Startups, Health IT

Livongo CEO Zane Burke on his move from Cerner, big tech’s intersection with healthcare

Burke joined the Mountain View, California-based chronic disease management company late last year after spending more than two decades at EHR giant Cerner.

Former Cerner President Zane Burke left the multibillion-dollar EHR giant last year after spending more than two decades at the company. Soon after, it was announced that he was taking the helm at Livongo, the chronic disease management company founded by former Allscripts CEO Glen Tullman.

The fast-growing company earned more than $60 million in revenue in 2018 and counts major employers like Delta Airlines, Target and Pepsico as customers. Mountain View, California-based Livongo has raised around $240 million funding, including a $105 million Series E round that valued the company at roughly $800 million.

MedCity News sat down with Burke at Livongo’s inaugural Signum conference in San Francisco to talk about his move to a startup company, tech giants’ entry into healthcare and Livongo’s 2019 priorities.

What follows is an edited transcript of the conversation.

How has it been moving from a huge public company to more of the startup mindset at Livongo?

It’s fascinating because starting here is very similar to when I started at Cerner in that they’re very similar size, so it kind of makes me go back to that time.

presented by

So trace for me what the young Zane was like back then?

It’s hard to imagine now, I get that (laughs). When I started Cerner in 1996 we were less than a thousand people, around $150 million in revenue and just branching out into other parts of the business. So I’ve seen some of that size and how that can play out properly. I think the difference here is that this company’s path to those similar kinds of numbers has been exponentially faster. I think the runway and the opportunity for growth is much bigger, as is the opportunity to impact people in a meaningful way.

One thing I will say is we’re all in a business where nobody actually wants to utilize our services. None of us want to have a chronic condition or have a need for sick care. We actually all want to be as healthy as we possibly can be and as close to home as we can possibly be. That’s been the long term personal vision for me and Livongo was just a perfect fit as it related to the things that I really wanted to see accomplished.

You’re joining Livongo as they’re making the shift from selling sensors, testing strips and health coaching and into what they call Applied Health Signals, essentially being a combined data health company right?

I think it’s actually the combination of those things that makes Livongo unique. One is a is a platform by which you aggregate that data and then really create meaningful clinical and behavioral interactions. But I wouldn’t discount the fact that the devices are easy to use and we focus on how we create a great healthcare experience. Try to think about the last great healthcare experience you had.

I’d have to go back quite a while.

I can think of one primary care experience where it was a great experience, it’s really rare. We’ve seen it in other parts of our lives and I just say healthcare so ready for this.

You’re using AI and machine learning as part of your platform to personalize health recommendations. Where do you see the role of genomics in that roadmap?

I do believe in personalized medicine at that level and I do think that’s going to make a difference. There’s just hard proof that that differences in genetic makeup absolutely makes a difference in medication and outcomes. We’re actually going to get there sooner, rather than later. We know what drugs work most effectively because we actually see what’s happening with the blood pressure levels and we’re getting the real-time data back. When you put that with genetic data then what do you have? That’s something that we already have our eyes on.

How do you see Livongo potentially integrating its data with platforms like Apple Health Records?

We actually do integration into Cerner’s EMR today and we’re open to that kind of dialogue with other EMRs or other ways to serve up data as we move forward. But that data is the person’s data. So we have a fundamental belief that people own the data, so the consent is going to have to come from the patient. We’re not just going to automatically be feeding it up.

I was a big supporter of (Apple Health Records) in my past role and I have my own data uploaded. I think that it’s just a first step at this point, I applaud any attempt to move my data closer to me, but the tricky part is the actual clinical relevance of that information. We have a lot of work to do as an industry to make it meaningful. You don’t really need to know that when I had a surgery seven years ago I was given this certain type of anesthetic.

Are you supportive of how CMS has used its regulatory power to wedge open data availability? 

I think what (Seema Verma) is doing exactly what’s needed because the industry hasn’t led with its chin. I think there are people that are seen as the villains in the conversation that may in fact have some responsibility. But there are some other villains behind the scenes that need to come forward and say my part in this is to be an open system and share my data freely.

I also have a very strong belief in the idea that the social determinants of health are every bit as powerful as what’s in the EHR. So I think that the Facebooks, Apples and Googles of the world ought to be sharing their data back. They need to belly up to the bar and serve their data back up should you as a person decide that you want to get your data out there for your benefit.

The big healthcare debate in politics is over Medicare-for-All. How is Livongo successful in that hypothetical world?

First off I don’t think I don’t think we’re going to end up with a single payer, but regardless our objective is to provide a great experience, a high value solution and we can provide that no matter who the payer is. So whether that’s the government as a payer or whether that’s the employers as a payer or whether that’s individual consumers.

Could we end up with things where we look at cost benefits as a country to say it makes social and economic sense to provide blood pressure medicine to people living with high blood pressure? I think so. Do I think Livongo has a future in that? Yes, I do.

A lot of digital heath companies selling to employers like Livongo and its competitors have been focused on broadening their platforms. Where do you see this market continuing to evolve?

I haven’t seen anyone that’s gotten the breadth and the depth of what we’re trying to accomplish. I think we see a bunch of little niche players trying to pick off a piece of behavioral health or even within that, substance abuse or insomnia. You may have the best insomnia solution but do you really want to go to every plan or employer and have them purchase it?

In chronic conditions people have comorbidities and multiple elements, so it’s not going to create a great experience for users to have all these different niche pieces in there. And then the learning we’re going to get from those those interactions can have a dramatic impact on both the clinical outcome as well as the user experience side. It’s a big difference in terms of how we’re thinking of things from an enterprise level rather than that little niche.

What are the company’s major priorities over the rest of 2019?

It’s straightforward. One is scaling the company for growth in the right way. Historically we’ve continued to double in size in less than a year’s time. I would anticipate that’s kind of the trajectory we’re going to stay on.

I think you’re going to see us he into a couple other conditions as we move forward. We started the year with our behavioral health acquisition and you’ll continue to see us broaden out those chronic conditions. There’s some pretty logical areas like respiratory and musculo-skelatal conditions. And then we’ll have to look and study the data on how these things come together and interact.

Picture: Livongo