Like something straight out of HBO's series Silicon Valley, former Allscripts CEO Glen Tullman made a splash on the TechCrunch Disrupt stage last week introducing the latest and greatest in cloud-based glucose testing tech: Livongo, with its new In Touch meter, backed by a $10 million seed investment.
But if you're like us, you were probably rolling your eyes at the news, thinking: Aren't there already a bunch of whiz-bang meters that wirelessly transmit diabetes data here and there? So what?!
In fact, what Livongo (formerly Eos Health) is trying to accomplish is MUCH bigger than using Bluetooth to send blood sugar values; they're truly hoping to disrupt the whole business of diabetes by: 1) creating a business model that is no longer dependent on expensive test strips, and 2) tying glucose testing directly into care and research.
This is accomplished with their now FDA-approved nifty touch-screen meter that incorporates a pedometer and is constantly in two-way communication with a "smart cloud" setup. It not only stores your data but sends you feedback and real suggestions on what to do next, and -- this part is big! -- can alert a care coach to call you immediately in case help is needed. That care coach is either one of a team of Certified Diabetes Educators employed by Livongo, or can be any physician or CDE of your choosing.
And the monthly cost to patients for any amount of necessary test strips plus this coaching service is not to exceed $75 out-of-pocket, and will likely be less for those whose employers or health plans choose to cover Livongo, Tullman says. That's a max of $900 for a full year of testing supplies; a platform to easily share data with your doctor, family, etc. at the touch of a button; and this coaching service complete with real-time response that can alert your emergency contacts in case you don't respond to a phone call after a low reading.
"This whole industry is focused on the cost of test strips... But nobody has data (on how these strips are used) to measure and improve care. We want to empower people -- to make it easy for patients to take care of themselves. We think we can make a good margin, and build a solid business that's not based on making fat margins on test strips," Tullman told me over a Diet Coke when we met last week, post-TechCrunch.
That was in response to my question about how they planned to stay in business if there are no copays and no supply costs. My other burning question was of course about open data access, i.e. will their cloud platform be compatible with that of Tidepool for example?
"Absolutely! We don't want to reinvent the wheel... The idea of Livongo is that you control where your data goes," Tullman said. "We would love to work with Tidepool and use some of their stuff. We also plan to talk directly with Dexcom, Medtronic, and others about integrating their data directly as well."
I immediately emailed Tidepool CEO Howard Look, and got this response: "We're thrilled that the ecosystem of connected diabetes devices and services continue to grow with companies like Livongo. It's great that Livongo is embracing the notion of patient-owned data, and enabling the ability for their platform to share data with other platforms like Tidepool's. We're also hopeful that our open platform can help them more quickly integrate data from other devices like Medtronic and Dexcom."
All good on the #WeAreNotWaiting front.
A Son with T1
Quick background on Glen Tullman: he's a well-known entrepreneur and investor who spent 16 years in senior management with Allscripts Healthcare, and even led their Initial Public Offering (IPO). He's also built and run a number of successful businesses in other industries. But his most important chops in this case are his niece and now-teenage son living with type 1 diabetes -- his inspirations, he says.
"A few years ago, my son had a seizure at night," Tullman told me. "He apparently got up and tested at 54 mg/dL, and then wasn't thinking clearly and just went back to sleep. That made me think -- there has to be a better way! The evidence was right there that he was heading for a bad situation."
The new Livongo system is set up to call patients within 60 seconds if they clock-in dangerously low. The level at which this kicks in is generally considered 50 mg/dL, but can set be set differently by every individual patient.
How Livongo's Meter Works
I got to play with the In Touch meter, and also see a demo of the cloud-based platform, albeit only for a few minutes each. The current meter and portal are only Version 1, I'm told, with many upgrades on the way. Still, my impression was quite positive. While the meter itself looks like just another little black box, the touch screen is super-intuitive, and includes many things you might not expect.
Instead of plain text scrolling, you use colorful quadrants to tap on the functions you'd like to access. The "Activity" tab is where you control the pedometer, "Team" is where you add the people you'd like to be able to access your results, and "Messages" is where you can exchange notes with your health coach.
The Messages area is also where the system provides actual feedback on your trends. For example, "It looks like you've been running high in the afternoons -- you might want to adjust your lunch dosing." Wow!
When you put blood on the strip, Livongo has replaced the traditional countdown with tips that appear on screen -- which ought never to get boring considering they've already loaded more than 1,000 unique messages today and are working on more, to "customize" the experience for users. "Behavioral scientists worked on it," Tullman tells me.
After each glucose test, the question pops up, "How do you feel?" and you get a choice of a variety of pre-set answers. While I initially found this rather annoying, I get that the goal is twofold: to record info on mood and physical well-being that you can cross-reference with your glucose results later, and to let the system know whether it should be alerting your health coach to reach out to you.
In the "Trends" area, you can view of 14, 30 or 90 days of glucose results, or other views. Little apple icons help you tag results -- a whole apple for pre-meal readings and a munched-up apple core for post-meals.
In Touch uses largish, colorful test strips that come in a variety of fun colors, and the unit uses a standard mini-USB cell phone charger. The charge lasts about a month if using glucose testing alone, or two weeks if you keep the pedometer function switched on. Full charging takes about an hour, we're told.
As far as the cloud portal where you access your data, the company also says they are feverishly working to improve on this even as I write.
"We are rolling out new ways to view the data... because physicians don't just want more data, but rather observations that help them with care," Tullman says. Yes -- and we patients too!
A Real-Time Coaching & Help Line
The really amazing part of this is the connection to a real-life health coach on the other end of your meter. These are CDEs located in Livongo's Call Center in Chicago and some other venues around the country (their company HQ is in the process moving to Palo Alto, CA.) You can also "turn off" the Call Center function if you wish, or set the system to have someone else be your health coach responder.
The emergency reaction -- in case you don't respond to a call after a low is logged -- is an individualized plan of action that you set up, similar to what you'd do with Phillips Lifeline for an elderly person in case they fall, or other med emergency service of this type. In other words, I could I say want my husband called on his cell phone first, then my best friend, and if they don't respond, then Livongo should alert 9-1-1.
You can also ping your health coach any time you have concerns and want to talk. Yikes! I was wondering what happens if people overuse this service...? Tullman tells me that anyone who calls frequently can be passed on to an appropriate healthcare provider, like perhaps a mental health professional if depression seems to be the issue. "This way, we know who needs help!" he says.
So the "equation" or "ecosystem" that Livongo keeps talking about creating = smart device + smart cloud + caring individual.
It's worth mentioning that Livongo is the first-ever virtual diabetes management program to be certified by the American Association of Diabetes Educators (AADE) -- because it's not just monitoring, but problem-solving, Tullman says. The meter allows you to set up reminders for your A1c, eye exam, microalbumin test and other parameters that AADE considers the cornerstones of care. You can also set medication reminders to pop up on the device if you wish.
The Cost/Benefit Equation
The low monthly payments for all of this service and all necessary supplies appears to be a great deal, since Livongo is offering:
- unlimited test strips
- no copay
- no regular ordering necessary
- no need to take your meter into your doctor's office and ask them to download the data -- no fax, email, text
- a meter that also includes activity data (pedometer), offering a more holistic view of your health
Experts estimate the average cost of care for a type 2 with some complications to be $15,000-$18,000 per year, Tullman says. "If we can take that down to $10,000 per person for example, that's a huge savings, and we think people will pay $500-$900 for this service... plus the quality of life stuff is huge."
When the Telcare meter was introduced in 2012 as the world's first cellular-enabled blood glucose meter that could automatically upload readings to an online logging portal, our T1D community seemed to agree it was "a step in the right direction." But many (including us) lamented issues like its short battery life and the fact that too few insurance companies covered the pricey meter and strips. And in terms of feedback, it only allows automated text messages from a doctor, triggered by certain patterns.
The Livongo offering certainly seems like it takes the whole concept of a wireless meter to the next level.
Plugging Into Research
I also spoke with Kim Angelides, founder of the former Eos Health and now Chief Scientific Officer of Livongo -- whose wife happens to be a pediatric endocrinologist. He points out that many healthcare organizations have only A1C data on their diabetes patients, and often not even that, since many patients don't get the test done regularly. "So they don't know how to help or who to call," he says. "A clinic using our system can have detailed data on patients' glucose patterns, whether they've had their lab tests done recently, and whether they're experiencing difficulties and need help," he said.
Studies using Livongo are going on now at UMass Memorial Hospital under Dr. David Harlan, at the University of South Florida, and at another major midwestern university to be announced soon. They're looking at people with elevated A1cs to determine whether a system like this can bring it down.
"People were surprised we would be investing in studies now -- after already getting FDA approval -- but it's so important to understand the baseline of care, and how can we make it easy for people to take care of themselves?" Angelides says. He's convinced the system "can help primary care physicians and endocringologists become better diabetologists."
Livongo is also giving away 50-100 free In Touch meters to the College Diabetes Network (CDN), in order to create a "feedback network," we're told. "These kids are texting their numbers to each other now. So a system like this can allow them to share better, and hopefully get more out of the experience," Angelides says. "This is collecting more than just a bunch of numbers for a glucose data dump."
When Will Livongo Be Available?
The meter will begin shipping later this week, we're told.
The main channel of distribution will be Livongo's organizational network, which currently includes HealthCare Partners, one of the country's largest managed care groups based in California, and Office Depot, a large employer that self-funds coverage for its employees.
They're also looking to establish partnerships soon with groups like Kaiser, big medical centers, at least one large school district, and employees of state and local governments. What makes these organizations want to invest?
"The pitch is -- it's a wellness program, and for the same or less cost you're paying now, people can do less and are more likely to succeed," Tullman says.
Angelides adds: "We understand that people want to do less for their illness, and still have better outcomes. Our system is designed to empower people to do that."
As always, the proof is in the real-world usage. We shall see.