If it’s healthy to bike, why doesn’t biking reduce my healthcare insurance costs?
My thought process on this one was interesting. I don’t quite remember when I started thinking about this, but it recently came together in my head.
The benefits of exercise
Just 20 minutes of exercise delivers health benefits. Depending on your malady — you can improve depression, diabetes, weight, and more with a small amount of exercise.
Biking is exercise.My bike and my doctor are talking behind my back… and it’s saving me money #SmartCities #UseCase Click To Tweet
I’ve been using Citibike for just that reason. I have a weak knee. My alternatives are surgery or 20 minutes of biking a few times a week. For those who don’t believe this, I’ve avoided surgery for about 22 years because I happened to find a doctor who was ahead of his time back then and treated with exercise first.
Who benefits if people are healthier?
Aside from the people, insurance companies benefit.
If an insurance company can improve their financial metrics, why wouldn’t they?
So, why wouldn’t an insurance company subsidize a Citibike membership?
There’s an ROI calculation right there.
Is the health benefit greater than the cost of a Citibike membership (assuming the health benefit is the only one for the moment)?
Simple, right? Maybe. So why don’t they?
Let’s have a look at how this would work to understand where the barriers are (TLDR; the barriers are not technical, they’re procedural in how companies think about their offerings and how they deliver technology products to the market).
What if… ?
Here’s how I’d imagine that working. Not all of the technology is in place for this today, though I believe all of it is possible.
- I have agreed with my insurance company that if I stick to their exercise plan they will cover my Citibike membership, otherwise I will. I will share data about my rides with my insurance company, and we will decide each week if I have met my goals for coverage. The insurance company will pay for my Citibike up front and each week that I don’t meet my goals, they will automatically withdraw 1/52nd of my membership from my bank (or Apple Pay, or whatever). It’s seamless, and if I miss a whole week of riding it’s a penalty I can live with — this is the customer experience part, and an important part of the implementation to consider.
- I walk up to a Citibike with my iPhone and Apple Watch.
- I swipe my phone or watch to unlock the bike. By using my phone/watch instead of a FOB, I can incorporate sophisticated identity authentication, so that I know with great certainty who it is that has unlocked a bike. There’s also no manual intervention to the process of making sure all rides are tracked.
- If I have an Apple Watch, Gymkit is used to automatically start a workout and collect extra health data with that workout (like heart rate).
- At the end of my ride I swipe my phone/watch again. This is different than today, where putting the bike in the rack ends my session. Swiping again allows the identity authenticated via the phone to verify that I was the person riding the bike (because I was at both the start and finish points of the ride).
- After the ride, data from the bike and from my devices about the workout are sent via a HIPPA-compliant app using a FHIR API back to the patient data record system used by the insurance company to track this program. The insurance company can even offer a service to patients/doctors to share this work out information with the patient and their doctor so that they can better discuss health outcomes.
All in, some things to consider closely but not terribly difficult of a technical challenge. I think today one could use Bluetooth LE on the iPhone (but not NFC) so that would require different technology on the bike racks (which might change their fundamental economics that would impact the ROI). Also, in order to ensure that people swipe before their bike is locked at the end of the ride would take some user retraining and reworking of the bike dock software.
The key thing here is changing some of our assumptions around how authentication is used. We can use biometrics and Device DNA™ to make sure it’s me, and tie that right into the application flow so that we get beyond trusting someone that they’re working out according to plan. That same identity would be used to govern the HIPPA implementation requirements. There would be no manual intervention to the overall process.
By the way, today many corporate healthcare programs include gym membership discounts… but have no way to track if people are actually using them. The discount costs someone something… but there’s no governance. What’s amazing about smart cities and these bikes is that we can govern the behavior we are trying to encourage.Gym discounts through health insurance companies are fine, but smart cities are going to do that one better… Click To Tweet
It seems like a win-win, except we’ll infuse this with faulty assumptions that make it impossible to get to an ROI metric or deliver something simple. Complexity is the devil for simple use cases like this, at least until they’re proven to be valuable use cases.
complexity is the enemy of done.
— Amy Hoy ✨ (@amyhoy) January 8, 2018
Stop with the bad assumptions
In my head I hear people saying things like:
- My city has something other than Citibike, we can’t do this until we can support all cities.
- I walk, I don’t like to bike, we have to do this for people who bike AND walk or it’s not fair.
- Whatever we do has to work for iOS and Android users, or we can’t do it.
The answer to these is all… not really.
I think insurance companies need to start somewhere. Who knows if something like this will even be successful. Start small, manageable. Then grow. It’s easy enough to add other cities once we know how it works. It’s actually harder to solve for modularity and expansion until you understand the core integration problem and what kind of modularity you need. NY would certainly give a lot of data it being the largest shared bike implementation in the US.
If you walk and don’t bike, you have the exact same insurance offering you have today. If you want to take up biking, you have some motivation. If you don’t, well, other people will benefit and maybe on the next project, you will. (PS it’s quite obvious how once this is in place, the same could be done for walking should the benefits be able to be quantified so that an ROI could be done).
As for iOS and Android… NO! It’s faulty to assume that something has to be done on all platforms or none (see Aetna and Apple Watch). Tight integration is necessary to maximize the focus on customer experience and to make sure that an ROI can be achieved. Trying to support too many platforms dilutes the capabilities that can be supported, and increases the friction for users because they will be presented with things that make sense on other platforms, but not their platform of choice.
Reminder: cross-platform UIs mean your product looks consistent to you and weird to all of your actual users. https://t.co/NvT3X8KKDS
— Benedict Evans (@benedictevans) July 4, 2017
That doesn’t mean there shouldn’t be an Android solution. It means that even an Android solution needs to be vertically integrated to maximize the experience.
When you make assumptions like these, you introduce complexity. The complexity makes it harder to get the project started, and harder to keep the customer in mind. Focused on one’s own process, this seems like an awful lot of work just to give a customer a discount… there’s not really a penalty for companies to keep doing what they’re doing today instead of trying something totally new. So nothing happens… at least in this specific use case… for now.
If you think this is crazy, you’re not paying attention. This makes perfect sense in a connected city and is a great use of technology to demonstrate the benefit of being connected. For example, in China if you don’t follow the rules on trains it impacts your credit score:
I’m on the Tianjin to Beijing train and the automated announcement just warned us that breaking train rules will hurt our personal credit scores!
— Emily Rauhala (@emilyrauhala) January 3, 2018
April 13, 2018 Postscript
Here are some results from London, where bikes are eating commuter transportation:
The 16,000 people who cycled as part of their commute had lower rates of #heartdisease and #cancer and were living longer compared with those who largely sat in their cars or on public transport. 💪🏼🚴🏻♀️ https://t.co/cDYiEjgyXo
— Liisa-Maija Harju (@LiisaMaijaHarju) April 13, 2018
Those of us who commute by bike have:
- a 52% lower risk of death from heart disease/46% lower risk of developing heart disease; &
- a 40% lower risk of death from cancer/45% lower risk of developing cancer.
— British study in @bmj_latest HT @jen_keesmaat https://t.co/ErZzPI3Ec2 pic.twitter.com/A2Fhp9PLVB
— Brent Toderian (@BrentToderian) February 20, 2018
January 2019 Postscript
This is the exact use case I’ve described above.
The Dutch invest €595 million — or €35 per resident — annually on cycling (15 times that of nearby England). Seem expensive?
Those 17 million people collectively cycle 15.5 billion km. — or 912 km. per resident — annually, saving their healthcare system €19 billion (3% of their GDP). pic.twitter.com/x2S1UApvVj
— Modacity (@modacitylife) January 27, 2019
July 2020 Postscript
Holy cow, time sure flies!
New UK research shows the magnitude of health benefits for those who commute by bicycle. If I were paying for someone when they’re unhealthy, I’d totally pay them to bike to work. But, hey, that’s just me.
People who commute by bike have:
- a 52% lower risk of death from heart disease;
- a 46% lower risk of developing heart disease;
- a 40% lower risk of death from cancer
- a 45% lower risk of developing cancer
— Brent Toderian (@BrentToderian) July 13, 2020