Background: Novel technologies to support real-time self-management of chronic conditions are of interest to entities bearing financial risk for healthcare costs. The Livongo Diabetes Program offers patients with diabetes (1) a cellular-enabled, two-way messaging device that measures blood glucose, (2) free unlimited BG test strips; and (3) access to Certified Diabetes Educators for real-time support and goal setting. Previous work has shown decreased medical costs of $83pmpm for Livongo members vs. matched controls during first year of program. This study uses biometric and claims data to investigate the association between use of the Livongo program, BG control and medical spending among a commercially insured population of diabetes patients.

Methods: We compared medical spending and clinical outcomes for Livongo users (n =2027) with matched non-Livongo users (n=8385) for 12 months before and after the launch of the Livongo program using multivariate instrumental variable regression models that included controls for patient demographics (e.g., age, gender) and risk characteristics (e.g., comorbidity index, prior-period medical spending and program usage).

Results: Following launch of Livongo, risk-adjusted total spending for users and non-users decreased by 15.9%. Launch of Livongo led to a risk-adjusted 76.2% increase in the monthly use rate of Livongo. A 10% increase in the monthly Livongo usage rate is associated with a 2.1% decrease in medical spending associated (p<0.01), which was driven by a 2.9% reduction in spending on office-based services. Mean monthly medical spending for users with mean BG<154mg/dL was significantly lower than for users with mean BG>154mg/dL ($505.86 vs. $681.01, p=0.02).

Conclusion: Patients with diabetes enrolled in the Livongo program for 12 months experience medical cost savings associated with improved BG control. Cost savings for Livongo program users are primarily due to decreased spending on outpatient visits.


J. Bollyky: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health. W. Lu: None. J. Schneider: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health. C. Whaley: Consultant; Self; Livongo Health.

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