Fitbit Medical Director Dr. John Moore on Wearable Tech Company’s New Personalized Health and Fitness Coaching Platform

Dr. John Moore

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Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter a show where we speak to the top thought leaders in
health innovation , health policy care delivery and the great minds
who are shaping the health care of the fu ture. This week Mark and
Margaret speak with Dr. John Moore, Medical Director of Fitbit Care a
personal coaching platform at Fitbit the wearable device company . Dr.
Moore discusses the platform which provides personal coaching and
health coaching services to help users achieve their fitness goals and
better control of chronic disease management.

Lori Robertson also checks in , the Managing Editor of FactCheck.org
look ing at misstatements spoken about health policy in the public
domain separating the fake fro m the facts, and we end with a bright
idea that ’ s improving health and well - being in everyday lives. If you
have comments please e - mail us at [email protected] or find us
on Facebook or Twitter iTunes or ever y ou listen to Podcast and you
can also hear us by asking Alexa to play the program Conversations on
Health Care . Now stay tuned for our interview with Dr. John Moore,
Medical Director of Fitbit Care on Conversations on Health Care .

Mark Masselli : We ’ re spea king today with Dr. John Moore a physician, engineer and
Medical Director of Fitbit overseeing the newly launched Fitbit Care, a
tech enabled connected health coaching platform for wellness ,
prevention and disease management . Dr. Mo ore is co - founder and
fo rmer CEO of Twine Health , a health coaching enterprise, which was
acquired earlier this year by Fitbit . John, you last joined us several
years ago while you were still at MIT Media Lab where your research
focus ed on solutions to an improving patient engage ment and
empowerment and clearly your frustrations with the health system ’ s
inability to help patients succeed in their own care management
beyond the doctor ’ s door really inspired you to leave the clinical track
focusing on efforts on the health tech spac e, launching twine in 2013
and since then, companies like Fitbit have added a key element to
advance that quest, the wide proliferation of user friendly wearable
technology and I’m wondering if you could just share with our
listeners your journey from that startup of Twine to this new
collaboration with Fitbit and why you think the time is now right for
health coaching to really scale up?

Dr. John Moore: Yeah absolutely, and as you mentioned, I left my residency back in
2007 then I was really, because I got inspired to support people
between office visits. I was struggling as a physician. There was this
aha moment for me that no matter how hard I tried in the office, as
we know, 99 .99% of health happens out in the real world. Until some
of the early technolo gies for digital health came out, there wasn ’ t a
whole lot we could do because if you just call people on the phone or

Dr. John Moore

try to schedule visits, it ’ s very hard to fill that time in between , but
right when I was in my residency , there was a time when mobile
c omputing started to catch on. It was pre iPhone, but you could see
that it was coming, and I started to get this conviction that there was
going to be a path to be able to rethink how we communicate and
collaborate with people. Even further the i r contribut ion could change
dramatically such that they ’ re not just at the center of care but
they ’ re actually driving it. That was really the impetus for this work
and spent six years at MIT , at the MIT Media Lab doing research and
really having the opportunity to f ail fast and try out radical new ideas
and then ran a few randomized controlled trials where we could
compare the state of the art and health coaching with the same
health coach, but with our tools that would augment their ability to
co - create action plans , track people ’ s progress, provide social support
and clinical support to individuals so that they could succeed in their
goals and then built Twine Health with that business proposal of
improving diabetes, hypertension, weight loss, smoking cessation, etc .
Working with organizations in a commercial manner in order to
validate that we could do this at a larger scale and then joined forces
Fit bit because what we wanted to do was expose it to many more
people and Fitbit is arguably one of the largest digital health
interventions out there and brings to bear a great capability of
inspiring and engaging people in health behavior change. T o partner
those health coaching skills with Fitbit’s ability to help people
measure and become inspired to change their health and bit of a
perfect combination.

Margaret Flinter: John, you ’ ve spent a lot of time analyzing what drives behavior
change, how technology can play a vital role at that ? You did that first
at Twine and now at Fitbit. What did all that research reveal abou t the
ways to get around or overcome the perennial challenge of fostering
behavior change in our patients that we know would lead to better
long - term health outcomes? What ’ s been missing? What do you see
as the solution?

Dr. John Moore: Yeah, so there ’ s a few foundational things that we discovered from
the research that are really key to helping people change behavior.
One is that people really need to set goals in very small steps , in order
to have a path that they believe is achievable, but they also need to
think about things in quite short timeframes. We operationali z e
behavior change as humans and in about two week intervals and in
health care we often operate in three to six month intervals, so
they ’ re foundational ly out of sync . If we can instead comm unicate
with people on a daily or weekly basis, especially at the beginning of
their behavior change journey, we can shrink that feedback loop
down to an appropriate amount of time that allows people to create
the motivation and momentum that they need to succeed. If people
really need small goals, short timeline feedback loops and they need

Dr. John Moore

more than just our own internal drive . The social accountability and
social support are two of the most powerful external motivators for
people to change behavior. You break the goals into smaller pieces,
make the feedback loop much tighter and then you add social support
and accountability to help drive them to feel motivated and to g ive
them the support that they need, and that combination just was not
possible to do a t scale without some of the new advances in
technology. As great as the health coach might have been , if they
didn ’ t have the right tools to get on that smaller timeframe, for them
to provide their support, it just wasn ’ t possible before, but now with
the technologies that came available for us in building our solutions,
we were able to close this.

Mark Masselli : John, we ’ re seeing a growing interest in deploying community health
workers to connect people where health happens , in the ir home , in
the ir workpl ace , in their neighborhoods, so that ’ s one way we ’ re
narrowing some of those care gaps between clinician visits, but you ’ re
presiding over a system at Fitbit care that goes way beyond that
model and the patient is connected 24 /7 to coaching infrastructure
that ’ s available through multiple interfaces and texting and messaging
and phone conversations. Then I ’ m wondering if you could talk about
that infrastructure of health coaching approach at Fitbit and what
makes it unique?

Dr. John Moore: The human health coaching is this piece that we ’ ve developed
technology that allows for the creation of what we call action plans.
The action plans break down your health goals into meaningful pieces.
For example, a gentleman in his 50s named Dave has high blood
pressure a nd he ’ s a smoker. We allow you to build action plans across
multiple health behavior change goals, but to do so in sequence. Dave
might say, hey, I ’ m not ready to quit smoking yet , but I ’ m ready to
work on this blood pressure p iece because my brother had a heart
attack. I can ’ t make it to the doctor ’ s office all the time, but if you ’ re
telling me you can be my health coach and can be available to me on
a day to day basis with a s simple as a secure text within this app . I ’ m
willing to give it a try. We have the infrastructure to create these
action plans that are very structured, and they break the goal into tiny
pieces. Instead of trying to get his blood pressure all the way down to
120 / 80, they decide to step it down in small increments from where
he is, fo r example, maybe he is in the 150s and they want to get it
down to the 140s and it allows you to decide, well when during the
day are you ’ re trying to achieve this, and it ’ s designed for co - creation.
It ’ s not someone telling Dave, you need to do this. It ’ s saying, well,
what do you think you can achieve and how can we get there
together? It automatically synchronizes to all of his devices, his cell
phone, his tablet, his computer, and as he tracks things, it flows back
to his coach and bubbles up at a popul ation level. Instead of his coach
needing to manage date and all of her other coachees, she manages

Dr. John Moore

based on need. She can see, hey, is Dave ’ s blood pressure going in the
right direction as opposed to I ’ m going to talk to him two weeks from
now and because of that she ’ s able to really give him an experience
where he feels like he ’ s the only person that counts and that ’ s an
incredibly psychologically motivating piece of this , that ’ s the
infrastructure . Action plans and communications on top of that , that
are team based and allow that team to see who needs help and
wherein, which allows you to scale this at an incredible rate. Then we
can measure the performance of every coach and every care team
member in real time. We know if a given coach has a cohort of 20 0
coache e s, we know exactly how they ’ re performing in things like
diabetes or hypertension and we can compare them to their peers so
that we can help them adopt best practices and so that was
something that didn ’ t really exist in health coaching in the pas t.

Margaret Flinter: John, not only are the clinicians looking for ways to get better health
outcomes, obviously stakeholders and payers have a big interest as
well. In fact, Fitbit just announced their big partnership with Humana,
making Fitbit Care avail able to some 5 million customers and that is
going to offer the coaching solutions you ’ ve talked about, but they
have to be willing it seems to share their data. The consumer or the
patient has to be willing to share their data, how well they ’ ve slept,
how many steps they have or maybe have not taken, and we see that
there ’ s been some real resistance in people to being held so
accountable for the personal choices one makes. Talk with us a little
bit about how this partnership with entities like Humana will work
and most importantly, how do you get the buy - in and engagement
from the consumer?

Dr. John Moore: Yes. First of all, I’d started to talk about the different tiers of what we
offer, and I talked about the coaching piece and how Fitbit also
inspires, an d the Fitbit devices and those pieces also inspire people.
While we connect that in with the coaching, we also leverage our
social communities which are very powerful drivers to help inspire
and engage people as well. Then we also have more and more digita l
tools that provide guidance. We have a whole host of video and audio
workout that sit between the coach and the self - tracking that
provides some more digital and automated guidance. Those are the
pieces and then to your question, well, how do we inspire people to
join this and how do we deal with potential concerns that they have
about their data privacy and security, especially if we ’ re dealing with
their health plan or with their employer. That answer is quite simple ,
in the terms of service and the way we work with employers and with
health plan beneficiaries who are not in these relationships, sharing
the individual person ’ s data back to any other entity without their
permission. Part of th at design is that we just share aggregate data
about the overal l effectiveness of the intervention back to the
organization to provide the value, but our coaches and our software

Dr. John Moore

are responsible for providing the services to help them succeed . So,
really they ’ re only sharing their data with Fitbit. Now there are certa in
relationships where there are data sharing agreements, but we make
that very clear to the individual and very clear of what value they
could provide and give them the choice of with whom they want to
share their data, but a lot of the times it ’ s just ab out us providing
them the service and then working with their coach to get the results
and that that eliminates a lot of the concern.

Mark Masselli : We ’ re speaking today with Dr. John Moore a physician , engineer and
Medical Director of Fitbit overseeing th e newly launched Fitbit Care, a
tech enabled connected health coaching platform for wellness
prevention and disease management . Dr. Mo ore is co - founder and
former CEO of Twine Health, which was acquired earlier this year by
Fitbit . John, one of the things that clinicians are increasingly dealing
with is data inundation and Fitbit faces this problem. It ’ s sitting on just
mountains of data and we recently had tech writer David Polk talking
about his recent foray into Fitbit ’ s a 1 50 billion hours of heart data
alone and while you ’ re platform is really great about gathering data,
how are you gaining insights from that data in a way that will make
this coaching platform an iterative one that continues to adapt to
huge data sets you collect on the individual level and how does that
system learn and improve itself?

Dr. John Moore: Yeah, this is a really fun and exciting time for us because we ’ ve
already just with the tools that we ’ ve created for coaching, we ’ ve
been able to on average, increase the panel size of a g iven coach by
about three times because of the additional contribution of the
individual participant and helping to identify people in need for the
coach , but to your point about how do we crunch through all this data
and make the process even more efficie nt and insightful. We have a
quite a large team of data scientist and machine learning experts on
our team that since th e advent of Fit bit had been using these kinds of
techniques to find tidbits in the data, even simple things like what
seems simple like tracking your steps or figuring out your sleep stages.
A lot of that is driven by AI. There aren ’ t simple algorithms to detect
those you have to crunch through a lot of data. Now what we ’ re
starting to do is expose what we call insights in the application and
these are already released and out there, especially around sleep. For
example, the other day I exercised about 15 minutes before going to
sleep, I went for a swim . In the morning it gave me an insight that
said, hey, it ’ s great that you ’ re exercising, but were you aware that
exercising right before sleep can affect the quality of your sleep. Take
a look at your sleep data and see how it ’ s, you know, your activities
are affecting that. It ’ s looking across my data, finding interesting
tidbits that are ba sed on science and feeding them back to me as an
individual to help me t une my behaviors. Well, we ’ re interested in
doing the same kind of thing with coaches. If we can feed those

Dr. John Moore

insights to the coaches as well, then they can help to doubly reinforce
that and help people to discover even more strategies for optimizing
their behavior, and you can imagine the more and more coaching
interactions, the more capability we have to learn from the kind of
insights that coaches are coming up with and they help to tu rn our
algorithms and improve this process. I think that kind of scale that
we ’ re at now is we ’ re quite optimistic that we can drive that
scalability up to even higher with leveraging all of this data and all the
ability to crunch through that and find the right people who need the
right care at the right time.

Mark Masselli: John, I said you were a physician and an engineer, a medical director
at Fitbit, but you really are a technologist with an eye out in the
future. One of the hats you also wear is as a judge of the Tricorder
XPRIZE competition, which is sought entries from developers around
the world to make a handheld smart device that does a whole host of
medical diagnostics in the palm of your hand , really just like the Star
Trek show that we grew up watching . A s we see a growing interest in
developing these kinds of technology and knowing personally how
difficult it can be to make such innovations viable in the marketplace ,
what are you seeing on the horizon that looks like a possible paradigm
shifter in the healthcare space?

Dr. John Moore: Yeah , I think really the paradigm shifter is leveraging human touch
along with scalability of technology to change the way we
communicate and collaborate. I think all of the exciting new devices
and sensors and oth er technologies only have value when you have
that ability to allow health coaches and nurses and doctors to
collaborate with individuals in this new manner, that is going to be
the game changer that is going to help all the digital health companies
to suc ceed in their goal of helping people be healthier. I think if we
just build more and more technologies that pull more data, it ’ s not
going to get us to the promise land. We ’ re really going to need to
double down on that ability to create this feedback loop where we
can set goals, social accountability and support and create small
feedback loops that allow people to collaborate together.

Margaret Flinter: We ’ ve been speaking today with John Moore, physician, engineer and
medical director of Fitbit overseeing the newly launched Fitbit Care , a
tech enabled connected health coaching platform for wellness ,
prevention and disease management. Dr. Moore is the Co - Founder
and Former CEO of Twine Health, a health coaching enterprise, which
was acquired earlier this ye ar by Fitbit. You can learn more about
their work by going to www.fitbit.com or follow them on Twitter
@Fitbit . John, thank you so much for your continued innovations and
for joining us on Conversations on Health Care today.

Dr. John Moore: Thank you very much for having me. It was a pleasure.

Dr. John Moore

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Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertso n is an award - winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what have you got for us this week?

Lori Robertson: In a contenti ous Oval Office Meeting , President Donald Trump and the
Democratic Congressional Leaders, Nancy Pelosi and Chuck Schumer
disagreed over funding for a border wall. The president claimed that
one reason for the wall was to stave off a public health risk. Tru mp
claimed that “ People with tremendous medical difficulty and medical
problems are pouring in. ” Prior to the meeting, Trump made a similar
claim in a tweet saying that democrats, “ Wants open borders for
anyone to come in. ” This brings large scale crime an d disease. The
scientific evidence, however, does not support the idea that migrants
are a substantial public health risks. It report published in December
in the journal, The Lancet directly addressed the subject and
concluded that, “ The risk of transmiss ion from migrating population
to host population is generally low .” When there are legitimate
concerns such as for tuberculosis studies show while there may be an
increased risk for transmission within migrant communities, that isn ’ t
the case for host popu lation.

A 2000 Study in Norway that analyzed tuberculosis cases over 12
years found that each year on average 13 immigrants and non -
immigrants develop the disease as a result of imported TB. The
researchers concluded that immigration , “ Did not appear to in fluence
the TB situation among the existing residents of the country, ” but
outbreak risk is low if the destination country has strong surveillance
in public health services. “ These services are also crucial to prevent
pandemics. ” The report said whether as sociated with population
movement or not. For some communicable diseases such as measles ,
some migrants come from countries that have higher vaccination
rates than the United States. According to the World Bank, 92 % of
U.S. children age one to two received the measles vaccine in 2017.
That ’ s compared with 96 % in Mexico, 9 7% in Honduras and 99 % in
Nicaragua. That’s my fact check for this week. I’m Lori Robertson,
Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accura cy from the country ’ s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you ’ d
like checked, e - mail us at www.chcradio.com . We ’ l l have
FactCheck.org ’ s Lori Robertson check it out for you here on
Conversations on Health Care.

Dr. John Moore

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Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. When Ventur e
Capitalist and Shark Tank Co - Host Mark Cuban decides to sink a
couple of hundred thousands of dollars into your business idea,
you ’ re probably onto something, and that ’ s what happened to Olivier
Noel , medical student and young geneticist at the Universit y of
Pennsylvania when he appeared on the popular ABC Show. Through
his research and studies, Noel learned that no matter how many
resources the clinical study has, it is still extremely difficult to get a
large sample of participants to join and studies. He thought, what if
you could simplify the process, eliminate the barriers to research
participation and build up a rich DNA database for future research all
at the same time , and he created DNAS imple because he wanted to
make it well simple .

Olivier Noel: I wanted to sort of leverage the Internet, particularly leveraged social
media to be able to build a national database where somebody did
not need to be a patient to be able to participate in this research
study.

Margaret Flinter: All the participants hav e to do is to take a simple swab of the inside of
the mouth, send it in and wait to see if your specific DNA is of interest
to researchers. Noel says that the company will make their DNA and
disease data available to researchers studying specific diseases,
offering those researchers a much broader spectrum of study
participants.

Olivier Noel: So one of the things we really wanted to do with DNASimple is to
allow for longitudinal study so that you can continue keeping contact
anonymously, obviously with a pa rticular donor , and so if you ’ re doing
a study and you have the ability to collect samples now, collect
samples in three months , collect samples in six months and see how
that varies , which is very difficult to do.

Margaret Flinter: Now the study participa nts themselves receive an extra something for
choosing to participate, a cash stipend for offering up their DNA to
research.

Olivier Noel: So we ultimately provide a minimum of $50 every time somebody
provides a saliva sample which dick a keep for himself or donated to a
charity of their choice .

Margaret Flinter: DNASimple , a vetted database linking researchers with a broad array
of participants to enhance lab research by eliminating the barriers to
finding participants. Now, that ’ s a bright idea.

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Dr. John Moore

M ark Masselli: You ’ ve been listening to Conversations on Health Care. I ’ m Mark
Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Peace and health.

Female: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected] , or find us on Facebook or Twitter. We love
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