Different year, same dream, more hope.  Connected Health Symposium in Boston sponsored by Partners Health Care had more than 1000 attendees and an optimistic tone following this past year's congressional investments in health care reform pilot programs that may include the use of telehealth-type technologies. If you were a new attendee with a pesky chronic condition, perhaps you would have been alarmed at the continuing (from previous years) discussions about what to do about you: 'nudge' via incentives or penalties toward healthier behaviors, overcome your underwhelming (10%) nationwide sign-up for personal health records, devise new ways to 'amp up' your compliance with doctor-prescribed regimens, argue whether your favorite social networks will get you to do what the doctor can't -- and above all, get your active participation in harnessing the ballooning cost of care.  Lots of talk about payment reform from today's transactional and confounding fee for service to (deep breath): 'outcome-driven, quality-based, global payments through accountable care organizations.' I think that means charge less, pay less, get less of what today costs too much for too little in the way of results:

• Is there an echo in the room: who will pay? The thematic ribbon that tied all of the sessions together -- when will the (choose any) insurance company, government, employers pay for the populace to (choose any) use telehealth devices, lose weight, get fit? When is that elusive reimbursement tipping point? It seems from the discussion that it's not going to be this year, although hospital systems and insurers are creative and may accelerate the use of remote monitoring technologies to avoid new 30-day readmission penalties. Gaming the system, coverage of telehealth devices will extend to 32 days post-discharge. As in all businesses, where there's a will, there's an out.

• Behavioral economics -- getting you to do X. Numerous agenda slots and speakers tackled the conundrum of our obstinate avoidance of what's good for our health. But stubborn patient predictability and Connected Health's agenda should come as no surprise at such an MD-focused event. Said Roni Zeiger, Chief Health Strategist of Google: "90% of 'things' in healthcare have been known for a long time." Still frustrating: if you give $150 to adults to go to the gym 120 times per year, they won't go.  Only 2-3 percent of smokers actually ever quit, even though 70% say they want to -- despite the fact that by 2014, per the healthcare bill, up to 50% of insurance premium pricing will be connected to 'outcomes'. Translate that -- individual costs will go up if weight or smoking behaviors don't go down.

• Persuasion or choice?  Stanford prof BJ Fogg discussed the most succinct model at the conference. He outlined the three required elements to get us to change behavior -- motivation, ability (time, money, physical effort), and trigger (sparks or signals) to get us to do something -- whether it's exercising or completing an online survey. Miss one dimension and we patients/consumers are flatfootedly not going to participate. So, says Professor Fogg: "Help people do what they already want to do by putting hot triggers in the path of motivated people." And there is hope for built-in defaults and automatic prescription refills -- as proven by UPenn studies  described by Dr. Kevin Volpp, Director, Center for Health Incentives, Director, Center on Behavioral Economics and Health. And tackling the question of how our minds work when faced with too many or too limited options was outlined by Columbia professor Sheena Iyengar, author of "The Art of Choosing."

Notable vendors will be covered in the 2 of 2 post.