Step 1 of 4 · 2016–17

A sensor pill, a weekly patch and a phone

A habit that sent its own data

Livongo started from something people with diabetes already did several times a day. Glen Tullman, the former Allscripts chief executive, launched it in September 2014 with In Touch, a touchscreen glucose meter with its own cellular connection that sent each reading automatically, needed no smartphone and required no test strips to be ordered PRTX-7. Certified diabetes educators sat behind the device, and by 2016 the program included unlimited strips at no extra charge PRTX-7 PRTX-8. Tullman says a member could reach a person within 90 seconds at any hour PRTX-10. The patient kept checking blood sugar, and the data reached the care team on its own.

Three new things to manage

Proteus added tasks. Founded in 2001 in Redwood City, it raised $487 million over 11 rounds from backers including Novartis Venture Fund and Kaiser Permanente Ventures and was valued at $1.5 billion PRTX-5. Its sensor system, Proteus Discover, first used by a health system in January 2016, needed a specialty pharmacy to put an ingestible sensor into each patient's medication and a patch on the arm to record when the pill was swallowed PRTX-1. Abilify MyCite, approved for Otsuka in November 2017, sent the signal from pill to patch to a phone app and a web portal for clinicians and caregivers PR1 PR2. Its label told clinicians to make sure the patient was "capable and willing to use smartphones and apps" and to have the patch changed weekly, and it reported rashes at the patch site in 12.4% of patients PR2. The FDA noted that "detection may be delayed or may not occur" PR1. By late 2019, sources said patients had not widely adopted the digital pill PRTX-4.

Rivals Livongo's In Touch meter sent glucose readings over its own cellular link and came with unlimited strips and a virtual care team of diabetes educators PRTX-7 PRTX-8.

Ease of UseEnd-to-End Workflow

Step 3 of 4 · 2016–19

From disease to disease

Livongo grew by selling more conditions to the clients it already had. By 2019 it sold Livongo for Diabetes, Livongo for Hypertension, Livongo for Prediabetes and Weight Management, launched in April 2018, and Livongo for Behavioral Health by myStrength, launched in February 2019 PRTX-9. Client retention was 96%, and the dollar-based net expansion rate was 113.8% at the end of 2018 PRTX-9. In May 2019 a Lilly-funded study at three employers found that medical spending among enrolled members fell 21.9% after one year, or $88 per member per month, against an average employer cost of $68 PRTX-11.

Proteus moved its sensor from disease to disease. Its 2016 pilot in uncontrolled hypertension and type 2 diabetes had 85% of 72 patients on Discover reaching their blood pressure target by week four, against 33% of 24 on standard care PRTX-3. The commercial work then went to severe mental illness with Otsuka PR6, whose label stated that its ability "to improve patient compliance or modify aripiprazole dosage has not been established" PR2. By January 2019 Proteus had begun moving into oncology, and by December it pointed to studies in hepatitis C, tuberculosis and cardiometabolic syndrome PRTX-5 PRTX-4. Everett Crosland, a digital therapeutics executive, says the partnership strategy did not push early enough toward the randomized trials and health-economics studies that drive coverage PRTX-5.

Rivals Livongo added hypertension, prediabetes and behavioral health programs for its existing clients and published employer cost savings in 2019 PRTX-9 PRTX-11.

Multi-Product