Mango Health, a health startup launched by former executives from mobile gaming company ngmoco, believes that by combining game mechanics with an intuitive, fun design and useful features, they can keep patients on track. Since August, the company has been beta testing the app with a small set of users, but on Tuesday it said it had launched in the app store.

“One of the biggest challenges in this space… is long-time use, loyalty and retention – and that’s the skill we bring,” said co-founder Jason Oberfest. Over the course of a 16-week pilot, he said, Mango Health’s medication adherence app saw engagement rates that were three to four times higher than any of its best performing mobile games.

The app offers several tools, including a simple way to check for medication interactions and timed reminders to take your meds. The app’s colorful, clean design is more inviting than many health apps on the market. But the real trick to getting people to stay hooked is a reward system. Each day, users have the opportunity to earn 10 points for letting the app know that they took their medication. Over time, those points can be redeemed for perks like Target gift cards and charity donations.

The reward system also provides a way to keep the app free. Oberfest declined to share details but said the brand integrations are paid for as a form of advertising.

Several other  health startups are attempting to address the same problem with different kinds of technology. MediSafe, for example, also offers a mobile app that reminds patients to take their meds, and if they don’t indicate that they’ve done so, the app notifies a friend, family member or a caregiver. AdhereTech, which was part of health startup accelerator Blueprint Health, uses sensor-equipped pill bottles to monitor whether patients take their prescriptions. And AllazoHealth, another Blueprint company, uses demographic, behavioral and other data to help health insurers and pharmaceutical benefit managers (PBMs) predict who will stick to their regime and who won’t and then determines the most appropriate interventions.

With a successful background in gaming, Mango Health’s founders bring an interesting perspective to the health care. But, as with all new approaches to behavior change, it will be interesting to see how effective the app is over time. The company, which launched last summer, has raised $1.45 million from Floodgate Fund, First Round Capital, Steve Anderson with Baseline Ventures, Zynga co-founder and CEO Mark Pincus and Khosla Ventures’ Keith Rabois.

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According to a recent Reuters article, parents in several states are up in arms about inBloom, a $100 million project funded by the Bill & Melinda Gates Foundation, the Carnegie Corporation and others to create a massive database of student data. In fact, it said that parents in New York and Louisiana, as well as the Massachusetts chapters of the American Civil Liberties Union and Parent-Teacher Association, had written to state officials in protest, citing privacy and security fears.

But while privacy and security concerns are certainly warranted (information about children is obviously not to be handled lightly), supporters of the project say they believe that by shifting the conversation from risks to benefits, those fears could be assuaged — and some say the health care industry can provide a positive example.

On a panel Monday at the SXSWedu education technology conference in Austin, Stephen Coller, a senior program officer at the Gates Foundation closely tied to inBloom, said the electronic medical records (EMR) legislation that accompanied the stimulus package played a crucial role in elevating public discussion and action around patient access to their data, and he’d like to see something comparable happen in education.

Privacy concerns related to health data certainly continue and, he acknowledged, the EMR effort is still in early days. But Coller emphasized that electronic records helped raise public dialogue around patient data and empower people to believe that they should be able to access their data.

“Unless you give parents access to data and you make them aware that they should have access to data, we’re not going to make fundamental progress on this issue,” he said. “We seem to be heading in the right direction in health care, the debate in education shouldn’t be that different.”

Right now, the conversation around privacy and student data is full of misinformation and irrationality, he said, and too many schools believe it’s only the vendors, not the parents and schools, who own student data — but by focusing on outcomes he hopes that could change.

Already, companies like Bellevue, Wash.-based Dreambox Learning are showing how adaptive lessons and real-time reporting can personalize instruction. Startups like Kickboard and Civitas are starting to show schools and parents the value of capturing and analyzing student data. And, at SXSWedu this week, several vendors are demonstrating the applications of inBloom (we’ll have more on that later this week.)

But Coller raised another interesting idea: a “digital student report card” (which, he said, President Obama once surfaced on the campaign trail in 2008) that, like an EMR, would give parents a digital record of their child’s educational progress.

“The notion that every student in this country is entitled to a digital report card, to me, seems like a fundamental civic right and strikes me as non-controversial,” he told me after the panel. “To any parent in the system, it would seem like a sensible idea – it’s their child, their school system, their tax dollars. The fact that they don’t have a line of sight into where their students are… has to improve. And I think it begins with putting more power in the hands of parents and caregivers.”

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But that growth is uneven. Whilst the sector is taking off in the United States, Europe acknowledges “barriers” remain. So the European Commission has drawn up an “action plan” to improve prospects (release, blog). That plan aims, by 2020, to:

• specify the structure of patient record data that can be exchanged across borders
• improved patients’ digital health literacy
• develop a mobile health green paper by 2014
• improved the market conditions for ehealth entrepreneurs
• and more.

Europe will have its work cut out. Every day, I read — on sites like Mobi Health News, Connected Health and GigaOM – about new mobile and web health management products that let patients monitor ongoing conditions, many of which are now being taken on by local health providers in the States. In Europe, not so much…

European digital agenda commissioner Neelie Kroes

The US health system is considerably more privatised than many others around the world, meaning far greater flexibility and willingness amongst local care givers to offer new technological solutions, and a greater opportunity for technology providers to succeed.

Healthcare in European countries is mostly publicly-funded, and that could lock out the commercial groups that are now developing innovative ideas. The UK’s much-loved public National Health Service, for instance, is beginning to creak under its own weight. My family has experienced such poor care and been given so little information about their conditions that I would rather they had a far greater individual role in their cases.

Apps and services that empowered them with more information and sent that information to trusted providers could improve the situation. Yet government proposals for greater private provision are routinely baulked at by citizens.

Some governments spend up to 15 percent of their budget on healthcare. But this very dependence on public funding — during, what, for many nations, is a time of public austerity — could also be the reason Europe has even more to gain from ehealthcare than elsewhere, absolving hospitals and doctors surgeries of the need to provide face-to-face care all of the time.

European Commission VP and digital agenda commissioner Neelie Kroes, announcing her new action plan, calls it “a win-win for ministers of finance and the patient”:

“Fundamentally, those health systems were designed to deal with a model of acute care, based around stays in hospitals or institutions. That was fine for the 20^th century but cracks in the system are beginning to show.

“These days, many health conditions are long-term and degenerative. That trend will continue as our population gets older. People with that kind of condition don’t always need the same pattern of care.

“So we have to adapt, and digital technology is there to help us change. Whether it’s remote monitoring that lets you be cared for at home, robots to help around the house, or simply mobile apps that empower you to take control of your own healthcare.

“There is a leadership gap between ‘eHealth’ technology and patients. The sector has been hesitant to embrace the digital revolution, preferring to stick to traditional methods and models. Politicians have preferred not to upset a system that has worked well in the past.”

Kroes is a one-woman digital beacon for Europe, pulling forward the continent on so many issues, like cloud storage, mobile data rates and audio-visual policy.

But healthcare is a national, not a continental, policy issue. If Kroes’ ehealth plan is geared mostly toward smoothing out national barriers — as so many one-nation European initiatives are — then it will be underwhelming. But if it aims to eliminate the barriers to technology’s entry in healthcare, then citizens should cheer the plan.

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In his latest book, former National Geographic and Time photojournalist Rick Smolan, who is best known for The Day in the Life series, features more than one hundred powerful stories from around the world about scientists, innovators and others using big data to improve medicine, conserve energy, track the weather and more.

MacArthur Fellow Shwetak Patel developed a sensor that can help homeowners determine which appliances are the biggest energy hogs.

The book, titled The Human Face of Big Data, hit shelves last month but on Tuesday Smolan and his partner Jennifer Erwitt released an iPad app that puts an interactive twist on about half of the book’s stories, with extra videos, charts and graphics. For example, in a story about how MacArthur Fellow and University of Washington computer science professor Shwetak Patel developed a sensor that can help homeowners determine which appliances are the biggest energy hogs, the app lets users tap on images of different appliances to see their energy load. Or in a piece about the global online collective art project The Johnny Cash Project, which combined fans’ illustrations of Cash into one video, iPad users can click on the individual pictures to see video of them being drawn. (You can see five of the stories from the book here, as well as a description of the project from my colleague Derrick Harris here.) All earnings from the app, which costs $2.99, will be donated to the nonprofit Charity: Water.

In addition to launching the iPad app on Tuesday, Smolan and his team sent copies of the book to 10,000 of the world’s most influential people, from President Barack Obama and United Nations Secretary General Ban Ki Moon to Oprah Winfrey and Actor Robin Williams to Facebook COO Sheryl Sandberg.

In October, the project hosted global events to bring journalists and big data innovators together. It also released Android and iOS apps that ask people around the world a set of questions about their beliefs, aspirations and lifestyles and then let them compare responses.

Earlier this fall, Smolan told me he believes big data is currently where the Internet was in 1993 but could change society in even bigger ways. While the government and corporations are considering its impact, he said he worries that ordinary people aren’t pondering about how big data could affect their lives.

“One of the goals  [of the project] was to get people thinking and talking about this world of big data while it’s still in its early formation stages,” he said.

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The acquisition, which is HealthTap’s first and is set to be announced Thursday, will expand its online community of doctors to 30,000 and enable the startup to provide local services for patients. It will also give HealthTap a directory of hundreds of thousands of doctors and dentists across the country (information that the startup previously licensed), which it can add to its database of more than a million medical professionals.

Through HealthTap, patients can pose anonymous questions to the general network of doctors for free or send text-based targeted messages to specific doctors for a small fee. They can also search the growing archive of questions by topic and see the top doctors in different specialties (as determined by other patients and doctors).

But co-founder and CEO Ron Gutman said that users increasingly indicate that they want to be able to find the best doctor for a particular topic as well as someone close by. The Avvo Health acquisition not only adds more doctors to its network, it increases the number of data points it can use to rank doctors and help pair them with patients.

“We’re able to match the question not only with the right doctor for you but also a local doctor,” he said. “And the directory can help you find a physician even if you don’t have a specific question.”

While HealthTap’s initial pitch was that it can help patients find credible and trusted answers to medical questions online, as it grows the startup is expanding its reach into doctor rankings and reviews as well as other services that help patients select physicians. On that front, it is beginning to compete with other consumer-facing sites like HealthGrades, Vitals and even ZocDoc, which provides patient reviews of doctors in addition to appointment booking services. But the added level of engagement on HealthTap could make it a more powerful marketing vehicle for doctors in addition to being a more complete information portal for patients.

Since 2007, Seattle-based Avvo has given patients a way to ask doctors private questions online. The company, which was backed by Benchmark Capital, DAG Ventures and Ignition Partners, also includes a site for asking questions of lawyers, called Avvo Legal. But Avvo only spun off the health side of the business and will keep its legal arm independent. The companies did not disclose the terms of the deal other than to say it was an all-cash acquisition.

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Because of that, as a category, aspirational apps and services that depend on real-world results have a significant built-in barrier to scaling that other apps rarely deal with: They’re subject to the frailties of human nature. Confronting users with the intent of getting them to change is a tough low-odds endeavor, and the early drop-off period poses a significant challenge to those web services and apps that are trying to make us thinner, fitter, or smarter.

Simply put, it’s tough for your company to scale when users uniformly drop off after the first few weeks.

There’s an understandable motivation then to look for ways to keep users coming back and engaged. The issue is that otherwise smart methods can become distracting gimmicks if not employed appropriately. Here are a few trendy options developers often reflexively turn to when creating apps that can easily become a liability if they don’t make sense to your service.

Make everything a game

There’s no arguing that gamification has been employed to spectacular effect. At the same time it’s extremely hard to do well. A common complaint about Foursquare, clearly one of the foremost examples of well-crafted gamification, is that users quickly suffer from “check-in fatigue.“ Once the initial glory wears off, most people get bored of staying on top of the leaderboard.

Perhaps more treacherous is when game-play features are strapped onto an app without proper context. Such applications routinely fail to get traction from the start. For example, Google News introduced “Google News badges” back in July 2011 to little fanfare. (I have yet to see anyone  show a level badge for how many news articles they’ve read; not surprisingly the company mercifully put the feature to bed in September)

The bottom line: gamification can help if it makes sense to the app and is designed within a context. As a gimmick it’s never enough to keep a user base engaged over the long haul.

Drag friends into it

In the real world, aspirational businesses often use a form of peer pressure to compel people to follow through on their mission:  personal trainers push us to keep our commitment to get to the gym, and Weight Watchers uses positive peer pressure to keep its members coming back and paying dues week after week. With apps though it’s a far different story. No matter how entertaining or lifelike, virtual avatars simply don’t have the same psychological impact as interacting with people in the real world. So while skipping out on a real person may trigger feelings of guilt, that avatar trainer in a PlayStation or Wii fitness game? Not so much.

The other approach, linking activities and milestones to the social graph, is a similar and obvious temptation for aspirational apps. The inevitable pitfall though is that most people tend to happily share the accomplishments they’re proud of (I ran an 8K!), but inevitably and understandably bury their disappointments (I skipped a scheduled run to eat a cake). The challenge for aspirational apps then is to replicate the discipline or positive reinforcement that’s created from real world interactions with trainers, professors, and peers, and not come off like a tattletale or nag.

Go quantified

While the  Quantified Self movement – succinctly described in ‘The Economist’ as “an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers and patients suffering from a wide variety of health problems” – isn’t new itself, new technologies are rapidly transforming what is possible with all that personal data.

Yet while data collection is becoming a more seamless part of our daily routine, quantified self applications tend to appeal to only niche, narrow markets (i.e., an early adopter fitness freak with sleep apnea). In order to scale on any appreciable level then, aspirational apps are compelled to target a broader audience base.

Require big cash, up front

In the offline world, consumers are often willing to pay a high price for aspirational products in a weak moment. You might call it the Rosetta Stone model, for the $500 language course we imagine will soon have us chatting up an Italian supermodel. Or maybe the fitness center model, as they annually convert droves of News Years hangover cases into pricey yearly memberships. In both cases, consumers feel great at the moment of purchase; however, only a minority of customers will actually use the product after the initial excitement and motivation wear off.

Similarly with an aspirational product, it’s possible this strategy could make for a quick initial hit (though at high price points there are low odds). But it’s unlikely you’ll maintain a happy, engaged customer base after that, which is crucial. More to the point, we’ve seen that people are hesitant to pay a lot of money upfront for most online services anyway, preferring to go with pay-as-you-go, no-commitment subscription models.

Humans are complex. We’re a convoluted mix of big plans and inertia. For self-improvement and learning apps to successfully scale, they need to find a way to keep their users happy, motivated,and committed over a long period. While there’s a large market awaiting apps and services that can overcome these challenges and can tap into age-old human needs for peer recognition, achievement, and self-improvement, designers need to consider the very real limitations of the methods they choose to keep users motivated.

Boris Wertz is the founder of Version One Ventures. Follow him on Twitter @bwertz.

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“Think of our vision as becoming a PayPal for the out of pocket [health] market,” CEO and co-founder Tomer Shoval told me.

From the beginning, Simplee offered users the option to pay bills directly from the site, but, over the past few months, it’s rolled out new partnerships that are bringing the company closer to Shoval’s broader vision.

Last month, for example, Simplee announced an integration with Silicon Valley’s El Camino Hospital to match a patient’s hospital bill with their insurer’s explanation of benefits (EOB) to resolve charges, explain claims, scan for billing errors and pay bills online. Earlier this year, it partnered with ACS|The HSA Solution, one of the largest HSAs (health savings accounts) in the country.

And on Thursday, the company introduced support for Medicare, giving the millions of Americans who qualify for Medicare benefits (according to the U.S. Census Bureau, there were 48 million beneficiaries in 2010) the ability to use the site to manage and pay their medical bills.

Navigating the health landscape is even more complicated for Medicare patients because their claims may be routed through two separate insurance companies. That means an even greater chance that they’ll miss benefits or make late payments.

With Simplee, Shoval said, patients (as well as the loved ones that might be taking care of them) can track their claims and bills as they are processed by both insurance companies, then see if they need to pay and, if so, do it through the site.

“The value that Simplee brings to Medicare patients is even greater than the value it brings anyone else,” he said.

And, with its Medicare integration, the company is bringing its services to a population that is not only growing steadily – 10,000 people turn 65 and become eligible for Medicare each day – but likely has a higher volume of medical bills and claims to sift through.

More startups bringing transparency to healthcare

Simplee is one of several new startups trying to bring more transparency into medical billing and health insurance process. CakeHealth, a San Francisco startup that has also been dubbed a “Mint for health insurance” and is part of Startup Health Academy’s latest class, similarly provides an online platform for tracking and managing health expenses.

But Shoval’s goal is to make Simplee the trusted destination for patients to make all of their out-of-pocket health payments, from hospitalization to dentist visits to primary care appointments. Between 2006 and 2010, Shoval said, the yearly amount that an average family pays out of pocket climbed nearly 80 percent, from $2,000 to $3,600.  As the consumer-driven healthcare movement makes consumers even more responsible for their medical spending, he believes there is an opportunity for Simplee to be the central hub for all of their transactions.

For consumers, he said, the platform will always remain free – Shoval launched Simplee after his family experienced its own confounding moment with the healthcare system and said helping others better understand their health expenses was a major motivation for the site. It plans to make money through a software-as-a-service model targeting employers, HSA banks and other partners.

By providing a single checkout platform, hospitals and insurance companies can receive payments that might be delayed or go through a collection agency because of patient confusion. And Simplee offers the added benefit of saving them money on paper (which can cost 70 cents to $1 per bill, Shoval said).

Simplee does not share the number of people currently using the site, but has said that it currently manages about half a billion dollars in member medical visits and that 60 percent of the members use the site at least once every three months.

One concern I’ve raised before is that consumers might not feel totally comfortable sharing sensitive health information with a new third-party platform. Data breaches aren’t an atypical occurrence and the procedures and care people receive from healthcare providers are very personal.  But Simplee said that it is very careful and strict about privacy and doesn’t sell user information. And, as people start using the site and realizing its advantages, the privacy tradeoff is one they might increasingly be willing to make.

Image from Andy Dean Photography via Shutterstock.

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On Thursday, the Palo Alto, Calif.-based company, which enables patients to connect with an online network of 15,000 doctors, announced a new Top Doctors Competition to bring more transparency to the quality of care physicians provide. As part of the ongoing online contest, patients and doctors will be able to vote for the clinicians they think are the top ones in each field. On each doctor’s HealthTap profile, users will be able to see the number of votes received from patients and other doctors.

In a sense, it’s similar to the 5-star rating system on ZocDoc, which is informed by patient reviews, and the patient satisfaction score on HealthGrades. But HealthTap’s voting system includes two separate tracks so that both patients and doctors can participate. HealthTap’s thinking is that patients can comment on a physician’s “softer” skills – their bedside manner, personality and empathy – but other doctors are best equipped to assess their peers’ actual practice and outcomes.

To ensure that doctors don’t try to game the system and hurt the reputations of other doctors, the system only allows up voting. And to discourage friends from just voting for friends, HealthTap adds accountability by randomly showing the names of a few of the doctors who have voted for a profile.

HealthTap already provides a “DocScore,” which gives patients a way to understand each doctor’s expertise and is based on publicly-available information, such as their medical school, residency, number of years in practices, as well as the reviews of other doctors on the site. But while that ranking may reflect a doctor’s knowledge about a particular field, HealthTap CEO and co-founder Ron Gutman believes the new ranking will provide more insight into each doctor’s ability as a practitioner.

“When people buy a phone, or something at the grocery store or clothing, we can easily see what’s high quality, what’s low quality, what’s the price and then make a good decision,” he said. “The funny thing is people aren’t even upset that they don’t [have this transparency] in healthcare… We need to demand to know who are the best doctors, and these kinds of things that make the doctors [competitive] among themselves and give patients the power to voice their opinion will make the whole healthcare system better.”

Image by Christopher Edwin Nuzzaco via Shutterstock.

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For now, the applications of personal health data are mostly the stuff of “Quantified Self” hobbyists and experimental research. But some say it may not be too long before personal health data becomes a powerful part of the mainstream clinical experience.

At the Health 2.0 conference in San Francisco on Wednesday, David Ewing Duncan, a journalist and author of “When I’m 164,” asked a panel of health data leaders when data-driven personalized health might reach “escape velocity”.

In reply, the panelists – who included Anne Wojcicki, co-founder of personal genomics startup 23andme; Andrew Litt, chief medical officer for Dell; Jake Leschly president and CEO of biomedical information and analytics company Ingenuity Systems and Aaron Horowitz, CEO of interactive toy company Sproutel – said they mostly agreed that widespread adoption could happen in five years, with some saying valuable but intermittent work could happen even sooner.

“I think you’re going to see meaningful impact in the 18-24-month time frame, but I think you’re going to start to see it widespread in all physicians’ offices in five to seven years,” Wojcicki said.

According to PriceWaterhouseCoopers, the personalized medicine market is expected to reach $450 billion by 2015, Duncan said. And an increasing number of companies are going after the opportunities. The field still needs more work to figure out how best the analyze and make discoveries from data. But examples are already emerging that point to what the future could be.

Wojcicki talked about how 23andme’s rich database of genotypic and phenotypic data (which users provide in response to surveys) is already helping associate genes and variants of genes with certain conditions. To date, she said, the company has 180,000 customers and receives one million new phenotypic data points weekly from the surveys.

“Big data – that’s the heart of what 23andme is doing,” she said. “How do I take all that survey data about you and combine it with the genetic data and make sense of it?”

Last October, the company announced that it had discovered a gene variant that may protect those at high risk for Parkinson’s. And she also talked about a recent example in which they helped determine that a specific gene variant was likely not responsible for pancreatic cancer. The traditional path would have involved months of research and potentially millions of dollars, she said, but 23andme’s genomic approach took only a matter of days.

And at Dell, Litt said, genomics research is working to help personalize medication.  Instead of taking a one-size-fits-all approach to drug recommendations, he said, the goal is for physicians to be able to prescribe the medication that is best suited for a patient’s particular genetic profile.

Image by wongwean via Shutterstock.

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