“We’re primarily based on a belief system that games and game mechanics are really going to be the motivating factor for chronic conditions that people struggle with on a daily basis,” Henry says. “In the healthcare arena, there’s a lot of discussion around patient activation, meaning getting people going [with games] and looking at the change in their engagement levels.” GameMetrix provides platforms for companies, such as insurers, to create games for their customers tailored to specific health parameters.
GameMetrix’s developers knew that pulling patients into the games would be a challenge, Henry says, which is why they decided to model their products on known properties. “One of the challenges companies face is they’re trying to build new kinds of games and game mechanics. We focus on classic games where customers already know the game mechanics. They are games that have already been proven and tested.”
When GameMetrix started in 2007, its founders tested their model by developing a game for people with diabetes that was based on classic trivia games like Trivial Pursuit. The company was stunned, Henry says, when 3,200 people started playing the game regularly, with very little marketing. “It’s still live, and people are still playing. We recognise the motivations going on with these patients: They have a difficult time living with their condition. We are giving them a relaxed and therefore receptive environment for dealing with it.”
According to Henry, one of the most valuable warnings in Werbach’s book is to be wary of “pointification” or the awarding of points and badges to people who play games. She sees the healthcare community “rapidly embracing what I would say are simply loyalty programs, where if you participate, you get points or rewards. But it’s really the deep elements of games and what makes them motivating that I think is missing. You may get a spike in participation, but it’s not sustaining.”
Werbach echoes that sentiment, adding that most of the unsuccessful games that have been tried in the business world failed because they relied too heavily on pointification. “The points aren’t going to be effective unless they’re embedded in a well-designed structure that uses them in a way people will find engaging,” he says.
Keeping customers engaged, referred to in the gamification realm as “stickiness”, is one of the biggest challenges for companies that are trying to encourage healthy behaviours, says Katherine Milkman, professor of operations and information management at Wharton. Milkman recently co-authored a study designed to test whether allowing people to listen to exciting books-on-tape when they are at the gym – and only at the gym – would cause them to become addicted to exercise.
The researchers found that the tactic worked well at first, but then weakened over time. “We were able to increase exercise frequency because we tied something to the gym that was instantly gratifying and attractive,” Milkman says. “It worked quite well for seven weeks, but then the kids in our study went home for Thanksgiving break. They came back, and they had forgotten about it. What I think that means is we have to be constantly evolving. You can’t build one Super Mario game that people can only play while exercising and expect it to do the trick forever.”
UnitedHealth is experimenting with several gamification models, including one that uses financial incentives to keep its members engaged over the long run. The game, called Baby Blocks, is offered to 50,000 pregnant members in seven states and is designed to encourage women on Medicaid to attend all their prenatal checkups. The women can unlock “blocks” in the game by going to those appointments. After they attend key checkups, they can receive rewards, such as gift cards for maternity and baby clothing. In 2012, the company says, 2,296 members actively used Baby Blocks pilot, logging 7,098 prenatal appointments and unlocking an average of 3.1 prenatal blocks per member. “We do think financial incentives are important,” says Arrianne Hoyland, game producer for innovation and R&D at United. “We felt using extrinsic rewards could increase engagement.”
