Q&A: Using gaming to reduce healthcare costs at Avivia Healthcare


Everyone in the healthcare business these days is looking for ways to reduce costs, and Avivia Healthcare, a wholly owned subsidiary of Kaiser Permanente, is no exception. For the past six years, Avivia, which provides care management services to large employer groups and regional health plans, has been trying to engage its customers' employees online, to prompt them to improve their habits and make better health decisions. The company's website offers a variety of Web 2.0 tools, but they only seemed to draw users in from time to time.

In March, Avivia is launching a beta version of a gaming and social networking system from Badgeville, to encourage individuals to engage more thoroughly in their healthcare on a more regular basis. This kind of gamification is being used in a variety of industries to help improve the bottom line. In an interview with FierceCIO, Nathan Petrovay, CTO of Avivia, talked about how gamification leverages natural human impulses to grab people's attention and keep them coming back.

FierceCIO: Why wasn't your website sufficiently compelling to engage users more regularly?

Nathan Petrovay: We've had tools and utilities in place to drive relevant content to our membership, but we found that they are ill-effective at creating behavior change. We've had these tools in place for the past six years, but realized we needed to engage users much more fundamentally.

Users would come to our site and engage with the material when incentivized by their employer or in conjunction with open enrollment. It's pretty common within large employer groups that employers will try to incentivize employees to engage in certain activities. These are singular activities that are episodic and don't really translate to medical outcomes. We saw traffic to the site ebb and flow.

FCIO: Why did you decide to try gamification?

Petrovay: We realized that most people are making healthcare decisions for themselves not in the context of delivery systems, like the physician's office. The decisions are made moment by moment. We are trying to engage people at the pre-chronic condition level. It's what we eat, it's our level of physical activity, it's our inability to manage stress. I think that systems like this have to emerge to really try to help people get engaged with their health. 

We wanted to have a site that would be so compelling to users that they would want to engage with this content more regularly, so we decided to utilize gaming methods to intrinsically motivate people. Gamification is nothing more than an abstraction of our natural human impulse. 

FCIO: How do the gaming tools work?

Petrovay: We allow users to come in on our gaming site and, in a fun way, provide information about their health. They can build an avatar [containing their health information]. We realized people don't want to sit down and fill out long, laborious forms. The construction of the avatar is done in the context of populating this form. We then try to drive suggestive health interests to them.  Our system finds out what motivates an individual. That's what gaming mechanics teaches us.

We try to drive the most relevant interventions to the person. It could be engaging with surveys and tools that help them improve their health. It could be a track for weight loss or for stress reduction. We try to engage them with specific tools and sustain that engagement over time. We provide a scoring system. They'll get more points for engaging in different types of activities. They can do this in a social context as well. They can join groups that are specific to their own condition or goal. The system can be deployed to your smartphone. We can track your movement, your motion and give you points for your activity.

FCIO: What kind of cost-savings are we potentially looking at?

Petrovay: Our goal and aim is to reduce total medical claims expenditure. That's our core business. For a particular user, that translates into less expenditure in one's own medical care. When you talk about wellness and lifestyle changes, it's nothing that is immediately quantifiable. The long-term benefit of making moment-by-moment decisions does translate into real-world savings.

FCIO: Are there any data privacy concerns in the context of gathering so much personal data via these gaming tools?

Petrovay: The [Health Insurance Portability and Accountability Act] mandates that employers are not able to see personal health information of their employees. Employees realize that this is not information that will ever make it back to their employer. There are safeguards.

Users can share whatever information or withhold whatever information they want. You would be surprised within the context of social networks what people are willing to share. We have a sense that this is the trajectory, and there is an appetite for this among the majority of the Americans.

FCIO: Do you see your organization as a pioneer in this arena?

Petrovay: We perceive this as something that's going to be game changing. We're not really seeing anyone [in the field] effectively using this, and we really feel like we're ahead of the curve.