Calling Shenanigans on Livongo

Ever since I heard of this company something tweaked my BS detector, so I decided to do a little digging around today to see if all the hype is justified or if my spider senses may be onto something. As you can tell from my subject line, I wouldn’t touch this company. In fact, if I shorted stocks I’d short it.

Below is text from Livongo’s About Page.

The bold are my BS triggers which I’ll discuss briefly below…

Livongo offers a whole person platform that empowers people with chronic conditions to live better and healthier lives, beginning with diabetes and now including hypertension, weight management, diabetes prevention, and behavioral health. Livongo pioneered the new category of Applied Health Signals to silence Noisy Healthcare. Our team of data scientists aggregate and interpret substantial amounts of health data and information to create actionable, personalized and timely health signals. The Livongo approach delivers better clinical and financial outcomes while creating a different and better experience for people with chronic conditions.

What exactly is a whole person platform? The term is laughable.

Not really even sure “behavioral health” is a term with any actual meaning. Is there anyone left on planet Earth who doesn’t know we should sleep 8 hours, drink water, eat lean proteins, veggies, work out and spend time in nature? In a video on their site they talk about treating the whole person and mention that they could be dealing with “socio-economic” factors. So if a person is out of work, has marital difficulties and lives in a high crime area with limited health resources, the Livongo “whole person platform” does exactly what?

They do “weight management?” They’re Weight Watchers? Jenny Craig? Peloton? Joe Rogan Podcast? Is there an industry more rife with nonsense and outright fraud than weight loss? Eat less and move your fat bottom and you’ll be healthier. There I just practiced behavior modification in the health care space.

They silence noisy health care to create timely health signals? So presumably if you fail to take your meds, you get a “nudge” or the like reminding you to take them. Fine. Sounds reasonable enough.

But the CEO and founder talk a big game that makes them sound like the Stitch Fix of health care, where the magic formula is to combine incredible amounts of data with a human touch. So if a patient feels chubby and just ate a pizza instead of a salad and bungled their health scores by forgetting to take their meds, they call a Livongo health pro? How many times do they talk to the pro? How dedicated is each pro to each individual? And how the heck does Livongo scale this without breaking the bank? Anyone who has ever tried to start - and stick to - a diet/exercise plan knows how hard this is. What exactly does the helpline/coaching staff do?

Maybe you think I’m just being too hard on them. Okay, well here’s a site that’s committed to shining a light on the nonsense of the “Wellness” industry…

Are Livongo’s Outcomes Real?…

The article questions a study Livongo cites…

By way of background, this study was conducted by Livongo’s employees, along with employees of its partnered diabetes supply company (Eli Lilly), which also funded the study. So there couldn’t possibly have been any conflict of interest, right? Right?

It was published in something called the Journal of Medical Economics (JME). And no, I hadn’t heard of this publication either. Turns out it’s an “open-access” journal offering “accelerated publication,” with an Impact Factor of 1.9.

Not familiar with the concept of Impact Factors? Those measure the influence of a publication. For instance, the New England Journal of Medicine tallies a 70.8. How hard is it to only get a 1.9?


Below is an article from the Validation Institute. Here’s a bit about their mission…

Performance validation makes it as easy as possible for health care purchasers to have confidence in the vendor partners and providers they choose to work with. Our attention to detail helps vendors sell smarter and purchasers buy with confidence.

The Livongo Study, as Interpreted by a CORA Pro

CORA stands for Certified Outcomes Report Analysis - if you become a CORA pro, the idea is you are better able appraise the validity of these studies we always hear so much about despite knowing nothing about what they actually did.…

This article, in combination with the one above, implies that Livongo has an aggressive sales division which incentivizes companies to badger employees into signing up and then pushes more testing than is necessary.

To be clear. I don’t work in healthcare, am not especially familiar with Livongo and I realize they are growing like mad and it’s possible these doubts are over-stated. But I wouldn’t touch this company with a ten-foot pole when there are so many less complicated, more legit (Muji backed) companies, telling simpler stories. CrowdStrike sells software to stop hackers. Hackers are indisputably real and coming after virtually ever site on Earth. Simple, clear, authentic.

I don’t doubt Livongo’s ability to sell to companies and jack revenue for now and maybe in the next few years. I doubt their ability to help masses of people actually improve their behavior. Modifying human behavior is incredibly difficult. Shockingly so. For example, I listened to the founder of Duck Duck Go on the Invest Like the Best podcast and thought it a no-brainer to have more privacy in my searches. But til I actually downloaded the app and started using it took forever. And it was literally the easiest thing to do in the world.

Assuming - as I do - the articles cited above raise legit questions, what we have here is a company making questionable claims, operating in a space (behavior modification) that has failed miserably before and one that is based on a narrative of applying its methods to weight loss, hypertension, etc, etc. This story feels like such absolute BS to me - we’re gonna help people with diabetes and THEN the sky’s the limit! Hypertension, weight loss, etc. Give me f’n break. I have a close friend with diabetes and have watched him for years need to closely monitor his glucose or risk fainting, losing his vision and worse. So he MUST tend to this condition closely. For this type of condition I can see a massive need to closely monitor his actions. I have no clue if Livongo has a better mouse trap than his current methods. But if it’s just diabetes that is no guarantee whatsoever their “whole person platform” works for anything else.

If you’re long LVGO know it’s unpleasant to hear someone call your baby ugly but the euphoria on this stock seems misguided and I think with social media, stock message boards here we are always in danger of over-amplifying our own positive biases. I do it all the time rooting for my stocks.

Bottom line - what we have here is a complex story that requires faith in something totally unproven. All their massive revenue growth has proven is they can sell the story to companies/orgs that are looking to save money on health care costs. That these orgs will see real deep $ benefits is questionable at best.

It makes absolutely no sense to me to be invested in a company whose core claims are utterly unproven compared to Fastly, Zoom, Crowdstrike, Okta and DataDog who provide products/services that are highly rated by our own techies, orgs like Gartner and even used by the Fool.

Not sure when, but I think Livongo is going to get shellacked. My guess is they continue selling the service and leaders will crow about the unlimited growth to come. But eventually word will come out that there’s no major benefit from using their service. And on a future ER call they’ll miss earnings, talk about losing some big customers and the bottom will absolutely drop out. Normally I do not put a lot of faith in gleaning anything from insider sales. But on this one I’d watch it like a hawk because no doubt the big insiders won’t be the ones to lose their behinds if it tanks. It will be the same suckers who loaded up on Groupon when that blivid was allegedly going to replace Amazon.

Fool On,



Do you know any type 1 diabetics. My sister was one. She likened it to being on a greased slide and holding oneself in place by gripping the sides. Any loosening of grip and one went farther down, hopefully stopping before one went off the end. She was a intelligent woman, but the latter part of her life she was making regular trips to the ER in an ambulance in a coma. Often, it was pure chance that someone found her in time.

Having something monitoring all of that can make quite a difference since the diabetic can often be unaware that things are not what they should be.


Bottom line - what we have here is a complex story that requires faith in something totally unproven. All their massive revenue growth has proven is they can sell the story to companies/orgs that are looking to save money on health care costs. That these orgs will see real deep $ benefits is questionable at best.

This implies that the excellent financial results thus far are perhaps ephemeral and will disappear as soon as folks realize there are no tangible reproducible benefits. However its been reported that clients of Livongo which include insurers and health service organizations see an average annual gross medical savings of about $2000 per diabetes participant. (Various TMF articles)Are you suggesting that this is false.?





I can totally respect the bear case here. Humans, especially, Americans in general, have a really hard time changing any habits. Most bad habits are especially hard (smoking, overeating, etc.) because they are either addictive, fun, social events, what-have-you. However, I am willing to take a small, <1% position and watch it play out. Obviously, the stock itself is performing wonderfully at the moment.

I really hope the company can come through with their promises and provide a better and healthier life for those with some of these chronic illnesses. I’d like to think that’s a better option than just ignoring the chance to help people out.

I really hope it’s not all B.S., but it surely could be.

Thanks for the post.



Hey Dan, I brought up the concerns highlighted by the Validation Institute in January and it garnered quite a few responses.

I suggest anyone planning to respond here first read that thread. Here’s the link to my post.…

Long LVGO (recently grown to top position)


Let me start by saying I’m long LVGO and it’s my largest holding. I’ve owned it since $25. So I’m biased. I will also say that even though it’s my largest holding I don’t have super high conviction on it. It has only become my largest because it’s quadrupled in 6 months and I was lucky enogh to be talked into taking a big starting position by someone that knows health care very well. I have been selling covered calls on it to lock it some gains because I do have some concerns - mostly about competition/moat (but let’s not go down that rabbit trail again…)

In response to the points by Dan:

  • There have been very few insider sales - VERY FEW. Look at LVGO insider sales compared to any other SaaS company and you will see exactly what I mean. I fully expect them to start selling soon - and they should - they have earned it. I would not make any conclusions on sales if they start coming.

  • The company states that they have a Net Promoter Score of +64. From the following website, an average NPS is +32.…. I don’t know how reliable this measurement is, but it sounds like their customers like them.

  • For diabetes, they do more than what you have described. They have on-demand coaching and they provide free glucose meter test strips that are automatically mailed to the patient. This is not hard to do, but no one else is doing it. It saves the patient money and hassle.

  • They have been growing 100%+ every quarter for a couple years. The growth is coming from large insurance companies and some of the largest businesses. Those buyers are not dumb.

I personally would not put large sums into LVGO at $100 per share (when to buy…another rabbit trail we don’t need to go down). I’m still holding a very large position - but I am selling some out of the money calls to get a little $ out (just in case it retreats or pauses).


Hey All - sorry I missed that others posted on the Validation article.

I really don’t have anything to add here. I realize how serious healthcare is and that it’s a great thing if they’ve found a way to improve and modify our behavior. I just don’t believe it based on the language they use, the doubts raised about their studies and the idea that they can target weight loss, hypertension and other conditions.

I will just say that I think Saul has an intuitive sense for what makes a clean narrative vs these more complex stories that require unproven things to happen. To be honest this thinking has caused me to reduce my position in TTD, a stock I love, as the fact is programmatic ads are a theory that’s yet to be proven. We don’t know that some ads will be targeted with great precision and deliver incredible results. We know that companies need to verify identify of everyone who logs on.

Why invest in what might be when we have what is?

As always, let’s not make too long a thread unless someone has something key to add.

Good luck to all!


I work in medicine, looked at livongo awhile ago and passed.

I’m just not sure what their special sauce is. I don’t quite understand how they actually provide any patient benefit. Proprietary blend of… What exactly? What can they do that a primary care doc can’t? Send diabetic test strips?

I think LVGO is honestly a money grab and good marketing.

Then again, the same can be said of robotic surgery (looking at you ISRG)- doesn’t really add much to patient outcomes, but those with disposable income go to hospitals that advertise robotics and bring their associated high margin business.

I struggle to see how livongo doesn’t go the way of Fitbit.


The game in investing is making money. And LVGO stockholders have been right. So far. Despite the fuzzy language that Livongo uses to promote themselves.

Diabetes is a medical problem poorly served by existing solutions. Compliance is always hard to come by in chronic conditions , but that is especially true in brittle diabetics who are always riding a roller coster. Too much ,too little. All in the same day. Constant attention, hard to do for many. And certainly something they can not get from traditional sources. They wind up in the ER often,which is very expensive for insurers . One ER visit probably costs what years of LVGO service costs,so LVGO only needs to make a slight improvement to be worth the cost. That low bar is an important point to keep in mind.
I wonder if AI will show patterns not obvious to health to providers or patients.
I suspect LVGO nudges can be helpful to some diabetics. Especially type 1. TYpe 2 is mostly about being way overweight a difficult problem itself, we are hard-wired to eat when we can.
I am a lot less sure about its usefulness in other conditions. I own some LVGO but not with high confidence. But since the big danger on these board is group think I appreciate your input.


another point- as diabetics get older they are more and more likely to have periods when other illnesses or injuries prevent them from managing their own condition . Others, usually family members ,will have to do it and they will need all the help they can get.


Hi BroadwayDan,

You likely made some good points…but some of your post is demonstrably wrong.

If you type ‘Livongo’ into PubMed (the NIH funded search engine for medical and biological research…and the best tool for finding academic articles in those fields) you find 30 results:

The first article is in Journal of Medical Internet Research (impact factor 4.9) which specializes in health informatics and health services research. Many of the others are also in similarly decent journals.

Skimming the list, and reading a few, it’s clear that there have been a series of research efforts addressing a range of topics (diabetes outcomes, diabetes cost, weight loss, etc.). Some of the papers I read were authored by Livongo employees in collaboration with researchers at Stanford,Duke, etc., and others did not have any obvious Livongo employee participation. As the performance of CGMs improves, and presumably Livongo’s software, it makes sense to keep researching the efficacy of their products.

So your assertion that their research is perched on two weak papers is simply not true.

As to why a ‘whole’ person matters…Type 1 diabetes is an incredibly complex disease. Depression, triggered by T1D is very common. Weight has a very significant impact on your odds of getting T2D and on your ability to control it. Buzzwords may really push your buttons…but there is substance there as well as hype.

My son was recently diagnosed with T1D, and I can tell you from my own dataset of 1, that having a CGM results in a significant improvement in quality of life. CGMs have demonstrated a very significant impact on long term T1D health outcomes, and thereby on medical costs (use PubMed to research these topics and decide for yourself). The linkage between tight control of your glucose levels and long term effects like blindness are very well established.

Read the papers for yourself.

I’d also note that Kaiser Permanente just bought their mental health service and is providing it free to all members. Evidently, their due-diligence established real benefits…sufficient to offset the cost of the program.

I personally have stock in Livongo. I found their diabetes product to have a significant positive impact, and their recognition of the coupling between chronic diseases to provide a strong basis for future growth. Good product today. More in the pipeline. I’m keeping my money where it is.

Best regards,


Livongo Founder and Executive Chairman said:
what we’ve done today is we have wonderful technology we have apps and we have devices and we have medications and we have health coaches and all of this and yet for people with chronic conditions it hasn’t gotten any better with all of this effort. and what we have to do is put that together into an experience that people have and that’s really what we’re doing at Livongo today and we call it applied health signals. and that is taking this information aggregating all this information from people’s bodies from their pharmacy records or healthcare records or electronic health records interpreting what that means for those people and then applying it getting it back to those people and doing what Amazon and Netflix and others do so well iterating to see did it work and if it worked do more of it and if it didn’t do less of it.

Livongo may not be doing any fancy stuff but they are trying their best to close the loop of all the disconnected pieces and serving their patients through iterations. We could call them a system integrator. While it is relatively easy to list out patient’s wants and needs, it is not easy at all to create an environment that will satisfy all your patients.

Livongo supports AI+AI for our members across a variety of uses cases. Here are just a few experiences that we’re already doing for Livongo members.

EXPERIENCE #1: Medication Optimization (in Partnership With a Pharmacist) for Diabetes
Problem Statement: Medication optimization (enabling the use of the right medication at the right dosage, and evaluation of the impact of that medication/dosage) is considered one of the most difficult things to improve in medicine. A member is on a number of different medications and is having a hard time knowing what to take when, maintaining refills, and is seeing a decline in staying on their medications due to that confusion and sense of being overwhelmed. As a result, their blood glucose levels are increasing. Livongo’s AI+AI Solution:
Livongo’s AI+AI engine uses a data science and behavior change approach that drives actionable and personalized impact in tight partnership with pharmacists from the leading national pharmacy chains.

First we Aggregate a variety of data: eligibility, formulary, current medications, pharmacy claims (to understand what conditions a member has), biometric screening data where possible, and their ongoing blood glucose data (from their Livongo blood glucose meter).
Then we Interpret that data and ascertain a set of signals that tell us the member is not taking to their medications, and that’s why their blood glucose levels are spiking. We know this, because the member’s blood glucose values are high, and they are intermittently refilling their prescriptions.

We then use our Livongo live coaching application (Apply) to help understand the member’s medication barriers. When the member speaks with our coach, we probe about why they aren’t taking their medication. If the member identifies a side effect of the medication, we identify an alternate medication that is on their formulary and connect them live with their pharmacist (by phone) to discuss the switch, or directly with their provider. The pharmacist (or provider) formalizes the switch to the new medication and guides them to make sure they are taking their medication optimally. The pharmacist has the new medication delivered to the member’s doorstep.

As the member uses their new medication, Livongo observes that their blood glucose is improving and Iterates the coaching messages, nudges, and encouragement to help keep the member on the medication.

In doing this, we reduce the complexity of the back and forth for a member with their pharmacist and providers trying to manage their medications and getting the right medication for them to be as healthy as possible.

EXPERIENCE #2: Medication Affordability for Diabetes and Hypertension
Problem Statement: A member has both diabetes and hypertension and is struggling to pay for their medications to stay healthy.

Livongo’s AI+AI Solution: In this scenario, Livongo can provide a special AI+AI solution for a member who is working for clients of ours that have put in place a program to completely pay for medications (with $0 co-pay for their employees) if a member performs certain health-related activities, such as measure their blood pressure regularly using the Livongo for Hypertension program.

So in this case, Livongo Aggregates the data that tells us which meds are in that $0 co-pay program and the criteria to be eligible for the program. We combine that data with the tracking data about how individuals are performing against those criteria. We mix in all the data we described in the last scenario: pharmacy claims, blood pressure values, blood glucose values, formulary, medications.

We Interpret all that data and create clear health signals that tell us that a specific member would use the medications more consistently if they are offered a $0 co-pay plan. And we also ascertain that the member often has a lag between prescription refills, so that signals to us that they may be having trouble getting to the pharmacy to actually pick up their prescriptions.
As part of a live coaching session, a Livongo coach Applies these signals by introducing the $0 co-pay opportunity to the member, and offers to help ensure delivery of their hypertension medication refills. The member is excited and uses the Livongo cellular-connected blood pressure cuff to measure their blood pressure consistently over the next month. They are then eligible for their $0 co-pay medication.

Livongo passes this eligibility information, blood pressure signals, and blood glucose values back into the engine, ensuring that the member’s next refill is a $0 co-pay, observes that the member’s blood pressure is improving, and Iterates the next coaching session content to congratulate and encourage the member to keep up their great progress.

In doing this, we reduce the costliness of healthcare for the member while also helping them achieve their health goals.

EXPERIENCE 3: Smarter Coaching for Weight Management
Problem Statement: A member has recently decided to take control of their weight but has been unsuccessfully using a traditional weight-loss program before. The coaches called them during the workday. They were too embarrassed to even talk to the coach, and so avoided the calls and had a bad feeling about the whole experience. They had one call and felt that the coach really didn’t know anything about them specifically and wasn’t a good “fit” at all so they gave up.

Livongo’s AI+AI Solution: For the member experience on Livongo’s Weight Management program, we Aggregate their eligibility data, nutrition and exercise data, psychographic information, and communication preferences. We have a powerful set of algorithms that allow us (from a few member-provided responses) to understand the profile of the member and how to most appropriately coach them in terms of content, style, and tonality. We also aggregate nutritional data, as well as Fitbit® exercise data.

We then Interpret their data and create a weight management curriculum that is most appropriate for them.

As we Apply that weight management curriculum, via digital, voice, video, or group-based coaching, we observe the member’s interactions and patterns. Members use Livongo applications to track nutritional data, Livongo’s digital scale to track their weight, and they interact with their Fitbit, which feeds data iteratively back into Livongo’s Aggregate layer.

Then we Iterate the coaching content and determine how best to deliver it specifically for them, continually tailoring the program to their needs. We also watch for signs of burnout and encourage them in the tough moments. For example, we may suggest they join a group coaching session to learn from their peers. Such advice is not based on speculation, rather on actual signals we’ve generated through AI+AI about what they need and what would work best for them (patterned on what we’ve seen work for others).

In doing all of this, we reduce the confusion around the set of options that work for a specific person to have impact on their weight. We help people understand what specifically works for them, and help them achieve their weight management goals!


Sounds like Sour Grapes to me Dan. Sorry you missed the ride.

Livongo’s revenue growth continues to speak for itself. It is higher than any company discussed on this board besides Zoom. Where does the revenue come from? Giant insurance companies- are they all being bamboozled like you seem to be implying? Do you think they aren’t doing their DD and all just throwing money at Livongo and hoping it saves costs for them? Do some research on Glenn Tullman, maybe that will help you change your mind.

I still see a lot of doubters in investing communities on this company. This to me is a good sign.

Disclaimer- Long LVGO, third largest position


Diabetes is a medical problem poorly served by existing solutions.

No, diabetes are TWO distinct medical problems, type 1 and type 2. As far as I know type 1 is chronic and incurable. Type 2 is curable, I know because I no longer have it. The cure was losing 50 pounds. Not only was I cured of type 2 diabetes but of all the associated illnesses. I no longer take any medication that I was supposed to take for life.

The main thing that keeps me from Livongo is that the two other monitoring companies I follow, BioTelemetry, Inc. (BEAT) and iRhythm Technologies, Inc. (IRTC) are not doing so well. Anyone know why the disconnect exists? Is it the sales method?

Denny Schlesinger


The main thing that keeps me from Livongo is that the two other monitoring companies I follow, BioTelemetry, Inc. (BEAT) and iRhythm Technologies, Inc. (IRTC) are not doing so well. Anyone know why the disconnect exists? Is it the sales method? – Denny

Rather than keeping me from Livongo, the examples you provide would have me thinking it was even MORE evidence to own it.

Disclosure: LVGO ~18% of portfolio

Rule Breaker / Supernova Starshot Home Fool & STMP/MTH Maintenance Coverage Fool
He is no fool who gives what he cannot keep to gain what he cannot lose.


Livongo offers a whole person platform that empowers people with chronic conditions to live better and healthier lives, beginning with diabetes and now including hypertension, weight management, diabetes prevention, and behavioral health. Livongo pioneered the new category of Applied Health Signals to silence Noisy Healthcare. Our team of data scientists aggregate and interpret substantial amounts of health data and information to create actionable, personalized and timely health signals. The Livongo approach delivers better clinical and financial outcomes while creating a different and better experience for people with chronic conditions.

I agree that this is a too long and too many buzz words for a mission. That’s because it is not a mission, it is a investor relations statement about the company – and I think they would be better off leading with their mission:

Livongo has reinvented the healthcare experience for people with chronic and behavioral health conditions. Our Applied Health Signals solutions deliver actionable, personalized, and timely insights that make our members happier and healthier, while reducing overall healthcare spending.

Behavioral health is a thing:
Behavioral health is defined as the connection between behaviors and the health and well-being of the body, mind and spirit. This includes a wide variety of healthcare services.…

There is a lot more at that site on behavioral health. This thread is helping me get clearer on what Livongo does – I was being lazy as I only have a small position.

One thing I try to keep in mind about innovation and disruption is that there is a tendency to assume that there is insufficient value, because it require a different way thinking in order to see that value.



Good discussion. I obviously own a lot of LVGO. In fact, it’s moved from my #4 spot (14.8%) to #2 (18.2%) with this recent surge. I tend to view my holdings something like this:

Conviction = numbers + narrative

You simply can’t deny Livongo’s numbers. They are overwhelming and meet just about every checkpoint we have around here. The recent preannouncement suggests this isn’t slowing any time soon. I’d guess at least through 2020 since current clients have already committed for the year.

The narrative is a different story. Even as a bull, I view Livongo’s story as about 50% substance and 50% slick marketing. It’s admittedly unproven, but LVGO is the only company I know in this arena diligently working to show positive ROI. They have a smart founder with skin in the game. The company president is also an MD. And they REALLY seem to know how to navigate this space.

As mentioned by several, it is near impossible to significantly change most human behavior. However, I don’t view that as what Livongo’s trying to do. They are simply trying to be a helpful tool for those who are willing to help themselves. There seems to be enough of those folks around to make it work right now. In addition, LVGO is perfectly positioned as a remote monitoring option during a pandemic where people with chronic issues are hesitant to even venture outside. Will these conditions be enough to justify the hype and bring about significant change? Darned if I know, but I don’t need to. I only need to know clients WAY more in tune with this market – Kaiser, CVS, Blue Cross Blue Shield – have decided to give LVGO a legitimate chance. Until that narrative changes, I don’t see a reason to adjust my current conviction.**

** Of course, it’s a lot easier to say that when my entire position built between March and June is up 202%. That’s taken away at least some of the sting from choosing SMAR over ZM last December. :smiley:


In addition to chemfool2’s points, I would think it is just as appropriate to question the trustworthiness of the blog you posted as it is to question the validity of Livongo’s solution. The author of this article shed some light on that here:

“With respect to your blogger himself, they (Livongo Management) noted that the blogger had approached them a number of years ago and solicited compensation to endorse LVGO on his site. They obviously declined, and since the post you referenced, he has been unwilling to respond to their requests to engage in discussion. They claim he has been paid in the past by one of their competitors and is running a pay-to-play scheme. We noticed that he is very promotional of the Validation Institute on his site. It turns out he is listed as a certified consultant/broker for the VI (, which offers a certificate program starting at $1195 ( In a prior post, he trumpeted the benefits of the CORA Pro certificate course while simultaneously cherry-picking a couple of points to disparage LVGO (…). We find his motives at best ambiguous. Needless to say, numerous 3rd party consultants have raised concerns to LVGO about this blogger and his claims.”

Regarding the author’s point that those study results were self-reported, there are certainly better methods to perform a study but may not be realistic to implement with live clients. In any case, Livongo’s results can be corroborated by additional studies that used more controlled methods:

A commenter on the Seeking Alpha article I wrote raised similar concerns and I addressed them thoroughly:….

The rest of your points seem to be related to questioning the effectiveness of Applied Health Signals as a whole. Livongo is the first to scale but they are by no means without competition as their largest competitor, Omada Health, is focused on pre-diabetes / weight management but is expanding to compete in the same conditions as LVGO. A look at their app reviews tells it all about how effective they are. Livongo is also no slouch, they clock in a 4.8/5 rating on 13,134 reviews on the app store, some of the reviews are of patients saying it has changed their lives.

But forget all that, look at their results. Employers signing up in droves for multi-year contracts, churn at only 2% a month, and an NPS of +64. They claim demonstrable cost savings of $1900 per year per patient which translates into an average 3.7x ROI after one year, and 4.4x after two years. Is that all due to good salesmanship? In an interview, the CEO said this: “What’s fascinating is that we have a handful of clients where the experience and the outcomes are so good that they’re paying for the insulin if the member uses Livongo (…).

And insurers are also loving it. It was the only “preferred service” on Express Script’s new digital health formulary. This was a clear indication of their dominance as Express scripts staked their own reputation behind LVGO.…

So here we have really happy insurers, employers, and patients. Patients get to see better outcomes from gaining a better overall picture of their health and having access to personalized resources at their fingertips to help them manage it; providers can better utilize precious appointment times to more effectively engage with patients on a deeper level, having been provided with the real-time dataset that the app has gathered; and insurers can save costs from fewer hospitalizations, lower intake of medications, and more productive and happy patients. I think the results speak for themselves.

I was first introduced to this space because my friend is doing something really similar with his digital health startup he founded for managing behavioural health and I can attest to the validity of the research behind it. I think it’s not uncommon for investors to share your concerns considering that nothing like this has been done before (the technology simply wasn’t there yet), but that is the reason why LVGO gave such an incredible buying opportunity in the months following IPO. Now, with COVID-19 shining a spotlight on this space, I think that investors are starting to realize that there is a revolution going on in healthcare and it’s based on empowering patients.



After skepticism to the point I tore apart one of their clinical trials, I came to your same conclusion. I bought a large amount of Livongo 5 or so weeks ago. I initially was very skeptical due to two things: (1) clinical trials, and (2) like what is the value add and CAP here? I tossed it aside after looking at the numbers, and realizing that this is a tremendous and disruptive (disruptive in creating green fields, not setting aside other solutions) in medicine.

There are two things in all of medicine that can save the most money and produce the most marginal improvement in medical outcomes: (1) exercise (and people are out there counting their steps these days, Fitbit and Apple have not hurt there), and (2) compliance with cardiovascular and metabolic disease. This latter point is an enormous and unsolved pain point. Here comes Livongo that finally produces a solution, and a solution that saves its customers (large medical networks) money.

Livongo is not a monopoly (VIDA, for example, is what is used by my health insurance network) but Livongo is the clear and undisputed leader in the market. It reminds me of ISRG (that was a clear monopoly) who was derided by medical insiders as no proof of improved outcomes, too expensive, and the like. Yet, the numbers spoke SO WHAT! ISRG did eventually produce those clinical outcome trials, but only years later.

Anyway, once I figured this out, and that this does not appear to be a commodity market, AND Livongo still has not expanded internationally, and its indications are mostly new and still really unexploited (thus lots of room for upside surprise even beyond the core product) I did what I do, and I bought a lot at one time. Subject always to changing my mind and sell at any time, or of course continuing to buy more if I please, but you hit it on the head, and Livongo is the clear market leader, and also clearly has the endorsement of the leading figures in the market, and its clinical trials are well ahead of anyone else:

Livongo has reinvented the healthcare experience for people with chronic and behavioral health conditions. Our Applied Health Signals solutions deliver actionable, personalized, and timely insights that make our members happier and healthier, while reducing overall healthcare spending.

One thing I try to keep in mind about innovation and disruption is that there is a tendency to assume that there is insufficient value, because it require a different way thinking in order to see that value.

It seems to provide more relative value than Teladoc does, and yet Teladoc continues to be the dominant player in its market. Livongo is not treated as anything but in its market. It has some customer concentration issues. 5 customers make up 58% of its current revenues. Will something else come along and knock them off? That is always a risk with any investment. But Livongo’s advantage is not its better product (which appears to be the case, with multiple and growing clinical evidence demonstrating its efficacy and advantage vs other solutions (well at least in one study)), but its first mover advantage, and network connections, and relationship with its customers.

Could be wrong, but that is why I invested here.



don’t want to be argumentative Denny but diabetes is one disease see definition….

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high.

Type 1 ,2 and gestational. All 3 are different forms or types of the disease