And it might actually work, maybe
FORTUNE — A few weeks ago I wrote a column for the magazine about how most health apps don’t work very well, aren’t reaching those most in need, and — besides — counter to all claims that technology will save health care, several proven solutions involve real people, interacting with other real people, in real life. My goal was to call B.S. on what I find to be an all-too-pervasive Valley-ism: that smartphone software that tracks steps or helps photograph food or replaces your doctors visit will revolutionize medicine and change the world. No. For the most part, health apps are selling to the least needy but most willing buyers: rich people who care about being healthy. My colleague Dan Primack, who is out in the Bay Area this week, calls it “a particularly insular narcissism” in Silicon Valley, which seems exactly right.
But to every rule there is an exception, and glad I was to be called out (and called up) by the founder and CEO of one mobile-health company whose entire premise is based on scientific research with repeatable results — the exact study, in fact, I had used as my example of what works better than a health app. Omada Health’s first product, called Prevent, is essentially an online version of the Diabetes Prevention Program, which grew out of an NIH study proving the most effective means of staving off diabetes is rigorous lifestyle intervention, overseen by health coaches.
Sean Duffy, Omada’s CEO, says he looked around and saw all these programs that “weren’t built upon a ton of medical evidence. This wasn’t the fault of companies,” he said, “Just more a symptom of tech-DNA, rather than clinical-DNA.” He went on to describe the problem as he saw it — that tech companies focused on making a product that consumers would love, with little attention to the underlying clinical effectiveness, while medical companies made products that were terrible to use, even for doctors, even though they were built on the back of important research. His goal, with Omada, is to do something in-between, that everyone likes to use, and that is proven to work. “It’s very human-based,” he said, playing to his audience.
Prevent works in much the same way the YMCA’s Diabetes Prevention Program works — a group of people (12, in Omada’s case) take classes, engage in challenges, and generally support one another with the help of a health coach for several months to a year, with the goal of losing 7% body weight and preventing the onset of Type 2 diabetes. Both programs cost between $400 and $500. Prevent’s cost includes a cool digital scale. The online group is made up of people who live near you and are of similar age and body mass. The health coach lives locally, too, and is available to participants by email, phone, and text-message. The power of an online platform, Duffy said, was that unlike a brick-and-mortar program, it’s easy to scale up.
This is true for all sorts of businesses, but I don’t think it’s true for one that aims to meet the underserved and most at risk where they are — in community centers, libraries, churches. These places already exist, there is no brick to lay, or even rent. Besides, how many older, poorer people have a smartphone or Internet access? “You’re right and wrong on that,” Duffy said. “Technology is expanding incredibly rapidly in every pocket of the world, and the trends are accelerating.” Every technology company is going to say this. It’s obvious and true, to a point. Lots more people today can go online in some fashion than were able to a decade ago, so, what, we wait 20 years for the olds of today to die off so the olds of tomorrow have smartphones? He pointed me to a survey conducted by the Pew Research Center this August, on home broadband, and said “technology is headed in the right direction, that’s where you are off.”
I looked at the survey. About 20% of all Americans neither own a smartphone nor have access to broadband Internet. Twenty per-cent. One fifth. That’s about 62 million people. And, according to Pew, if you make less than $30,000 a year there’s nearly a 50-50 chance you do not have Internet access at home. Further, 43% of those 65 or older do not have home Internet. The rate of adoption may be accelerating, but there is a long, long way to go.
The last argument Duffy made, however, was more compelling. And it wasn’t an argument so much as it was a scenario. So many medical problems are problems about prescription, he said. Doctors want to give a patient something, some action, to make them better. With lifestyle illnesses like pre-diabetes, the action can often feel fuzzy, unspecific. Lose weight. Take the stairs. Eat more salads. With Prevent, Duffy said he knows of doctors setting up patients with the program immediately, while in the office. Which is, in a way, one step more powerful than sending a patient off to a program at the Y, perhaps. But this also assumes an awful lot. For example, that an at-risk individual would be in a doctor’s office to begin with. Duffy is well aware of the limitations. “It is hard to move the U.S. health care system, and it is hard to build a business in the U.S. health care system. But we’re doing that, with consensus. We are trying, and the program is working in certain pockets, and those pockets are big, and that difference is meaningful.”