Chronic disease is one of the most expensive and rapidly growing areas of U.S. healthcare. Over thirty million Americans currently have type 2 diabetes, and another 88 million are at risk of diabetes. Over 100 million American adults have hypertension, and only 24% have their blood pressure under control. Actuate aims to apply new research to demonstrate a breakthrough approach to closing the gap between effective care and those at risk: long-lasting behavior change for effective prevention that can scale across the U.S. population.

For many people, the tremendous personal and financial burden of these and other behavior-influenced diseases could be avoided or reduced through sustained healthy habits: a good diet, regular exercise, and smoking cessation. The power of this kind of behavior modification was most clearly demonstrated in the original Diabetes Prevention Program (DPP) in 2002. It showed that personal coaching led to healthier habits, which in turn led to a 58% reduction in diabetes for a diverse population of adults with prediabetes. Yet nearly two decades later, coaching is still expensive, insurance coverage is limited, and doctors rarely even prescribe it. Numerous apps offer activity monitoring, reminders, or social networking to address habit change; these can be far less expensive, but none has proven efficacy. Good and useful companies have been built, but the nation’s problem remains: fewer than one percent of Americans at risk of diabetes are in an evidence-based coaching program.

Today, behavioral research, data, and machine learning could be combined to create a radically better personalized coaching system. It would start with a secure data system on a smartphone that puts control directly in each person’s hands. It would provide them with a realistic assessment of day-to-day activities and eating patterns from smartphone sensors and linguistic analyses of texts. It would provide on-the-spot incentives to make good choices, offering the potential to be even more effective than previous coaching approaches. And it could do so at a fraction of the cost of coaching by trained specialists.

Actuate’s program will conduct research on behavioral assessment, personalized engagement and coaching, and tailored incentives, each applied to the challenge of healthy habits. It will integrate successful results into an evolving research prototype that combines all of these elements within a robust privacy and trust framework. The program will then use those prototypes to conduct multi-arm trials over an extended period of time to understand long-term effectiveness. The program will also engage payers, providers, community health organizations, companies, investors, and others who will be essential to scaling successful outcomes so that they reach those at risk.

Actuate lead: Wade Shen, CEO, Actuate Trust and Democracy