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COVID19

Livongo’s Glen Tullman: After COVID-19, we can’t go back to the old, broken health care system

Gabriel Perna | May 7, 2020

The COVID-19 pandemic has forced a massive shift in the health care industry and how patients interact with providers.

Only a quarter of health care organizations had a virtual care program in place in January, according to Forrester. Surely, that number has risen in the three months since.

Regular visits to the doctor are down significantly across every major specialty and region. Usage of telehealth and remote care monitoring are up significantly (90 percent of physicians are seeing patients remotely, according to one study). Two areas that are particularly needed for the quarantine-induced digital health revolution are chronic care management and behavioral health. The researchers from Forrester, in fact, predict 80 million virtual visits in 2020 alone will be related to mental health needs.

This week, digital health company Livongo revealed that it has seen a 100 percent year-over-year increase in members enrolled in its diabetes management program, with most of that coming in the last few months. Livongo had 222,000 members enrolled at the end of 2019 and accumulated 328,000 at the end of March. The company increased its client total by 44% in the first quarter of 2020 alone.

Health Evolution spoke with Tullman about the impact of COVID-19 on digital health adoption and Livongo in particular, how CEOs can rapidly shift their mentality to digital health-first and more. Below are excerpts from the interview.

What conversations are you having with CEOs of providers and payers as they shift to digital thanks to COVID-19?

You can’t start without talking about the amazing job that our first line of defense has done. That’s where a lot of my conversations with CEOs start. From there, they go into an interesting place. Livongo has found itself in a critical area of caring for the most vulnerable and expensive parts of our health care system. People with chronic conditions like diabetes, hypertension, mental health challenges, weight issues. The CDC report says that 78% of people in ICUs today have either a pre-existing or chronic condition. Over 90% of all the deaths are people with those conditions. If you understand what Livongo does, empowering people with chronic conditions to live better and healthier lives by giving them technology that allows them to stay home, then you understand how critical what we do has become to this whole crisis.              

People are starting to understand that a hospital, the ER, even a doctor’s office is a dangerous place to go if you have a chronic condition. There’s this new realization that says “if you have a chronic condition, stay away from the hospital.” What we’ve seen, whether it’s large payers, PBMs, large employers, they’ve all come to us and asked us, “How do we keep our population of people with chronic conditions healthy and out of the hospital?” And then they want to ask us how they can manage costs. We’re seeing an acceleration in our business, even in the most challenged industries. They may have a reduction in workforce, but for their remaining employees they want to keep them healthy and they have to do it cost effectively.

When it comes to chronic care management digital health solutions, what opportunities do you foresee coming out of this pandemic? 

I don’t think there is any question that the market has already voted on this. We hear health system after health system, employer after employer say, “We’re not going back. We’ve now tasted what telehealth looks like. We’ve tasted what remote care looks like.” I think it’s clear when you talk to the experts that remote monitoring is the new standard of care. Those changes are permanent, just like if you look at other areas of the economy are getting used to [this new normal]. Someone recently told me they had 48 bottles of water delivered and said, “Why would I ever carry those home again when Amazon will deliver it right to my door?” Just like you’re going to see an accelerated use of digital commerce, you’re going to see an aggressive expansion of digital health.

This is an opportunity to rapidly evolve the health care system. They have no choice. Almost every health care organization is using telehealth to provide care. But there’s no reason for anyone to go back to the old way of doing things.

Glen Tullman, Livongo Executive Chairman

We’re seeing many organizations quickly turn to digital technologies in the pandemic. How is Livongo working with customers to rapidly transition to digital health during this time?

What’s unique is what would have taken us 10 years was done in three to six months. It would have taken years to have this many people try Amazon for grocery delivery. But today you have literally millions of people. It would have taken years to take everyone in the country to use Zoom. Today, millions of people are using it. People’s behavior has changed to a better, more efficient way overnight.

What’s happening in health care is what’s happened in other countries with telephones. What you’ve seen in many countries that didn’t have telephone infrastructures is rather than putting up telephone lines they’ve skipped right over that and have gone directly to digital. If you didn’t have a single digital project going on at your health care organization, overnight you have the ability to go fully digital. That’s what we’re seeing. People are requesting, “How quickly can you implement?” That wasn’t always the request from existing health systems and payers. That’s not just payers and providers either…but government entities. The government itself has concluded we need to go digital health, and in particular, for mental health.

In the new world, we’re going to have to use digital health solutions for mental health. That’s become an enormous challenge today. In just the past month, we’ve seen a doubling of our members who have [indicated] they have stress when they’re getting their blood sugar checked. They’re generally feeling more stress and anxiety about what’s going on…we think COVID-19 is going to accelerate the use of digital health across the board, but in particular for mental and behavioral health. We’ve seen 140% increase in utilization of behavior health services just between September 2019 and March 2020.

How has the recent flurry of COVID-19-related policy changes from CMS and the CARES Act impacted remote monitoring?

There have been two national emergencies, The Stafford Act and The CARES Act. Four legislative avenues where the government has provided support in the health care arena. Some will expire over a period. Some will last for years. That’s the legislative side. On the regulatory side, HHS and CMS have made changes that are long lasting.

A number of hospitals made a request because they didn’t have enough personal protective equipment and they wanted to reduce the number of exposures where a person had to go in with diabetes and get their blood checked. Every time that happened, they had to use new personal protective equipment and they had another exposure. They needed a way to capture blood pressure results remotely. They requested the government give them clearance to use Livongo to monitor people and allow patients to be managed remotely. That request was granted quickly. That will expire over time, the government will have the opportunity to renew that but it will expire. Other changes, allowing certain billing codes to be used for remote monitoring and within a Medicare population, those changes are permanent.

What advice do you have to CEOs?

One, this is in fact what their customers—health consumers—this is what they want. In every other area of our economy, people have what they want 24/7 digitally. That trend has accelerated dramatically in health care. This is an opportunity for them to truly become consumer directed.

Second, this is an opportunity to rapidly evolve the health care system. They have no choice. Almost every health care organization is using telehealth to provide care. But there’s no reason for anyone to go back to the old way of doing things. We all know that was a broken system. This is an opportunity to take what digital has to offer to lead organizations to a new place. We’ve seen great leadership from some of our health care organizations and we need all of them to step up. We’ll never have this opportunity again to make the changes we need to make.

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email or on Twitter at @GabrielSPerna