New Glooko CEO: Livongo gets a lot of press but our approach is different

Glooko, the diabetes data management company that has been slowly traversing the path from a digital health startup to one with clinically-validated, FDA-cleared solutions, announced a new CEO on April 10.

Russ Johannesson, previously the chief operating officer at ShareCare, took over the reins from Rick Altinger, who had been the chief executive at the Mountain View, California-based company for five years. Johannesson’s goal is to scale the business that is aimed at both Type 1 and Type 2 diabetes patients. The company also has raised $71 million from a diverse set of investors. Read Medtronic, Samsung, Insulet as well as Canaan Partners, Social Capital and angels like Vint Cerf and others.

In a recent, wide-ranging phone interview on the future of Glooko and his role, Johannesson pushed back on the idea that he is the CEO whose sole goal is to take Glooko to an exit, opined on competitors like Livongo, and painted a picture of a company with a data and engagement platform that everyone from payers to providers and vendors to employers and of course, patients, value.

“We just don’t have life sciences and device companies investing. We also have provider organizations investing. So it really truly is across the whole ecosystem and that supports the model of [Glooko] being the connective tissue across it all,” Johannesson said.

Glooko’s roots go back to 2011 when it was founded by Silicon Valley technologist Yogen Dalal, mobile app developer Sundeep Madra, and Chamath Palihapitiya, then a Facebook senior executive and now the founder and CEO of Social Capital, a venture capital firm. The startup had humble beginnings — selling cables that connected glucometers made by different vendors to an iPhone with a companion app that served as a digital logbook for patients.

Fast forward to 2018 and much has changed as the hardware+app startup has transitioned to a software-as-a-service company with an FDA-cleared, HIPAA compliant platform. Providers can obtain population-level insight into their diabetes populations through a dashboard and individual patients can tracks their blood glucose levels, among other things. Also, after a February FDA clearance, clinicians can push a treatment plan to patients, where an interactive app allows Type 2 diabetes to titrate their long-acting insulin. This automates a task that apparently requires a lot of math and calculation.

“The mobile insulin dosing system [MIDS] … is an important step for the business,” Johannesson said. “I think it continues to advance where we can add value across the spectrum. Being able to do insulin titration in between visits in a seamless mobile perspective is a valuable add” [to helping patients manage their condition better while helping providers care for them better.]

The FDA-cleared Glooko app, within which MIDS sits, shows blood glucose levels and also provides insight that was not available as easily before – food intake and calories consumed as well as patients’ exercise regimen. Johannesson believes this it’s important to gather a variety of patient data.

“It may continue to look like we are investing heavily in data analytics and to drive insight from the unique datasets that we have and combining those with more lifestyle-focused datasets to create new kinds of insights that drive a deeper level of engagement with patients,” he said.

Whatever they are doing seems to be working.

In March, the company shared results of a pilot study conducted by Sharp Rees-Stealy Medical Group, a health system in San Diego in 2016. The goal was to track patient engagement and a group of diabetes measures called diabetes Advanced Perfect Care (APC) that includes A1c, LDL, microalbumin (MALB) or Neph Screen and blood pressure before, during and after the pilot. Per a Glooko news release, patients improved their average blood glucose levels by around 15 mg/dL from start to finish of the pilot. Also, the 50 patients who participated had doubled their daily BG testing frequency from less than one time per day to an average of 1.8 times per day.

Separately, Johannesson pointed out that app users have also seen a significant reduction in hyperglycemic events.

While Glooko has gone from a hardware + app company to a Saas firm rich with data that users and customers can glean from apps, one thing has remained the same: the platform is agnostic to the type of hardware device diabetes patients uses be it a glucometer, continuous glucose monitor or insulin pumps. [Glooko still has a hardware piece that connects to the patient’s device though it is much snazzier-looking than the cable of yore.]

And this device-agnostic approach is what distinguishes it from the other big name in the world of mobile diabetes management: Livongo, which has a proprietary glucose meter with strips available for people with diabetes along with a coaching program.

In the words of Johannesson:

Livongo is getting a lot of press and they have taken a very specific approach. It’s very different than ours and they offer certain things that we don’t. They’ve taken a decidedly device-specific approach. They have bundled and packaged the device and strips and everything else as part of their program. Part of what I think they pitch is their value proposition is packaged solution – one-stop shop.

Glooko doesn’t provide the coaching component to this. We have coaching partners that we can bring to the table in a bundled solution. We don’t have those capabilities in house. The concept is that we will plug in and be the underlying data and technoogy platform for anybody’s coaching capability whether it’s a health plan or another digital health company that does the coaching.

We think the device-agnostic piece of our platform is more in line with driving more engagement over time as we do believe that patients with diabetes have a preference with diabetes [products] not unlike people having a preference for their cellphones. We think choice is important and we think that will improve engagement and outcomes ultimately, and so that’s why we have taken the approach that

Livongo – they get a lot of press but I wouldn’t think of them as a direct competitor. We go head-to-head sometimes.

What’s with the “getting a lot of press” statement?

Livongo’s April announcement of a Series E $105 million fundraising round was covered by multiple news outlets from Forbes to HIT Consultant and Becker’s Hospital Review to Law360. And of course MedCity News. In all, a Google search revealed two pages worth of stories on this news alone. By contrast, Glooko’s $35 million Series C round in June 2017 yields fewer stories, including one by MedCity, but none by Forbes. [In defense of MedCity’s journalistic brethren, there is something about a $100 million venture round by a digital health firm that inevitably grabs our attention.]

Media affection aside, both companies are later-stage startups though Livongo was launched with a new name in 2014, three years after Glooko was. Which means venture capital investors of Glooko may be seeking an exit sooner rather than later. But Johannesson wouldn’t necessarily put a timeline for that even while conceding that at some point all venture capitalists seek an exit.

“Obviously, when you have financial backers and venture capital backers, they make money by growing businesses and exiting, so I am sure at some point there is [a desire to exit.] But I was brought in to scale this business and to take its business to the next level and not necessarily to package it up for sale,” he said.

With that in mind, Johannesson is focused on working more closely with paying partners like Medtronic and Novo Nordisk, which launched a partnership with Glooko in January 2017. The five-year partnership with an auto-renewal feature built-in started with the Cornerstone for Care App Powered by Glooko that Novo Nordisk launched in June last year for the company’s insulin users.

Details of the financial arrangement were scant. Glooko is paid based on patient usage and Amy West, senior director, patient marketing and digital health innovation at Novo Nordisk, for the most, part declined to give details on almost anything.

How many people use the app? Sorry, not public information.

Has there been an improvement in outcomes? Sorry, we haven’t done any “deep dive assessment at this time that we can share out so there’s so further outcome that can be reported at this time.”

Do patients on the app adhere more closely to their medication regimen compared to those that are not using the app? “I have not seen that yet but we are still collecting the data and we haven’t done the deep dive analysis yet.”

Perhaps the lack of any information or the lack of willingness to share it can be chalked up to the uniqueness of the collaboration. West noted that the partnership has been  “our first step in the space with a third party collaboration as far as the app goes.”

But apparently, the partnership “has been really insightful and been a great experience” and Novo is “very pleased with the engagement.”

While Novo-specific user numbers aren’t available, globally 1.5 million are using the Glooko app and 7,000 providers use the platform including the Population Tracker, according to Johannesson.

Aside from gaining new customers and users, Johannesson is also focused on better integration of Glooko’s Diasend acquisition that occurred in September 2016. Diasend, a diabetes management company based in Sweden, has a solution involving the transmitting, storing and analyzing data from more than 140 different glucose meters, insulin pumps, continuous glucose monitoring systems and fitness trackers.  Johannesson said that he wants to get the Diasend platform and Glooko platform into a single platform globally.

And, of course, show good growth.

“We’ve got some pretty aggressive revenue growth goals,” Johannesson said while declining to provide details on annual revenue and stating it is not profitable. “We are a business that is really well-positioned and on the launchpad for the next evolution of the business and the scaling of the business.

Success, of course, will depend on whether Glooko can demonstrate behavior change that is sustained over time.

Clarification: An earlier version of the story said Livongo was founded in 2014. In fact, the company was founded earlier with a different name but launched under the Livongo name in 2014.