There’s a common saying that “time flies when you are having fun.” If that is true, then the last year has moved quickly! At Wellsmith we have had a large cohort of participants on our platform for more than 12 months, and we have learned a great deal.

So, 12 months on, what have we learned and what does it tell us about our mission. Here are five hypotheses that we have learned enough about to answer – even partially.

Hypothesis 1: if you create a digital care plan that is intuitive to follow, people will want to follow it.

One reason I decided to join Wellsmith was the Wellsmith Team – a combination of three different disciplines:  consumer marketing, technology, and healthcare. Within the Team was a belief that people do not follow medical care plans because they are too confusing and complicated. If we could make them simple, memorable or actionable, then consumers (patients) would be more likely to stick to them. While our current population is not huge, around 400, after 12 months it is clear that we still have a majority of people sticking on a majority of their care plans a majority of the time. This seems like our hypothesis is still holding.

Hypothesis 2: digital care plans on smartphones are not just for the young

We hear lots of objections to ideas like Wellsmith and one of the most frequent was around age. Smartphones, the argument goes, are for the young; older people do not have, do not understand, or will not follow instructions delivered via a phone-like device. Here is what we discovered about our engagement rate (do people do what we ask them to) and age:

  • Our best engagement rate is with people between 60 and 70 years old.
  • Our worst engagement rate is with people between 20 and 30 years old

The biggest issue may not be age; it may be the economic status of potential participants.  Lower income participants tend to have limited phone plans, and those often come with low-priced or older devices. These devices may not support the latest technology and Bluetooth devices. At some point, it may be worth giving a free newer phone than lose the benefits for these potential participants.

Hypothesis 3: the key for Wellsmith is not medical outcomes but engagement

While it was clear from our early trials that we were making a difference, we struggled to know how to prove and quantify that difference. Our first idea was to ask ourselves “are we curing people?” The problem with this question is that Wellsmith doesn’t cure people (assuming that they could be cured). It is the care plan provided by the healthcare provider that gives the participants the opportunity to get better.

What Wellsmith did was to show, through data collected from engagement metrics, whether participants were following their care plans. More specifically that they were telling us they were following their care plans.  Despite what people might think, this is something that they didn’t know before.

Hypothesis 4: you can motivate people to engage more if you find the right way to communicate with them

It is not surprising that different participants responded to different communications tools. Some were responsive to in-app messaging and some needed to be contacted outside the app on their smartphone. In this second group, we use different channels – from email to texting, to personalized phone calls.  Part of the learning process is understanding which communication channel is most useful for select participants and to make sure we use that channel first.

One interesting thing we learned was, with some,  two-way communication wasn’t needed for it to be effective. There is a group of participants who will re-engage if we reach out to them when their engagement drops, even though they do not respond to our outreach directly.  We believe this group sees the communication of a ‘nudge’ that holds them accountable as useful without having to respond directly to that nudge.

Hypothesis 5:  people will get better

Another question we get a lot is, how do people on Wellsmith do compared to a matched cohort that is not on Wellsmith? We will publish this data later, but it does show an improvement for those on Wellsmith. What is interesting to me are some of the issues at the core of the question.

Follow this logic chain:

  • Are your Care Plans good? Yes or No
    • If No, write better Care Plans
    • If Yes
  • Are people following them?
    • If No, it is unlikely that they will get better.
    • If Yes and they don’t get better, then something else is wrong.

The result of this simple logic game is this: if the Care Plans are good and people follow them then they will probably get better or at least find a way to reduce the effects of this condition on their quality of life.

All of which is why we started Wellsmith.