on tweaking the messaging, the design, the buttons. That’s been the focus over the past couple of months—how do you dramatically increase engagement by leveraging the technology.
WR: You had a large alpha test with over 3,000 people even before you entered Rock Health. How are things going on the user acquisition side?
ZL: We are on a growth curve that is totally driven by our public relations campaign. When stories get placed in magazines and blogs, we see immediate spikes. We were in AARP’s magazine last week, and in the South we saw a bunch of new users, especially in Florida. Another thing we are trying to figure out and capitalize on, as I mentioned in my demo day presentation, is that a lot of people are doing weight loss rallies before weddings. And it’s not just the brides and bridesmaids doing it, it’s the groom also. So we want to make that part of our secret sauce.
WR: A wedding is an interesting example. By definition it’s a one-time event with a real deadline. How do you get people to stay active after that? And more generally, once a reward on HealthRally has been claimed, how do you get people coming back to pursue additional goals?
ZL: There are a couple of ways we target that. First, we recommend maintenance rallies. When somebody is approaching their goal, we send out notes to their supporters saying “Your person is 95 percent of the way there, now is the time to start thinking about a maintenance rally.” Say it was a three-month weight loss rally—you might double your pledge in order to get that person to stick to their new weight.
From a theory perspective, I feel our product differs from any of the enterprise-to-employee products because the money is coming from your aunt and your mom and your brother. When they put in the money, you have an obligation to stick with it. They are the people who will say, “Hey, those jeans look good on you,” or “Hey, it looks like you are falling back.”
WR: Yeah, it’s funny how our friends and family members can be more brutally honest with us than our co-workers.
ZL: A lot more. That is part of the secret sauce too. I think we are in the early days of understanding how you mix social and financial incentives to reach health goals, but in the long term enterprises will want to adopt this approach.