We were excited for a chance recently to connect with one of the newest execs at the disruptive diabetes startup Livongo, one of a few new outfits pairing a sexy glucose meter with coaching services, along with unlimited test strips via mail order (!)
Andy joined in mid-August as the three-year-old startup's president and chief financial officer, coming off a rich background that includes work at 23andMe, StubHub and other well-known companies.
This is a crossroads for Livongo, as they're about to expand beyond just diabetes into another big chronic condition, so it's exiting to hear from Andy about his first few months on the job and what our D-Community can expect as we head into 2018.
An Interview with Livongo's Andy Page
DM) Thanks for taking the time, Andy. First off, do you have any personal connection to T1D?
AP) Well, interestingly, I did not when I began interviewing for this position at Livongo. But coincidentally, I have a 10-year-old nephew who was just recently diagnosed. The timing was fascinating because I was just in discussions with (Livongo CEO) Glenn Tullman and it all happened at the same time. But before that, I have really enjoyed my experience within the healthcare industry and being one step closer to impacting people directly with a condition. So while we all pretty much seem to have connections to someone with diabetes these days, that was not a driving factor here. To me, it was the company and the mission and being able to work with a great team at Livongo.
Sorry to hear about your nephew’s diagnosis, but “welcome” to the Diabetes Community from an uncle's POV…
Yes, I’ve heard people say that it’s "the club no one wants to join," but the community is amazing and I’ve seen that here. There’s a disproportionate amount of diabetes at Livongo and we don’t look at it as some big dark cloud, but just a condition that we manage as best we can.
What actually was the driving force that led you to Livongo?
A bunch of factors all came together at the same time. I’d left 23andMe in January and wanted to find something in healthcare. There are a lot of interesting Bay Area companies with a focus on gene sequencing, such as biopsies for example. I put those in the category of companies with a lot of technology to build out. On the other end of the spectrum, there are companies trying to automate care and have a significant impact on people working from home. I spent about six months doing about 25 in-depth company discussions, and also spent four months consulting at Verily (formerly Google Life Sciences). I gained a real appreciation and passion for understanding the areas of our healthcare system where we’re spending a tremendous amount of money and it’ll get worse, and diabetes is on the top of that list… and also in looking at opportunities to turn care upside-down… and that really led me to Livongo.
Can you elaborate on that notion of turning diabetes care upside-down?
We’re about making this a personal journey, looking at it from the perspective of an individual who has a chronic condition like diabetes, rather than a caregiver’s perspective. That orientation is fundamental in having a true impact, and it goes back to my 23andMe experience. We often don’t know what’s required to transform or significantly impact behavior change. At Livongo, we’re working to figure that out. That was very appealing to me.
How do you see Livongo helping influence diabetes behavior change?
It’s overly simplistic to look at a particular chronic condition and say ‘Everyone uses a meter, so what does it take to get people to check more?’ That’s a very narrow view of diabetes management. As opposed to: What are the emotional needs? Who is the influencer and caregiver and decision-maker? How can we communicate to the person with diabetes – using a device, at a particular time of day? Even what tone is going to resonate with them and have the most impact? We can’t do that unless we understand and are truly integrated into our membership. That’s a big challenge, but Livongo is dedicated to doing that.
What lessons have you brought with you from 23andMe, StubHub and other past positions?
For me, 23andMe was an incredible experience just because the company went through when I was there. I joined six weeks before we received a warning letter from the FDA (about its genetic testing practices and marketing), and I left in January 2017 when the business was continuing to thrive. (see release here)
It was about educating about the importance of participating in research, and then engaging those individuals so they participate on a frequent basis. So when a company has opportunities that are relevant to the individuals, those individuals look at the emails and read them and participate at unprecedented rates. 23andMe has really cracked the code on that. That was a major learning, and it goes to an understanding of what we’re doing at Livongo for people with diabetes…
So it's about how an individual is managing their chronic condition and how we can take away the friction, and capture information that feeds our analytics and database so we can then offer insights to enhance that person’s management – to help them learn something, or change behavior. That's what feels so similar to 23andMe, having data at our fingertips to feed into unique insights that lead to engagement.
For StubHub, what I think was most effective was the focus on trusting the brand. It started with the ticket market being a bunch of seedy people outside a venue in a trench coat selling tickets. So StubHub was all about trust, safety and guarantee – and seat selection, obviously. Without that, the StubHub brand never would have taken off.
The learning there for Livongo is that we have a community of more than 50,000 members utilizing our device and sharing a lot of health information with us. It’s imperative that they not only trust us, but engage with us as we help them manage a very intimate and important part of their life. Building that brand and relationship, while very different from StubHub, is just as important.
Whoa, now we’re imagining a world where you could use your Livongo glucose meter to order tickets on StubHub…
That would be funny! And it’s interesting you say that, as I ran the business strategy side at StubHub, and we talked about knowing all these people are going to venues, so why don’t we offer limo rides or coupons to the local bars? We learned that further monetizing the individual doesn’t necessarily leading to long-term success. The gateway to success was brand maturity and not sharing a wallet. Different organizations have to solve for different things. For Livongo, we’ve been talking about 'reducing friction' for the individual – offering unlimited test strips, understanding when they want them, and potentially offering other tools people might use, like the Livongo Connect (wireless connectivity device) we'll offer through the Diabeto acquisition.
We have to demonstrate the impact that the population is getting healthier. So getting distracted by one-off services that might allow us to monetize an individual’s experience, is not where we want our focus to be.
What are your day-to-day duties like, as President and CFO of this small growing company?
At the moment because I’ve just recently joined a new organization, I tend to spend the most time examining the CFO duties. There’s a lot of opportunity for any incoming executive to focus on one area and bring that up to the standards, and finances is no exception. I do have other departments that report to me, but they are very functional and strong and require less time – device and supply chain, products, and administrative functions like legal. My expectation going forward is that I’ll focus on whatever I need to.
I also need to go to diabetes school, to understand not just the science but the individual journey. That’s where I think I can make some difference. We have a very strong team, on clinical and medical, in products and the coaching staff, and at all levels within the company. I’m learning a lot from my peers.
What can you tells us about the Livongo offices?
Just recently in our main Mountain View office, we doubled our space there. That’s more product engineering and related aspects, and a third of our Livongo people are in Chicago at our outward-facing office with sales. The rest work remotely.
People like Manny (Hernandez, formerly of the Diabetes Hands Foundation) embody the culture of this company, and it’s really an exciting place to be. If you just walked into our offices, you'd feel that. It’s different than just any startup providing a product or service. We’re very enmeshed into this community.
As you know, Manny is respected as a pivotal member of our Diabetes Online Community over the years. How does he help shape the company culture?
What he brings to Livongo is the difference between just a healthcare technology provider and what he helps turn us into on an ongoing daily basis – an organization that is truly embedded into the Diabetes Community. We spend an incredible amount of timing giving back because we want to – from JDRF and walks, to people participating and donating to so many different things. We’re 'walking the walk,' and that's core to our culture.
It all starts with Glenn (Tullman, Livongo CEO), and the style of leadership that he has. It’s different from anything I’ve seen before. He has been wildly successful in multiple leadership positions over time, yet he treats Livongo like it’s his first startup. He's on 24/7 and it’s the most incredible thing – it's inspiring to all of us. He sets the tone and we all do our best to keep up with him.
What are your observations on Livongo's business model in your first few months of leadership?
It’s a more complex business than what I anticipated and it’s a bit more to navigate than meets the eye. We have what I’d call a two-tiered marketing structure – initially to large, self-insured employers. We have done a very effective job in that channel, with over 250+ employers, up from about 210 when I joined. That is an enterprise sales driven process. Then, we market to the employees of those organizations and that’s a more direct-to-consumer effort. We can then reach out through those partnerships by emails, direct mail, benefit fairs, or posters in break rooms. That second tier to consumers is a separate business in its own right.
Once we then launch the program, our enrollment rate – i.e. for an employer with 10,000 employees, maybe 600 will have diabetes – will end up looking like 200 to 300 people enrolled as members. That enrollment rate, from what we’ve been told is unprecedented in the market, we believe is 8-10 times some of the smaller companies in this space. We are proud of that, but still have a lot of work to get it higher.
What happens after you get a new member?
We keep in regular contact with them, not only because they’re using our device and checking, but other aspects of the program to help them feel like they’re part of the family. Right now, we have lots of different opportunities for people with diabetes to interact with our overall program. It’s a community feature, offering insights and many ways that the device itself, the mobile app or the website, can be used to interact. Our members can look forward to increased personalization efforts and a more refined service tailored to the individual going forward. We’re excited about that.
Personalization is a key to this, isn’t it?
Yes, that user experience is at the heart of everything. We want to tailor to your specific needs. It’s going to take some time to evolve to the point where we can potentially accept other strips or become more device and strip agnostic. That was behind our acquisition of Diabeto, where the intention was to use your existing meter while allowing Livongo to provide many of the services through uploading data into our app to leverage it for people.
Aside from the latest partnerships with clinical care providers, what else new can we expect to see from Livongo coming soon?
We’re expanding the management team and have a very exciting growth trajectory. There are certain channels for payers and providers that take a long time to develop, and we’re making progress there. We have announced hypertension as our next chronic condition focus beyond diabetes, and that will roll out starting in 2018. There are a lot new and exciting things happening.
Our brand is reasonably well-known in the Diabetes Community, but we’ve done zero marketing outside of that. The company is not particularly well-known in Silicon Valley either, as so far the focus has been on product development and scaling the company. We have not been trumpeting the success of Livongo more broadly just yet.
Why choose hypertension as a focus?
There are several reasons we’re evolving our services. Perhaps most important is that 70% of our members also have hypertension. I think it’s roughly 45% of people in the United States who have hypertension, so it’s a huge challenge for the health of the country. So in order for us to be the most effective in helping people manage one condition, we need to help them manage more than one. We’ve also been pulled in that direction from existing clients. Because we’re providing unique insights and have a very engaged platform, we can do that on hypertension. It's a silent and complex condition because patients often felt OK to begin with before even taking any medication. We believe we have a unique approach and we’ll be sharing more on that. We’re excited about the prospects!
Sounds like a great step into 'comorbidities'?
Yes. We can then monitor the medications people are using, and if for example we’re seeing some observation worth sharing, we can encourage people to go see their doctor about what medications are effective. We can weigh out what options are available. When someone has multiple conditions with different medications, we can look at how they interact and report on that to help people.
It’s a first step showing that we’re not just focused on diabetes, but we’re developing a platform for the monitoring of various chronic conditions. This is challenging for benefit managers of employers, so it’s something we’re keeping our eye on.
What else would you want the Diabetes Community to know about Livongo?
There are companies with great ideas and that’s why they flourish. They build a widget that’s really interesting and that’s what succeeds. I think one of the factors in the success of Livongo is that we live and breathe this condition internally every day. We really drive to understand what each person is going through, so we can create great products AND services AND features that assist them in managing their condition.
Thanks for sharing your insights, Andy! We look forward to seeing what's on tap at Livongo.