The year was 2018. Our practices had been around for 25 years, and I knew something had to change - specifically the name. For years, we were known as Sport and Spine Rehab. When I created that name, there were no other practices in the DMV (District of Columbia and surrounding Maryland and Virginia suburbs) that had a similar name.
While I could trademark our logo, I was unable to get a trademark for the name itself, which became problematic. Why, you ask? Because by 2018, there were chiropractic, physical therapy, orthopedic and pain management practices in the region with sport, spine, rehab or any combination of those terms as part of their practices’ names. This created a lot of brand confusion. Our medical referral sources even got confused when attempting to refer us patients.
So, my leadership team and I decided to rebrand. Our new name? Kaizo Health. Kaizo is the Japanese word for “rebuild,” “reconstruct” and in the gaming world kaizo means “a hack” or “pushing the limits of human potential.” Now that is our company’s DNA!
I knew that the rebrand was also a great opportunity for us to “rethink” everything about our practice. A rebrand shouldn’t just be about a name, a logo or some hot new colors. It’s really about reinvention. So, my team and I decided to address one of our largest challenges: self-discharges.
The Problem: Self-Discharges
Self-discharges are when patients don’t complete their prescribed care plan. Why does this matter? Well, from an outcomes perspective, we would expect that when patients complete their care plan, their function (and therefore their short- and long-term outcomes) should be better than those who do not. And of course, the business case for patients attending their prescribed visits ties directly to greater revenue.
Because we are very data-driven, we have lots of data on our doctor discharges (those who do complete their care plans) and self-discharges. In fact, our EHR allows us to populate why patients self-discharge and when we reviewed the data, we clearly identified that “feeling better” was one of the main reasons patients discontinue care.
Patients feeling better is a good thing, right? Yes! But if they don’t complete their care, and they are only symptomatically better, but not functionally better, then their condition may return. That means more health care services, fragmented care delivery, more health care system costs, and ultimately could mean poorer outcomes. Further, there is clear evidence that previous injury often correlates with past injury.1
Creating Behavior Change: An Intriguing Discovery
So, we evaluated multiple clinical studies and researched large Fortune 100 companies’ strategies around creating behavior change, and meeting people where they are which is on their smartphones! Study after study, systematic review after systematic review, we found that mobile apps can improve care plan adherence.2-4
So, we went to work. We built a prototype. We did human-centered design studies. And we had a hypothesis: Gamification, specifically a rewards program built into an app, could drive improved prescribed care plan adherence. We built the first version of our app, and we launched it in our clinics in 2019.
We built the app with all sorts of benefits: The patients get points every time they attend their clinic visit (gamification). When they hit a milestone number of points, they receive an OIG compliant reward.5 Furthermore, the patients can do their home exercises right through the app. The patient can schedule a visit, leave reviews, or refer a friend or family member, and more – all through the app!
The response from our patients was all over the map, from mostly, “OMG, you have your own app? How cool!” to some saying, “I don’t download apps on my phone.”
After the launch, we reviewed some preliminary data and it strongly suggested that our patients who downloaded the app were more adherent to their care plan. In early 2021, we reviewed all our data from 2019 and 2020. The sample size was over 4,000 patients. We found that patients who were on the app attended 36% more of their visits than those patients who did not engage with the app.
When we looked at all our back-end analytics to see how our patients were using the app, we saw that the #1 screen being used was the rewards screen. The #2 screen being used? The home exercise screen. Pretty cool, right?
In-clinic adherence through gamification should drive better patient outcomes. More home exercise adherence should drive better outcomes. That’s pretty exciting! But we haven’t yet proven that better adherence with our technology directly correlated with better outcomes – yet. (More on that in a future DC article!) We subsequently published our study in the Journal of Medical Internet Research Rehabilitation and Assistive Technologies.6
Why It Works
How is this even possible? Well, think about it. Are you enrolled in any rewards programs? Hotels? Airlines? Gas stations? Coffee shops? People inherently like free stuff, so if they are rewarded for good behavior, then they are more likely to behave in a way that aligns with the mutual goals of both patient and provider to get the best possible long-term outcome.
Let’s be clear, this is not about running up a bunch of unnecessary visits. This is about using behavior change science to drive better patient behaviors to a clinically appropriate prescribed care plan based on the latest clinical practice guidelines, patient values and clinician experience. There is a growing body of evidence to support this principle.7 And still, we know that more research needs to be done.
Technology, behavior change science and data science are changing the health care landscape. Chiropractic as a profession has not kept pace with other health care industries, but that is changing. I, along with many other like-minded technology entrepreneurs in our profession, am committed to doing everything we can to leverage technology, meet patients where they are, and drive demonstrably better outcomes for population health.
This is no longer our collective future; it’s our present. So get ready, because we are on the cusp of supporting exponential growth for chiropractic and the patients we serve!
References
- Fulton J, Wright K, Kelly M, et al. Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. Int J Sports Phys Ther, 2014 Oct;9(5):583-95.
- Zhao J, Freeman B, Li M. Can mobile phone apps influence people's health behavior change? An evidence review. J Med Internet Res, 2016 Oct 31;18(11):e287.
- NG R, Carter SR, El-Den S. The impact of mobile applications on medication adherence: a systematic review. Translational Behav Med, 2020 Dec;10(6):1419-1435.
- Rathbone AL, Prescott J. The use of mobile apps and SMS messaging as physical and mental health interventions: systematic review. J Med Internet Res, 2017 Aug 24;19(8):e295.
- https://oig.hhs.gov/documents/special-advisory-bulletins/887/OIG-Policy-Statement-Gifts-of-Nominal-Value.pdf
- Greenstein J, Topp R, Etnoyer-Slaski J, et al. Effect of a mobile health app on adherence to physical health treatment: retrospective analysis. JMIR Rehabil Assist Technol, 2021;8(4):e31213.
- Cugelman B. Gamification: what it is and why it matters to digital health behavior change developers. JMIR Serious Games, 2013 Dec 12;1(1):e3.
