Resolution

Every neuron plays a role in destiny, and individuals who get that will keep their resolutions.

Humaginarium modulates playing and learning so transparently that consumers don’t know or care which experience they’re having in the moment. They care only about winning and they know when they reach the pinnacle. What happens next?

That’s a choice. Some consumers play again at higher levels of difficulty and challenge, or with different people. Others change course for a completely separate challenge and experience. Still others exit the entertainment and make use of what they learned in real life. How does that happen?

It starts with self-assessment of health and lifestyle risks typical of illness battled in a just-played game. By completing an intelligent questionnaire, individuals enable our back end system to identify vulnerabilities and threats in their environment, medical history, and genetic phenotype. The assessment produces a kind of living quest map with critical branches.

The next step is to design a choice architecture based on a personal quest map. The architecture computes formative and summative impacts of choices on an adjustable timeline. Shorter and longer term outcomes are modeled by altering choices. It’s plain to see that no quest map produces immortality and freedom from pain, but at the same time regular folks can discover far more control over symptoms and outcomes than they ever thought possible.

The penultimate step is to make a resolution. Fiddling with choice architecture heightens self-awareness and the sense of personal responsibility for illness and wellness. Resolution cements hard and easy choices into a promise, like the New Year’s resolution we make and break year after year. What’s different about this?

The fantasy novelist Ursula K. Le Guin has an answer. She writes that “need alone is not enough to set power free: there must be knowledge.” In other words, one’s need to lead a longer, healthier life is inconsequential unless it is based on understanding, the deeper the better. In matters of illness and wellness, that’s understanding of one’s body. Not just what it looks like and how it feels, but how it works and grows; how it avoids and overcomes adversity; how it decays and fails. Precisely the things that are observed and learned while playing for hours and hours in Humaginarium.

Knowledge rather than yearning positions resolution for success. Along with knowledge comes sentiment such as courage, resilience, curiosity, conation. Every neuron plays a role in one’s destiny, and individuals who understand that are more likely to keep a resolution.

The logic here is tight yet incomplete. It still leaves people vulnerable to a threat that dates back to Ancient Greece and is more common than ever in a depressed and depressing world. It’s the Sisyphean Condition.

People who confront and master a chronic illness in Humaginarium are not cured. People who self-assess, design a choice architecture, and make a brave resolution continue to struggle, rolling their own immense boulder to the top of a hill where it inevitably rolls down another side. Does that make them futile? No. Foolish? I don’t think so because now they understand their struggle; they know where their controls are; and in the spirit of Albert Camus, they have captured meaning and purpose in a world that can seem, to people with a chronic illness, utterly cruel and indifferent.

The final step after resolution is community building. Individuals who have played, learned, assessed, designed, and resolved are still pretty much on their own. We can’t leave them there and expect the best outcomes. Instead we invite them to join self-assembling communities of interest on our social network where personal decision-making continues with those who care deeply about each other. Which is just about everybody who has or treats a chronic illness.

Website

A new website for investors, sponsors, advisors, business partners, and employees.

One of my 16 milestones for 2019 is an overhaul of the Humaginarium website. This will be version 3 since getting the startup off the ground. Versions 1 and 2 retailed abstractions like vision and mission; stuff that feels good but doesn’t yield much traction. Version 3 has a higher calling. It’s about products and services. What we make and sell. What consumers buy and use.

Version 3 is streamlined. It tells a simple story in big scrolling pages that answer a few basic questions:

  • What is a “Humaginarium”?
  • How does it work?
  • Who’s it for?
  • What does it cost?

A Humaginarium in this context is not an idea but a thing. I’m focused now on how our pioneering product will be made; the experience it will create; why thousands or millions of consumers may love their Humaginarium and a few may decide to pay for it; and how much value a Humaginarium is likely to have for those who build or use or share it. We’re rigging a simple version 3 story along these lines in our online shop window and will invite passersby to come in for a closer look.

A few who are intrigued may enter; when they do version 3 will be ready for them. It offers nine substantial and practical resources for potential investors, sponsors, advisors, business partners, and employees. The resources are:

  • Business Model
  • Commercialization
  • Marketing
  • Finance
  • Fundraising
  • Elevator Pitch
  • Links
  • Paper Prototype
  • Evidence

My web design challenge – familiar to every startup doing innovative things – is to describe product and market in concrete terms without saying too much or too little. Saying too much too soon may eventually force the company to abandon choices that don’t hold up over time; to stop work that isn’t well thought out and shouldn’t be continued for technical or financial reasons. The agile term for that is “pivot,” but it feels a bit like “drift.” Fine for others, but I prefer to think carefully before acting, do what I said I would do, and stay the course come hell or high water. Hence my 16 milestones and the version 3 website.

Saying too little is also a problem but for different reasons. It betrays a lack of courage, one of the qualities we’re set to kindle in consumers with a chronic illness. And saying too little lacks excitement. I believe a startup that isn’t risking a moonshot is just another small business. So I have to say enough to ignite passion without making stuff up that I suspect isn’t true. That puts the challenge somewhere between Mark Zuckerberg (fabulist) and Elon Musk (dreamer) on the path of Steve Jobs (Zenist).

I’m designing the raw materials of humginarium.com version 3 and liking how it’s coming along. Technical wizard Dave Walker will take my bricks and mortar and craft a shop with a crystal clear window facing the world. We can’t wait to hang the OPEN sign.

Money

The mechanism for empowerment is not rocket science. It’s health science.

The annual spend on health care is well over three trillion dollars in the United States; far more than in any other country. How much is three trillion? Three thousand billion. 20% of gross domestic product. Every year. Merriam-Webster defines trillion as “an indeterminately large number.” It’s imponderable. And the spend on health care is increasing.

But precisely who spends all that money? Is it the United States? Not exactly. Regular folks known as taxpayers and adult consumers actually foot the bill. The US government merely regulates the market.

Normally when regular folks decide to spend even a little money, it’s for something they want. To solve a problem or satisfy a need. Is that why Americans spend so much on health care? You’d think so, but I wonder. The United States ranks eleventh of industrialized nations on aggregated measures of quality, efficacy, accessibility, efficiency, value, and equity of health care. We stand out only for extravagant cost. Does that sound like solving problems or satisfying needs?

The answer depends on who? As in, whose problems are solved and whose needs are satisfied. There are mainly four kinds of who in health care: providers, suppliers, payers, and patients. Three solve their problems and satisfy their needs by absorbing hefty shares of that trillion dollar spend. One doesn’t. Guess which one doesn’t.

The answer is patients. Patients, aka taxpayers, aka consumers, aka regular folks don’t charge for their health care. They pay for it. Actually they pay out the wazoo for treatment that on the whole is relatively poor. Why? Possibly because in care settings regular folks are helpless, ignorant, vulnerable, afraid, and malleable. People who fit that description are easy to control. They pay the money not to solve problems and satisfy needs, but because they don’t have much of a choice. Most don’t even know how to choose. Everything is so complicated! They can’t manage their spend though they underwrite the entire industry. Geez is right!

Enter Humaginarium. Why? To lower the cost of health care? No. To increase the quality, efficacy, and value of health care. No, no, and no again. To empower folks who maybe can do those things? Yes, indeed yes.

The mechanism for empowerment is not rocket science. It’s health science, a branch of knowledge that helps folks understand and make good choices, thus becoming good stewards of their bodies and not just bill payers. You will not find a provider, a supplier, or a payer in the health care industry who empowers patients with that knowledge, because it’s not their job. That’s not what they’re paid for.

Then whose job is it? Regular folks, of course. And an unprecedented, astonishing new program of job training for them is called Humaginarium. It’s in the pipeline! So consumers, now hear this:

  • You can understand things like physiology and pathology.
  • You can enjoy learning how your body deals with chronic illness.
  • You can make good medical and lifestyle choices.
  • You can be brave, curious, well-informed, and strong.

That’s your job. Humaginarium is like the eagles. Don’t look down. We’re coming to help.

Scientific entertainment. Variation on Daphnis et Chloé, by Louise Marie-Jeanne Hersent-Mauduit

Contests

Corporate stakeholders like shiny new toys.

Soon after I joined the MATTER Healthcare Incubator in October, three partner organizations announced contests. None were a good fit for Humaginarium but I entered them anyway. Why? To learn more about the needs of corporate stakeholders; stretch my universal value proposition to the limit; practice my nascent pitch; and assess the competition. It was fun actually and I gained a few insights.

The partner organizations were Novo Nordisk (supplier), Advocate Aurora (provider), and Blue Cross Blue Shield (payer). Each called for innovations that serve a special interest:

  • The supplier wants to improve the treatment of diabetes
  • The provider wants to improve the quality of primary care
  • The payer wants to improve health equity in the community

Each contest attracted about 70 submissions from around the United States. I was surprised by the number and distribution because the prize in each contest was just a small amount of money. More than money though, the partners promised to commit human resources to the winners in order to advance their ideas to the next level.

As far as I can tell, I’m the only contestant who proposed a solution involving health education and literacy. Among the finalists, all of the others pitched technology that collects or generates data from patients. The data theoretically get used by clinicians to increase the speed and certainty of treatment.

The bleeding edge of these innovations is data analytics. “In God we trust, all others bring data.” Some contestants also preached the gospel of artificial intelligence. They coupled data analytics with expert systems in order to make their apps perform medical diagnosis and recommend treatments. Some contestants further broadened their scope by aggregating third-party technology into their architecture. So for example, after a patient enters a description of symptoms, the app crunches a universe of medical records and research to suggest a diagnosis and course of treatment. Assuming that you, as the patient, are sufficiently alarmed by that point because the signs point to cancer (like what often happens on WebMD), the app schedules an appointment with your doctor and calls a Lyft to get you there. You lose no time before experiencing the full curative force of our marvelous health care system. Providers capture more revenue from you, who would otherwise be oblivious to your condition; and they spend less time treating you because a lot of your health care has magically become self-serve.

I think all of the final pitches fit under a rubric of “connected health,” though there’s still a lot of variation. This overall pattern reinforced my perception that connected health is “hot” and shouldn’t be ignored in the design of Humaginarium. AI is likewise hot, but that makes me a little nervous because the science of AI is many years away from making life or death decisions about health, at least when it comes to mine. It’s a safer bet for pizza delivery. There’s a slight chance that data analytics and artificial intelligence in health care are digital lingo for “smoke and mirrors.” I doubt it, but it’s possible.

Anyway my takeaways from all three contests are:

  • Corporate stakeholders like shiny new toys
  • The top innovations solve provider problems, not patient problems
  • They want to automate health care to the extent possible
  • That pairs nicely with increasing capacity and efficiency
  • Patients themselves are objects rather than subjects of innovation
  • Self-care is a euphemism for medication adherence

Most of the finalists were pretty far along on their journey, with fully developed products, teams, pilots, partners, and customers. Thus their innovations were low risk because they were seeking support for execution rather than ideation. They have traction.

I was delighted to be the only contestant promoting health literacy, delivering health education that empowers regular folks to think like a consumer and not just behave like a patient. This brought to mind the Jungian gallery of archetypes. My brand archetype of sage is uncontested at least in these contests. The question remains though, can a sage attract investments and make boatloads of money? We shall see.

Revenue

Humaginarium is more moonshot than pizza delivery.

When it comes to revenue, consider two types of startup. One wants to solve problems and also make money. The other wants to make money and also solve problems. They sound alike but their raison d’être is different. I thought I observed the difference in a series of pitches this week. Problem-solvers edified and inspired me whereas money-makers pressed for my buy in. Hopefully I’m not making this up. I think it’s real. The difference between the types of startup is like the difference between quality and utility, transformation and fulfillment, moonshot and pizza delivery.

Be that as it may, all startups have to spend and make money, the more the better. For their innovations to engage, they must scale so that they solve one huge problem for many different customers or a lot of little problems for just a few customers at a time. AAA game studios are examples of huge; indie studios of little. Ideally and rarely, when innovations solve a lot of huge problems for many different customers, brands like Amazon and Google are born. Humaginarium may be that kind of startup.

It’s a nice thought, but in any case where will our revenue come from? Most likely from multiple streams including:

  • Direct sales
  • Sponsorship
  • Advertising
  • Analytics

With a freemium pricing strategy, direct sales to consumers will occur when uncommitted users become paying customers. Why would they do that? In order to unlock extra content and premium services. Freemium will help Humaginarium build a large fan base by removing piddling barriers to entry. True, only a small portion of users will actually become paying customers, but the value of scale to us far exceeds the value of purchases alone. Strange as it sounded before Chris Anderson explained this for me, free is far more lucrative than subscription or PPV.

In addition to consumers, we will also book revenue with direct sales to organizations that hire Humaginarium. Hire us? For what? Most likely to develop branded content for their customers, members, students, or employees. This contracted work for hire will be vended by a sub brand named Humagine Learning. That brand draws from the same creative and technical resources as Humaginarium, but makes different products. Organizations get to own what they buy from Humagine Learning, and they also get to decide what it is and whom it’s for.

Our work for hire is a kind of “sponsored content,” but not the only kind. Content we make for direct sale to consumers can also be sponsored. For example, by nonprofits making program-related investments in health literacy or by for-profits trying to build their brands with a large audience of our consumers who have the problem that our sponsor claims to solve. In this way, the Cleveland Clinic could decide to sponsor our cardiovascular portfolio because it promotes health literacy in a segment of the population that the Cleveland Clinic famously serves.

Advertising is yet another revenue stream, different from sponsorship because ad sales are specifically for demand generation rather than brand building. Thus a pharmaceutical or food processing company might decide to advertise to consumers playing in our immunological portfolio. Why? Because the advertiser has a specific product that mitigates a chronic illness that we are helping consumers understand and maybe do something about.

Analytics is different from the previous streams but also valuable. Consumers who explore and challenge chronic illness in Humaginarium may generate mass insight into behaviors, beliefs, preferences, habits, and concerns that transcend play and factor into real-life choices. We will sell this insight to customers in health care and population health who can use it. For example, insight into complex emotional causes of medication non adherence for marketers of drugs.

These multiple revenue streams are organic to the value propositions of Humaginarium. They all represent transactions that reinforce our nudge to wellness. Unlike Walgreens selling liquor and tobacco products in their pharmacies, they fit our mission. Am I sure that there’s enough revenue in these combined streams to warrant investment in the highest quality scientific entertainment that I have in mind? I won’t know for sure until I have a financial model that presents the data and passes the test. However I’m pretty sure that Humaginarium is more moonshot than pizza delivery. The upside potential looks incredible.

Customers

Fully realized human beings, imperfect and aspiring.

Humaginarium customers are people with a chronic illness who enjoy video games. This begs the questions: what people, what illness, and what video games?

My people are 18 and older. They’re “regular folks,” a denominator I borrowed from Chris Anderson. Diverse in age, gender, ethnicity, community, socioeconomic class, vocation, and education. That sounds like everybody, but it doesn’t include children or puerile adults. Cognitive and emotional loads of Humaginarium are for the types of people Ralph Waldo Emerson called “man thinking” and Johan Huizinga called “man playing.” Fully realized human beings, imperfect and aspiring.

These regular folks have a chronic illness; or believe they have or risk developing one; or empathetically care for somebody who is afflicted. Approximately half the population of the United States has a debilitating chronic illness; many individuals have more than one. I don’t know how many more worry they have something that hasn’t been diagnosed; nor do I know how many healthy people care for others who are chronically ill. Still, the total population of my people is very large and is projected to grow about 1% annually. At this point it’s fine to leave it at that.

What chronic illness am I talking about? Well, there are many. Humaginarium has nine portfolios to cover them:

  1. Cancerous
  2. Cardiovascular
  3. Endocrinological
  4. Hepatic
  5. Immunological
  6. Neurological
  7. Renal
  8. Respiratory
  9. Rheumatological

My starting point in conceiving Humaginarium was immunological disorders, for personal reasons, but I switched to endocrinological for technical reasons. In line with that choice, our prototype project Diabetes Agonistes simulates type 2 diabetes. There will be several more Humaginarium games for customers concerned about this dreadful malady; and eventually there will be hundreds of games across all nine portfolios helping millions of people come to terms.

That said, we can advance to the final question: what video games? I bifurcate the lot according to the ways they’re used: streaming and downloading. Streaming refers to PC games but I expect the PC to subsume game consoles while Humaginarium is breaking away. So think of these video games as all that stream from the cloud to a screen. In contrast to streaming, downloading refers to games retailed by Apple and Google; and probably by Amazon and Microsoft before long.

My streaming video game is long-form in the strategy genre. Hours of thoughtful and engaging entertainment in each portfolio with themes, stories, characters, immersive aesthetics. In contrast my downloading video game is an itty-bitty app in the casual genre featuring mind-bending puzzle forms. Customers may play downloading games that unlock content in their streaming adventures. They may likewise collect clues and tokens in streaming games that solve some of the thornier problems in downloading titles. Streaming and downloading both promote escapism and catharsis.

Thus Humaginarium customers are people with a chronic illness who enjoy video games. Even accepting that, however, it’s reasonable to wonder something like this: Why would any customer want to play video games about chronic illness? Well, a similar question has been asked about popular games that depict violent crime and warfare. After all who enjoys rape and murder, pillage, pain and suffering? The answer (I hope) is nobody; but the timeless function of art is not to purvey sadistic pleasure. It’s to reframe and overcome horror in ways that are gratifying and empowering. Grownups use all of the arts – visual, literary, dramatic, cinematic, musical, and interactive – to face the terrifying mysteries of life with curiosity and courage; and use that experience to beautify and make better sense of living in the real world.

I’ve noticed that some critics who question the utility of games for people with a chronic illness neither have a chronic illness nor love video games. Not surprising. Moreover they haven’t considered the therapeutic affordances of art or the developmental impetus of play. That being the case, they can relax, they’re off the hook, because Humaginarium is making stuff for the other half of humanity. Skeptics are not my customer.

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Scientific entertainment.  Variation on Male Nude Study, by Gustav Klimt

Roundup

Humaginarium will keep people up at night jailing the baddies of chronic illness.

I recently shared quick impressions and opinions of meeting with the Diabetes Technology Society. I’ll begin now with a rumination that kindled slowly; then offer a roundup of other recent activities.

Concerning my passivity at DTS. Though I traveled as an NSF sponsored investigator, I didn’t hunt and gather evidence that shores up my business model. I didn’t follow the I-Corps script for customer discovery and afterwards I wondered why. Without realizing it, I may have become recalcitrant towards the empiricism of lean startup. There I was, schmoozing and kibitzing in Bethesda, getting out of the proverbial building. But instead of probing stakeholders about problems and needs, I was learning their science and taking time to ponder and reflect. Ideation and reflection are among the missing pieces of lean puzzles. Lean technique is more reactive or opportunistic than inquisitive and creative. So maybe I was reverting to form at DTS after my summertime plunge in the turbulent Mines of Moria-Newark.

Concerning revenue streams. At my poster session in Bethesda I told a diabetes drug company that it doesn’t want what Humaginarium is making. You invest in sickness, I said, but Humaginarium is an investment in wellness. They told me I was mistaken. A few days later a marketing advisor told me I was wrong. A few days after that a business mentor told me I was stupid. The net? I must restore health care companies to my customer segmentation! Why? Because two pharmaceutical executives liked the idea of Humaginarium. That counts as evidence in a lean startup. Yet I don’t want to do it! I already view health care companies as revenue streams because they are potential sponsors and advertisers. I don’t view them as customers because that, honestly, is not what they are. Think about it. They sell products and services to clinicians who care for patients, but how does that qualify them as my customers? They don’t even qualify as my business partners because their job has little if anything to do with promoting health literacy. They sell stuff to doctors but they don’t empower patients. In this light the advice I got feels unhelpful and distracting (not unusual when a startup is incubating).

Now looking beyond DTS, I recently wrote three challenge grants for support of our prototype project Diabetes Agonistes. All three were (ironically) sponsored by health care companies: big pharma, a provider system, and a payer organization. I’m not sanguine about making even the first cut in these pitches, but it’s good practice and I hope to collect a bit of useful feedback from potential sponsors and advertisers about the role of Humaginarium in the health care ecosystem. I learned yesterday about a fourth challenge grant that resonates because the corporate sponsor claims it wants to disrupt the health care industry. I’ll write that grant as well.

After returning from Bethesda I interviewed two consultants, one in Indiana and another in Michigan. They advise startups that want to apply for SBIR funding. SBIR has been a goal of Humaginarium for about a year now. We were prevented from making a December 2018 submission by nuisance factors in I-Corps. However these consultant interviews were encouraging and a good reset. Right afterwards a third consultant was recommended to me, this one in Illinois. On the basis of these inputs, Humaginarium may apply for Phase 1 SBIR at least twice in 2019: to NSF in June and NIH in September. There’s also a chance that we’ll discover other sources of government funding and foundations that make program-related investments in health education and wellness.

Still looking ahead, after the Thanksgiving holiday I’m going to visit somebody I’ve wanted to meet for years: a research scientist at UChicago Medicine who founded a studio making games for health. Though her focus is pedagogy and mine is andragogy, I am so looking forward to meeting and will write about it in a future blog. She and the medical director of LevelEx are in my gallery of local heroes.

Speaking of university, over the past few days Humaginarium became the subject of a practicum for business school students at Northern Illinois University. If enough students sign up, starting in January 2019 they and a faculty advisor will research and draft marketing and commercialization plans that bridge the abyss between entertainment and health. That bridge building is fundamentally my mission, so I am very excited about this project. I’ll ask the class to study the commercialization model of Professor Scott Meadow at the University of Chicago, which is the best thing of its kind I have seen and way better than lean templates that are more familiar among startups.

Last but certainly not least in this meandering roundup, I interviewed a quant named Richard Cross who is not looking for work but who easily gets what I’m trying to create (bless him). Our 30 minutes together were full of ideation and reflection. My kind of guy. He offered to connect me with people who can plot the kind of mathematical model that I want for consumers exploring the human body in Humaginarium. A model I can use to generate real-time scenarios of adventure, complementing the real-time scenarios of physiology that I already have with HumMod. My vision for world building in this fantasy platform is biology that truly mimics and yet improves nature. When consumers roam the miracle known as the human body, I want them to experience what exists under their skin as well as what could happen there with a braver and more skillful self at the controls. A digital engine that turns our teeny weeny Diabetes Agonistes into gobsmacking cool video games that keep people up at night jailing the baddies of chronic illness in their own bodies.