As wellness information becomes more varied and voluminous, and as we continue to grapple with finding what is "right" for "me," the challenge morphs into one of information aggregation and sorting: aggregation to assemble the available options, and sorting to enable consumer choice. Our wellness purchases today are typically one-off decisions, with products and services purchased from individual, disconnected suppliers. These suppliers do not chat with each other as to how to better take care of my overall well-being, which means that my efforts to optimize my well-being will, unfortunately, turn out to be near-sighted and sub-optimal. Attaining an optimal state of well-being is more akin to charting a course - mapping a journey - from a known starting destination, as opposed to simply choosing the best possible option at each step.
From healthcare to yoga, how can companies present wellness options to customers to allow them to proactively choose? How can customers play a bigger role in crafting their wellness journeys?
These are growing concerns in the wellness and healthcare industries, and one area that provides a model for this type of consumer engagement is the airline industry - specifically, the way we book travel online. Today, we simply have to imagine our travel destination, and a plethora of possibilities lie at our fingertips to bring our vision to life - from booking flights, to hotels, to entire itineraries. Yet, it was only 30 years ago when this entire process was still controlled by a network of middle-(wo)men: travel agents. At that time, you could tell your travel agent where & when you wanted to go, but you would never know if you got the best price or what options you had to forgo.
The transformation of the booking experience was driven by information technology, and it has been nothing short of revolutionary. What if we could manage our health & wealth in a similar way? Could it be as simple as booking an itinerary between your current state of wellness and your target destination?
In travel, our starting and ending destinations are known: the airline simply needs to calculate all paths between points A and B, while considering any filters or constraints you have applied to your search. I would argue that we are getting closer to a state where we can identify points A and B in our wellness journeys. There are a growing number of diagnostic tools that help us map where we currently stand (our "point A"). For example:
- The surveys used by personalized vitamin suppliers: Persona, Care/Of, Rootine
- Assessments of our sleep (BigHealth, Calm)
- Physiological assessments (BMI, resting heart rate, ovulation cycles, and more) and dietary assessments (MyFitnessPal)
- Surveys to identify your Ayurvedic dosha (Dosha quiz)
Each of these services asks us a battery of questions - or uses machine learning and sensors in our phones - to assess certain dimensions of our well-being at a particular point in time. In effect, they are assessing our "point A," our starting point.
In turn, the wellness movement is encouraging us to take a proactive view of our life, and wellness lingo has taken on an aspirational bent. We want to be woke, we want to vibrate at a higher level, we want to be fit, flexible, lean, we want to be mindful, and we want to be peaceful. The yearning is evident in the massive popularity of wellness blogs and Instagram influencers. From Kim Kardashian to Marie Kondo, the betterment of ourselves has become mainstream. As such, I believe we can start expecting the general consumer to be able to pick their wellness destination - their "point B" - from a list of options.
While simply defining points A and B is far from enough for a fully mapped wellness trajectory, it is a sufficient starting point for us to draw parallels to the airline industry.
Information technology breathed new life into the airline industry in the 1990s (see this timeline here). We first saw the emergence of online booking systems that allowed consumers to bypass travel agents, the traditional gatekeepers of airline booking. This alone was an important step, as it encouraged price shopping and led to greater fare transparency. By the late '90s, as the internet took hold, we began to see the emergence of "airfare consolidators," websites, like booking.com, Travelocity, and Expedia, that aggregated price information from multiple sources online, enabling consumers to search multiple sources simultaneously to find the trajectory that best suited their criteria.
Airfare consolidation and aggregation was made possible by a long history - dating back to the 1950's - of structuring, organizing, and integrating airline data. In my view, the wellness industry today is worse off than the airline reservation systems of the 1950's: in wellness, we can't even easily identify our origins and destinations! That is where we need to start.
Nonetheless, there are important lessons that the wellness industry stands to learn from the history of airfare consolidation.
From my study of the history of online travel, there are 3 key lessons that are applicable for the wellness industry today:
The real revolution in travel came not from the content companies, but from booking systems.
"We negotiated with this company, Worldview Systems. This was a content company. They had lots of destination content, and, at the time, we didn't know whether booking or content would be big. We did a joint venture with this company, we called it Travelocity." - Terrell Jones, former chief information officer, Sabre; founder and first CEO of Travelocity (from The Definitive Oral History of Online Travel by Dennis Schaal on Skift)
As Travelocity demonstrated, content about the journey was secondary to the creation - the booking - of the journey. Today, the internet is caught in the middle of global arms race of wellness information and misinformation. This pattern of unorganized and unchecked information growth is not sustainable, which will lead to the emergence of businesses that can plot wellness journeys, essentially charting a course for consumers through the maze of information and misinformation.
We also need to enable the creation of more comprehensive booking systems in wellness - systems that provide a holistic picture of who I am and can recommend a sequence of treatments to take me to my wellness destination. I argue that this technology is predicated on a more comprehensive description of the wellness space, a unified taxonomy of wellness concepts with semantic relationships connecting them. I call this a "wellness knowledge graph" and we need a wellness informatics to bring this idea to fruition. A knowledge graph is a crucial piece of infrastructure in building a queryable system for consumers to ask questions and receive answers about their wellness.
Central to the ability to negotiate with airlines and hotels was the idea of forecasting demand - an approach pioneered by Priceline.
"So we began working on the idea of a demand collection system. How would you collect demand for people who wanted to fly and were willing to fly, but at the same time were not getting this right price? That's where we had the insight to say, hey, if they told us the price they were willing to pay and secured it with a credit card, we would know that the unit of demand was indeed a real customer, not some fake customer, right? ...we said to the airlines, look, we have a new product, this super-leisure product. We have a new way to collect demand for the product and we're going to use this new-fangled thing called the internet and we're going to let the customer price the product so that will allow you the airline to see the demand curve all the way below the price line." -Jay Walker, founder of Priceline (from The Definitive Oral History of Online Travel by Dennis Schaal on Skift)
The wellness industry currently suffers from an inability to forecast demand. This is partially due to the small and local nature of wellness businesses - comprised of independent practitioners, studios, spas, and gyms - who largely do not have the analytic or marketing tools to create demand or forecast demand on large scales. I predict that, akin to airfare aggregation, the need for demand forecasting (combined with the need to aggregate information) will spur a wave of mergers in the wellness industry, which will result in larger companies capable of aggregating and forecasting information at scale.
There is value in the sheer aggregation of information, as evidenced by the story of Cheapflights:
"Cheapflights started as a listing service for flight deals from consolidators, from people who had websites, but predominantly people who had telephone numbers so it was kind of a Teletext killer in many ways. Because Teletext was a non-user-friendly source of cheap flights deals, and Cheapflights knew [it could succeed] in terms of being user-friendly and offering a great range of deals in an easy format. John [Hatt] had a goal of transparency and aggregation from a very early stage. He felt that by not selling and by aggregating all the different suppliers and sellers of products that he could offer a more interesting and better product. And that was at the heart of his vision, simply buying cheap flights." -Hugo Burge, former CEO of Cheapflights Media (from The Definitive Oral History of Online Travel by Dennis Schaal on Skift)
In the wellness industry today, the old adage that "content is king" still prevails. Google searches for any health complaint or symptom will return results from the same 5-10 companies, each of whom (e.g. Healthline, WebMD) has enlisted a small army of writers and bloggers to pump out content and dominate the search rankings. The next step in the evolution of wellness information is aggregation: websites that source content from other sites and present the "best" results to consumers, "best" being a function of the consumer's search criteria. This technology requires two components: the scraping & curation of content from secondary sources, and the sorting of content based on the user's search criteria. The latter is dependent upon a system of sorting, prioritizing, ranking, & organizing wellness information, which is best accomplished through a knowledge graph approach.
Aggregation is an intermediary step before we can enable full-fledged wellness navigation, online tools to help consumers get from point A to point B in their wellness journeys.
To define your "origin" - your current state, your starting location, your "Point A" - in wellness, we need to, first, consolidate our survey and measurement instruments. This means that surveys of well-being and our biometric measures of health will need to brought together to paint a unified picture of where we, as individuals, currently stand. This will likely involve comparing us against others so that we can define "normal" and assess how far we deviate. As our data collection tools become bigger and better, I believe we will be able to find narrower and narrower slices of the population with which to compare ourselves, leading to much more personalized and nuanced definitions of "normal" than in the past.
However, simply plotting us on a continuum against a population is insufficient for wellness, for our well-being is largely subjective. We need to distinguish subjective measures from objective measures. BMI (body mass index) is a perfect example of a metric that is strongly correlated with a number of adverse health outcomes (e.g. obesity, lifespan, and cancer, to name a few), but may not be a correlate for the subjective sense of "well-being."
Second, in wellness, our point B - our destination - is defined relative to our starting point, our origin. If I have a BMI of 27, a realistic goal for me would be to attain a BMI of 25, for example. The destinations - our goals - must be attainable and realistic, and, as such, the optimal way to define the goal is relative to our starting point. This is an important difference from air travel, where there are no ad hoc constraints between our origins and destinations.
Once we have instruments to assess our wellness origin, and a means of goal-setting to define our wellness destinations, then we can turn our attention to connecting the dots.
There are many paths between point A and point B in wellness. From yoga to CrossFit, mindfulness to meditation, crystal healing to aromatherapy, the number of things we can try appears endless. How can we be sure that a particular treatment will truly move the needle on our personal wellness? Of all the options available, what is the best option to try first? And what should we do after that?
Unfortunately, the answers to these questions are still being unearthed, both in the lab and in the real world. As the evidence emerges, we will need metrics to help qualify the strength of the evidence for a treatment and for a treatment plan. These metrics will be critical in designing trajectories that truly work, that actually help us reach our wellness destinations.
A final important characteristic of wellness trajectories: the layovers matter. A layover - time when you are not making forward progress toward your destination - wears on you, both physically and emotionally. In traveling toward our wellness goals, we are going to be very picky about where our layovers are, how many there are, and how long they will last, for these layovers directly impact our health and well-being. In fact, we will want - nay, demand - reassurance that these layovers are time-limited and that we are not taking any steps backwards during these stopovers.
As we think through the nuts and bolts of a wellness trajectory, it becomes apparent that wellness is a journey, a series of steps to reach a destination, and that no single modality will suffice to improve our wellness in every dimension we seek. To empower consumers to find the answers they seek, the wellness industry is poised to undergo an information revolution, and there is much that we can learn from studying similar revolutions in other industries. In the airline and hospitality industries, a paradigm shift was required to pave the way for new systems for booking and searching travel options. While this change was painful and arduous, it ushered in a new era, and, today, we would be hard-pressed to imagine going back to the way things used to be, travel agents and all.
The wellness industry is at a similar crossroads. The choices that consumers need to make are many, but we are nearly blind as to what constitutes the "best itinerary" to reach our destinations in terms of our health & wellness. By learning from the history of the airline industry, we can better imagine how we can empower consumers with the ability to craft their own itineraries, and we can be better stewards of the imminent information revolution in wellness.