Kristina: Hey. Welcome, everyone. I'm going to go ahead and start and introduce the panel. I'll start with myself. My name is Kristina Bartoccini Bryndal and I'm the Director of Sales at MapMyFitness. MapMyFitness is the largest and fastest growing community of fitness enthusiasts.

We're growing at a rate of about 25,000 a day. We've got about 10 million users. What we are is a suite of apps that connect to The Cloud, allowing people to plan, track, and share their fitness and nutrition information with everyone.

James: At Fitbit, we develop a series of products that allow people to track a variety of different metrics about their health, whether it is steps, calories, distance, sleep quality, weight, and body fat. Currently, we have two products out on the market. One is the Fitbit tracker, and that's mainly to help people track their activities and sleep habits. We also have a product called the Fitbit Aria, which is a WiFi body fat scale.

So, all these devices are meant to be used by consumers. They are all connected to the web, so any data that's collected by these devices automatically upload wirelessly to Fitbit.com. We also have a health dashboard on Fitbit.com that allows people to chart and view their health progress. Also, if they're interested in competing with friends and family across a variety of different metrics, you just use a lot of those steps.

Catherine: We've been in the weight loss for about 50 years now. It is based on long-term behavior change. So, long-term behavior change so that you lose weight and lose it for the rest of your life. We have about a million people that attend meetings every single week around the world, and we have about two million active paying online subscribers who to the program entirely online.

Our system, if you haven't heard about it, is based on what we call the Points Plus system, so every food and activity is given a point value. Our goal with the points is to simplify all that data that's out there around the foods you can eat and help make it easier to make those smart choices.

Our digital tools are online tools. We have a series of trackers that helps you follow that program and teach you the program by doing the Points Plus. Our other big principle is the value of support in a community. That support comes in the form of meetings and that's where our core business grew. But more and more in the last couple of years we have the real need for an online digital community around people who are trying to lose weight.

They have the ability to share tips and tricks, and also enter challenges together, weight loss challenges, and activity challenges, to hit your points target challenges. We're looking to integrate with mechanic devices that we're talking about today.

Jeff: I'm Jeff Hyman. I'm the CEO and founder of Retrofit. Like Weight Watchers we're a long-term behavior change program with just a different approach. We integrate a number of devices and experts, and allow people to work with their own private weight loss team of experts via Skype video conference.

Across the country we've got hundreds and hundreds of customers that every day interact with their own private team, and then use devices to track and monitor their progress. The results have so far been outstanding.

Jack: I'm Jack Lord. I'm the Chief Operating Officer of University of Miami School of Medicine. I've been a serial entrepreneur in this space, starting from the time I was Chief Innovation Officer at Humana. I've focused on ways for people to live healthier lives.

The focus of our work in some of the companies that we've started have included Sensei, which is a mobile weight loss and fitness program; B-Cycle, which is a joint venture between Trek Bicycles, Humana; and Crispin Porter, which is an alternative urban transportation program that links bicycles to the social network.

Navigenics, which is a personalized direct-consumer genetics testing company, which gives people information about their own life and the things that they can do to make a difference. Through our work at the University of Miami, now we're trying to figure out ways to build wellness into what historically has been a sick-care delivery system.

Kristina: Gary Wolf and Kevin Kelly are credited with launching the Quantified Self movement, and Gary subscribes to self- knowledge through numbers. How does self-knowledge impact how you build your business with technology? Have you been touched by this movement personally?

Gary: My interest in actually starting a company came from personal experience. I was enthralled with this Quantified Self movement, which for those of you who don't know, is just kind of the phrase around this trend of using devices and other metrics to quantify what we do as people, whether it's activity or food consumption or any kind of other event.

So, I'm just an early adopter of some of these devices, and it's really profound. It provides accountability. It provides a way to actually measure oneself, whereas in the past you kind of had to wing it, or kind of hope. I believe hope is not a strategy. So, in areas like weight loss, strength training, or some of the other applications that our companies provide, the Quantified Self movement just kind of pulls it all together.

I think one of the next frontiers, which we'll talk about in a few minutes, is kind of how to use this overwhelming amount of data to actually make it useful. Which is now starting to happen since we have so much data on so many devices and so many platforms, that it can actually overwhelm people. So, we'll talk about that in just a few minutes.

Kristina: Yeah, and anyone else have their own... James, do you want to chime in?

James: I actually think it's kind of funny that the Quantified Self meet up started just a few years ago, because actually Weight Watchers is considers theirs the first Quantified Self first, I suppose. Weekly meetings are the first Quantified Self meet ups.

For us I think the challenge of Quantified Self is that - I went to the very first one and I think a lot of the people there are very interested in very deep data, and I think in some cases and scenarios that aren't necessarily applicable to a larger audience. So, the challenge is figuring out what's truly valuable.

Catherine: Kevin, I can just chime in on that. I think that, like you just said, Weight Watchers really started with the sense of just understand the points of all your meals as a preliminary form of Quantified Self. Our challenge is exactly that. We've grown our business on simplifying the data that's out there.

So, instead of really focusing on all the nutrients and the different background nutrients, frequently we try to put it in one simple number. Then the number guides you to the better choices. Just a little background on that, an example of that is things like fresh fruits and vegetables are zero points. Foods that are high-fat, high-carb, unhealthy carbs, are higher rated on points.

So, it's kind of a system that tries to push you through small behavior nudges to make those healthier choices. I think where we're focused on is, a lot of data overload can actually be detrimental to someone's weight loss effort.

The equivalent that I think about, it's almost like you've moved to a new country, where you don't know the language and have an entirely new job. That is the situation that we're actually addressing in consumers that come through our door. It's people that have had a tough time. They don't feel good about the weight that they're at.

They're looking for us to help actually be that solution, the one that works and works forever. A lot of it is simplifying it, so it's easier to start versus being overwhelmed with the amount of data to take in.

Kristina: I think maybe that will lead to our next question about where is the technology going? How do we become maybe less unhealthy? How do we use technology to spearhead that change in behavior?

Gary: In terms of the first question, where's it is heading, no surprise. It's heading to mobile. It's heading to social. It's heading to gameification and all these macro trends in technology will be applied to this as well. There are, as you said, some different segments. So, there are some people that we find that really like the gameification and some that hate it, some that like the social aspect and some that really don't want to share their data with others.

So, there will be different approaches, different takes on it. Miniaturization is another key triumph that will make these devices to the point where you would think they'll be implanted at some point. It sounds crazy today. 20 years from now...

Kristina: It's not that crazy.

Gary: ...I'll bet a steak dinner that they will be. Or someone will have it implanted.

Kristina: It's a little creepy, but...

Gary: James is probably already working on that.

Jack: Actually, one of the companies I'm involved with is called DexCom. DexCom makes a wearable sensor that a person puts underneath their skin and it monitors their blood glucose in real-time on a continuous basis. It interacts with an insulin pump if people need to have insulin. So, I think the idea of wearables is really there.

Fibers, I think, are the next spot in terms of integration with clothing and/or other apparel will be another spot that we'll start to see. Partly, the segregation of comments, this is a spot of multiple micro segments, in terms of people's interest and how they approach it, their base on their activity, their device, or data.

But the challenge has always been, is going from changing something once to sustainable change. I think the art form is making these things interesting for people overtime. I think where gameification is part of the process is continuing to add new features and create new types of venues for the information to be used, as opposed to making it once and done.

Part of the challenge for the engineers is that they can become really enamored with their product. They don't spend nearly enough time on understanding the user experience and some of the ethical and logical components of how people interact with these devices.

Kristina: Yeah. You have all these devices being developed, handhelds and ways to check your glucose and blood pressure. There's all this data, we're going to somehow need to aggregate it, whether it's for whoever is using it, physicians and consumers. It seems like most of the devices manufacturers are creating have proprietary software. Can you talk a little bit about that and where you see the future in that regard?

James: I'd say that most device makers I've talked to are probably a little wary. I guess that it's definitely not a priority for all of us to be working on a standardized format. It's just not important to a lot of device makers right now. I think there's some level of wariness to being aggregated at a higher level with other devices, especially if there's no clear value being added by parties that might end up using that data.

Kristina: Value to the company or value to the consumer?

James: Hopefully both.

Kristina: I mean, I see it as if I'm a user and I have bunch of different devices, am I going to go to 17 different websites? At some point there's got to be some simplification, sort of like using Windows versus Mac or Linux.

James: Right, but I think most device makers, including ourselves, to some extent, although we've had a pretty open API for quite a while, are always worried about modification. I think it's a fine line between how open you are, and making sure that you still retain some commitment.

Kristina: What do you feel your customers are craving right now? What's on the next horizon that they're kind of chomping at a bit for? Itching to see?

Gary: I would say knowing what to do with the data. There's so much data and I think now we're approaching a point where it becomes about interpreting that data. So, what do I actually do with that, working with experts that can help you do it, or the devices incorporating more predictive mechanics, where if this, then that. So, if you achieve these kinds of data points or these kinds of metrics, then you should be doing that.

I think the other challenge that consumers are facing, or our customers are facing, is that many of these devices measure things after the fact. Right? Half of this challenge is up here, so it's behavioral. So, it's kind of how can these devices and data start to change how people think before they eat or before they exercise, as opposed to just measuring these things after?

Jack: One of the areas we were working on at Humana and continue to look at is a concept around a personal simulation game called Virtual Me - which basically would take the data, both health data and metrics from these types of devices, and allow you to see what is going to happen to you in the future.

I think the issue of having some insights about the future is very interesting. One of the things we learn in the genetic space is how many people thought it was a cool idea, but then really didn't want to do it. Our biggest surprise in the personal genetic space was the level of buyer's remorse for people paying between $500 and $1000 for a test, had the kit shipped to them, and then never sent them back in.

It ran at about a 20% level of buyer's remorse, which we could have never predicted. But there are some people who just they naturally want to know everything about themselves. That's a segment. There are some people who are ostriches, who don't want to know anything about themselves, and then there are people in between.

But one of the things that I think we really hadn't anticipated is this issue of real worry about what they may find out about the future. Many people who are in that grey zone, they have to be accommodated in this space.

Kristina: Sort of "ignorance is bliss" kind of thing?

Jack: Right.

Catherine: It's interesting, one of the metaphors that I think now is that there's a storyline with these devices, and we're in the early stages. So, I think we've gotten to the point, where when someone first uses the device, they're really excited usually about the data.

The next step though is having, in my mind, a program that helps that data become useful. I still think we're barely in this program phase about guiding you to reach your activity overtime. I think Fitbit's got great challenges, things to increase that.

To me, the last chapter in the story is how do you actually have this long-term behavior change? In my mind, it's almost the opposite of what you get with these devices. When you get to long-term behavior change and you're doing healthy activities without thinking about it, you no longer need this device to give you feedback.

That, in our world at Weight Watchers, is the key to success. So, those things like finding your breakfast that make you actually just have a great day and stay on the plan, or finding a way that you're active every day at a base level that keeps weight off.

Jack: So it actually becomes habitual.

Catherine: Exactly. It's mindless.

Kristina: So do you think that can bring in - At Weight Watchers you've been doing this for a long time, using sort of the buddy system. Now that we have social media, we have ways to connect with friends and people that you don't know to help support us. Do you think that that is going to be an underlier for success as we continue forward? How is it affecting you guys?

Catherine: Yeah, I mean, I can answer briefly. In a behavior change progress, I think the two most important things are the support of a social community and your environment. So, if you can commit to a behavior-change process and have support from a group of people, and also change your environment so it helps you. Get the trigger foods that cause you to overeat out of your house, right there that will lead to long-term success.

Kristina: Then, let's talk about the technology and tools. I mean, they're better now in the health arena than they've ever been. Why do you think the population's overall health has declined? The numbers I'm seeing are astonishing. 60% of the United States is now considered overweight/obese. Jack, I'd love for you to talk about this.

Jack: I think part of the challenge has been as we live in a world that's a paradox of abundance and the realities are we now do things so differently in our lives. Before, work used to be something that was physical. Now work is pretty much knowledge- based. A bottle of this water still costs more than a gallon of gasoline if you add up the number of bottles.

If you think about how our world has gone upside-down, it's we now had to find new things to create to take the place of old things that were natural. As we start to now really re-imagine this world, we need to spend time understanding people. I think that there has been a part of this industry that has been immature.

It's really been a deep level of research around the preferences and the behaviors of people, and adopting new technologies to those behaviors as opposed to coming out with cool technologies. I always used to say, "It's cool technology's account that you have to really discover, not just cool technology with it."

The environment, the ability to do a lot of stuff is there. The question is how to create the experience around the device, and then have that fit into different populations. As an example, the Hispanic or Latin population has a completely different viewpoint towards health and what health images are than the Anglo sort of view around health.

Health viewpoints are different in different socioeconomic groups. We really need to be thinking about creating a world for people, and to do so is very difficult.

Jeff: I think we're first in the first inning of these devices. Unfortunately, like I said, the environment is so obese right now that it's hard to be fit and thin and healthy in this environment. Hopefully these tools and data can help navigate people through just how to deal with this environment.

Like food, and soda, and portion sizes at restaurants, you almost can envision a day where these devices and data will help steer people to health. But they have to want it, all right? They have to choose that path over fast food, and unfortunately, there are many Americans that still don't.

Kristina: Well it's an interesting theory. So, I guess as the population has gotten "smarter", we've gotten fatter. So we're our own worst enemy really. I mean, 50 years ago, 60 years ago, we didn't have the same problem, because we didn't have as much stuff. Let's talk about, then, solutions for lower-income families. You touched on that a second ago.

Catherine: I think we have to make health as sexy as food and alcohol has been over the last 20 years. That's going to be a big challenge, because when I say that, I also think the message about what it is to be healthy is very skewed. Most people think of their weight loss effort, they're thinking of being a swimsuit model.

If you actually look at the numbers, and there's a little site on it, for someone who has type 2 diabetes - and let's say is in the obese or overweight category - if they lose 10% of their body weight, 10%, they have a 50% reduction in their risk for diabetes. So, 10% of their body weight - and our CEO Dave Kirchhoff talks about this quite a bit - you've got a 200-pound woman, 10% is she loses 20 pounds. She's down to 180. She's not a swimsuit model, but she's made a dramatic improvement in her health.

So, how do you make it fun to go through that effort and get the same credit, response, and support from your community for that effort? Because that's a big health impact.

Gary: Especially when we live in this all-or-nothing society, where she may not feel it's worth the journey to 180. Unless she can get back to her high school weight, she may say, "It's not worth it."

Kristina: Maybe everyone around her is the same, so it's almost shocking. Maybe if you can get one person, and then two, and then three, it becomes a social movement, instead of just a one off then.

Jack: The other thing, when it comes to weight loss, the data are pretty clear that they help people to get back to what should be their normal weight. They have very high levels of recidivism, or bouncing back and forth. In fact, it's elements of the kinds of fat that are in your body, where the fat is located. It's pretty clear that what we need to do is create models that incent people to get to that normal body weight, because simply losing 20 pounds and having it off for a few months, and then gaining it back doesn't do anything for your health.

It's one of those things that are really frustrating for people, because they don't understand why they climb back up, as opposed to getting down to their normal body weight. When we talk normal body weights, it's a real challenge.

If you look at American Airlines alone, they have spent an incredible $300 million on jet fuel just to lift the weight of Americans off the runways over the last 10 years. It's a Small World at Disney wasn't so small, and had to retrofit all of the features of its ride because the kids that were going on the rides were heavier than they ever were when they initially built the ride. Gurneys now at the Veteran's Administration are having to be purchased for weights of patients that can stand up to 500 pounds, because they're seeing patients in the 350 to 400 pound range.

So, there are really serious issues embedded in this that require more than just dalliances with changing. I think you really have to get people to understand what they have to achieve in order to be on the road to really be healthier and sustain that weight loss. It's the foundation of physical as well as behavioral.

Kristina: That's just astonishing, some of the numbers. Do you see the change coming from the population? Do you see it coming from physicians pushing it, or government, or more of a combination of...

Jack: Well, I don't believe it'll come from government, and I don't believe it'll be coming from physicians. I think we have to make these activities fun, or at least part of people's everyday lives.

Kristina: So, it's back to behavior change?

Jack: The government can't tell people what to do or what not to do. It simply sets an infrastructure in place. Doctors are about as boring as possible when it comes to health. It's historically been the land of "no", which is "don't do this" or "don't do that". That's really not going to help motivate anybody. We need to find ways that are, again, fun and engaging and sustainable.

James: I think that as insurance companies start to provide reimbursement for these devices or services, as employers start to penalize their less-healthy population with higher insurance rates - which they're starting to differentiate now, I think that will drive some, it won't drive all - but it will start to incent people who are on the margin to improve their health.

Catherine: If I could just build on that? To me, I think of it as where are the communities? Where are the close tied communities, where the concept of health can become more viral? I think that's what's interesting in an employer kind of B2B model, because a company naturally cares about its employees. You do have a sense of community there. So, if you can activate that community within an employer base or a community within a local town, I think that's how you can have a big impact, as soon as that social aspect is used to our advantage.

Kristina: Yeah. I totally agree with that.

James: On the device side, I think what we're also seeing is trying to add that cool factor as well, to get people excited about these devices. For a very long time, tracking devices were very utilitarian. They had online pedometers for fat kids that looked like they were blood glucose meters or some other type of medical device. It's really only been in the past five years that there's been this gradual shift in most of the design of consumer, I guess, health tracking devices. Fitbit is one. FuelBand is another.

Of course, I think that the big challenge is, as we start make things cool and exciting, at the beginning it's also very difficult to make it affordable as well. So, I think true pervasiveness might come once someone cracks the nut of how you make something cool, exciting, and affordable. I think that's what it is. At least, in our space that's true.

Kristina: Let's talk about technology benefiting the medical condition management. Jack, I think you probably would be the best one to speak on this. Just how the technology is benefiting medical condition management? What are the most promising opportunities today? Which conditions do we need more technology for?

Jack: Most of the medical conditions we're facing and fighting with today are chronic conditions people will live with for a very long time. So, the kinds of things that range from medication reminders to activity levels, to actual measures of analytics like glucose, will be really part of our future. The mobile phone is probably the most important medical device strength breakthrough for the next ten years, because it is a ubiquitous device. It's easily worn. It can become a central depository for any of the devices whether they're medical or social, and it provides for immediate feedback.

I think all of us, or at least,to watch the audience, half of the people in the audience, have been checking their iPad or their iPhone during this session. It's very easy for all of us to adopt that kind of behavior to be used in terms of mobile monitoring. It's a great way for them to be able to interact with their clinician.

The ability to have the same information available to you as your physician or health coach, or whatever title we give people in the future, I think [inaudible 00:26:37] and will come off the mobile, into the generations that will come after the mobile.

Kristina: It's almost like the smartphone at some point is going to be more of a router or almost like a receptacle, because we're going to have smaller and smaller devices that we're going to need to use. Like the Fitbit and some of the other ones that are coming out. The phone's not getting smaller. The phone is almost going to be a go between to The Cloud.

Jack: Well actually, the challenges aren't about the phone. It's about the battery.

Kristina: Oh, really.

Jack: It's about the battery. The battery is really critical to get the phones approved as medical devices, to be able to have them last. They obviously take the extra batteries that people can put onto their phones. But, as you put more of a greater dependence on the phone as a utility or as a medical device, making sure it stays powered is going to be a critical component of making this work.

Jeff: I do think that form factor is also a big issue, just because it's very difficult to carry your phone on your person at all times. There's a lot of lifestyle activities that actually surprisingly generate, for instance on the steps, like what a necessarily thing to do, that would have been captured. I think just relying on the phone is a great entry tool, but I don't think - there's a limit to what it can do and it doesn't actually capture the type of [inaudible 00:28:10].

Kristina: How are companies currently using technology, and how do you foresee companies being able to use technology to address the emotional aspects of behavioral change? For example, someone who has diabetes and knows very well that eating a muffin or a cupcake is going to increase their blood sugar level. How can you use technology not just to provide the data associated with that transaction, but actually have an emotional impact that causes them to make that change?

Jeff: At Retrofit we use Skype as a way to do that. It's a technology, obviously, it's not necessarily a data-collection device, but it's an application that wasn't possible until recently. Where from your iPhone, your iPad, you're dealing with your own therapist or behavior coach, dealing with, 'Why am I doing this?' and kind of interpreting your actions and breaking that habit and forming a new one. There are all kinds of technologies other than just data-driven devices that I think are going to affect the behavioral or emotional pieces.

Jack: I think, too, on the diabetes front, as people are able to see the actual change in their blood glucose, there's a really a direct correlate to understanding what I've eaten and what I've done, to see the change in real-time data. The flip side is that I think it is devices that I think people have seen here, that are a mouse for a computer that also has a mood sensor in it. So when you put your hand on your mouse, you can tell how you're feeling that day or how tired you are. You can use it as a feedback, or as a biofeedback to changing your level, affecting your stress as you work.

Catherine: Yeah. I guess the other thing I'd say is that technology is also letting you reach out to that social network in a way that we couldn't before. Going back in time, social network was in person, then you had telephone, then you had online to make it more computer-driven. Now, as we all know, we're on Facebook all day long and Twitter all day long, connecting to people.

I think there's going to be a way to reach out through that network for social support. We see our Weight Watchers members do this all the time. Like, "I'm at a restaurant. I have no idea what to eat. What do I do?" They can get kind of some response so that they feel like they've gotten support in the moment when they need it.

Kristina: So you're talking more about that feedback loop and that sort of instant connection that we didn't have before. Instead of getting voicemail, you can actually get someone live, especially when [inaudible 00:30:48]...

Participant: Firstly, I'd like to pick up the call where you said that people who didn't want to have genetic tests, they're the ostriches of improvement in a sense. Frankly, what is the use of a genetic test in many cases? It's not only genetics. It's a whole lot of other complex factors that determines your health outcomes.

So, too much unsophisticated knowledge is actually harmful and denial is a very healthy psychological defense mechanism. I'd just like to echo what other people have been saying. Here you're dealing with very complex psycho-social issues. There may be short-term effects, but unless you actually really address complex psycho-social, emotional, and sociological - because it varies from social classes, I know you did mention that - you actually may be harming people. You may be having a lot of harm.

So, I think that's where your big data, you should be looking at, because you should be looking at, what is really the long- term impact? How can we address it? I think you should engage with professionals to actually get feedback on this.

Jeff: I happen to agree with you, although I think that this isn't about guaranteeing health or life-long health for anyone. This is about reducing risks, controllable risks, which many diseases in this country are caused by, controllable behaviors. I think for a long time our population has relied on will-power, and will-power just doesn't work. What does work is habits, breaking bad ones and forming new ones.

There's many ways to do that, social support in group meetings, social support online, using data to provide the feedback loop. Any of those things I think can help. They're certainly not going to guarantee anything, but they do make an impact, but to Jack's point, only if they're lasting changes. Short-term changes are almost worthless and in many cases more dangerous, the yo-yo effect.

Jack: Understanding risk and how people think about personal risk, risk awareness, and insights about yourself, those are all different things that, depending on the stage of life, your gender, a host of other things, can be interpreted by people very, very differently.

Gary: Do you think gameification has more of a fad in this instance or do you think it actually has value?

Jack: I'm a big believer in gameification, from the standpoint of everything from devices where we integrated the Nintendo Gameboy into a glucose device, to the use of Tamagotchis, to the use of comparative games among schools, where kids wore a wearable pedometer and uploaded their data just by walking into the school. The schools competed with each other. We've seen those all work.

The challenge is you need to create new games. You need to create new features and ways for people to continue to participate. It is one way to bring people into new habits. The example of kids wearing a wearable pedometer, it caused their parents to park further away from places in the mall, because the kids wanted to get more steps. So, it had a secondary effect of kids teaching parents about activity levels.

What I think is great about the space, and I challenge the assertion that this has to be studied by professionals, this really needs to be read by innovators in the space, and try different things. We start to see what happens and develop trends. Everything in life, I think, has the [inaudible 00:34:49] to sort of be [inaudible 00:34:51] imperfect.

I think we need to look at it from a non-judgmental basis. It's not either going to be good or bad. It's going to be different. I think what we're trying to create in models like this are really here for the environments of people for the future.

Participant: There's a lot of activity happening in mental health disease management. I guess, there's not really a clear distinction between sort of the disease management part of health tech and the health and wellness part of health tech. So, maybe just removing some of the reimbursement barriers, the obvious barriers, how do you guys plan to sort of marry the two over time?

Because again, like you said Jack, physicians are boring. They're not going to be all that helpful. It's got to be driven by the community, by the innovators. I guess, I don't necessarily see a clear picture of how that's moving forward to kind of come together.

Jack: I'll start. The issue that we tried at Humana was around the idea of rebating a part of people's insurance premium relative to their activity levels and their weight management, blood pressure control. Most of the challenges in health care, in costs coming in the management of chronic disease, most of the issues in health and well-being, are pre-sick or pre-chronic disease.

The kinds of things you want to see people adopting in terms of activities that they ought to be living are pretty much the same whether they've been diagnosed or not. But I do think we need to say that when people do things to take better care of themselves. They need to be rewarded or recognized in some way.

The way James' company does is you get badges every day, or we get little messages every day, and we love that. A badge is interesting. $40 a month is more interesting to some people. It just depends on who you're talking to and what they're looking for. But I think we have to think about it from the standpoint of liking health and wealth, as well as health and other things in our society.

James: There's also just the standard adoption curve. Like I said earlier, we're in the first inning, so we're still the early adopters. Even something like the Fitbit, which we've seen a few employees in the company use it, and then it just goes viral.

At first they lose weight and become more fit, and others say "Wow, how'd you do it?" "Fitbit." Then it goes from there. So, I think as with any category, we're just starting to see that adoption curve. The devices and programs that don't work, they'll fade away.

Catherine: I think the other clear component I'd add is the better handoff between healthcare providers and the health and wellness providers. The example that comes to my mind is Weight Watchers ran a study that was published in the Lancet, which was looking at doctors who identified individuals who were overweight. They handed them recommended Weight Watchers as a program, and that was three times more successful in weight loss than those individuals trying to go through the weight loss effort guided by a doctor.

It makes sense. I mean, doctors are trained on a certain set of skills, and there's a different set of skills around behavior change. I think if we can get that handoff right and I guess everything else we spoke about, incentive structure that will help quite a bit. But I think that handoff is important.

For example, people are diagnosed with pre-diabetes, and usually there is no clear action plan. They'll be feeling like, "Okay, what does that mean? What do I do now?" Actually, the best thing to do would be to lose couple pounds.

Jeff: I think in the device case in general, for us what we try to avoid in that line between wellness and disease management is trying to minimize the amount of regulatory issues that we face creating devices. Just because, consumer electronics isn't quite at the pace of, let's say, software in terms of the ability to interact very quickly. But when the FDA gets involved, it just gets that order magnitude slower. I would say worse, because there are a lot of advantages to why the government wants to regulate mobile devices. It's something that you have to balance.

Kristina: I think that wraps it up, so I'd just like to thank everyone for coming and...