It’s been nearly a decade since Glen Tullman exited the electronic health record (EHR) space when he left Allscripts as its CEO, eventually paving the way to found Livongo, a consumer digital health program designed for people with chronic conditions.
Then last year, following Teladoc’s massive $18.5 billion merger with Livongo, the Chicago-based Tullman embarked on his next venture: becoming CEO of Transcarent, a company that is looking to overhaul the employer-self-insured business via a consumer-directed health and care platform intended to help individuals better understand their options in care and the associated costs.
Needless to say, Tullman has certainly been around the digital health block, and has unique perspectives stemming from multiple decades of wearing different hats across the sector. In a recent interview with Healthcare Innovation Managing Editor Rajiv Leventhal, Tullman discusses innovation in the face of the pandemic, the Teladoc/Livongo deal, the next big paradigm shift in healthcare, and more. Below are excerpts of that interview.
The pandemic has resulted in rapid innovation and a shift to digital, industry-wide. What do you think have been the most important learnings that can be applied to a post-pandemic environment during this major transition?
When we focus on the pandemic, we normally focus on the tragic loss of life, the economic issues, and the longer-term mental health issues, which we’re just starting to understand. But when we look back 10 years from now, we will actually look back at this as the time when healthcare went digital.
If you go back a year, the penetration of telehealth was 3 to 5 percent. We were told it would take five years to get to 40 to 50 percent. But in three months, we saw penetration go to almost 100 percent, and I think it will eventually settle in between 30 to 50 percent. That’s a 10x improvement. We saw similar gains in virtual physical therapy and many other areas. Based on that, the industry learned that we could innovate much more quickly, and they understood the focus [should be] on the convenience and quality that consumer digital health brings. So once you open that door and people get a taste of what it could be like, I don’t think [you can] go back. I believe we will see a dramatic change of what we think of as whole-person health, which will now include a consumer digital health component. Consumer digital health will eventually just become health.
In that context, what was the strategic rationale for the Teladoc/Livongo deal?
We will see dramatic innovation and change that will be focused on how to create a consumer-directed healthcare system that puts people back in charge of their care. As we look at the rest of our lives, we see everything we love is available on our terms, and is personalized to us. If I go to healthcare, however, I’m told when I need to be someplace that may be inconvenient for me, so I have none of those benefits. But that will flip around. Telehealth is available when you want it, and you can speak to someone about your specific concerns. That’s step one, but beyond that, it’s going to become much better in terms of [your] overall healthcare experience.
The idea behind the merger was to create the largest virtual healthcare provider/company, and at Livongo we were able to empower people with chronic conditions to live better and healthier lives. That empowerment put them in charge of their care, and we demonstrated that it’s not only a better experience for them, but also that their care improved. And we did that for less money.
What was the challenge? We had people calling us [at Livongo] in the middle of the night saying they have a sinus infection, [for example]. We would ask them why they were calling us, and they would say that we’re the only people who are picking up the phone, we’re the people who truly know [them], and we deliver solutions to them on their terms. However, the reality was we weren’t doctors who write prescriptions; we do chronic condition [management]. So we said if we really want to be there for our members, we need more capabilities that’s all in the ease of one spot.
In doing that, we started to search for what we didn’t have—and that was telehealth. We came across Teladoc, and they said of their 10 million visits, 60 percent [were for] chronic conditions. So they needed chronic condition expertise and we wanted a telehealth footprint. They were in more than 50 countries, and we weren’t international yet. And there was only about 25 percent customer overlap. Put altogether, it was perfect industrial logic from a fit standpoint.
What do you see as the next big paradigm shift in healthcare? Who do think the leaders will be in this new world?
We are seeing the world come together in a way that’s completely focused on the consumer. Today we have a lack of alignment in delivering care. If you go back 20 or 30 years, we had large payers, PBMs [pharmacy benefit managers] and health systems, and we were told they would together deliver a world-class experience in a cost-effective way. But healthcare has become more confusing and more costly than ever before. The next stage comes along with innovators like Livongo, and they have done great. But the problem is that now, all of a sudden you had one person—say who has diabetes, hypertension and weight management issues—who is dealing with multiple apps, devices, coaches, and medications. So their life got worse, not better; it’s just too [overwhelming] for them.
So who is good at figuring this out? The folks who are customer-focused have mostly come out of Silicon Valley, as they understand how to create consumer experiences. When you look at who’s now interested in healthcare, it’s Amazon, Walmart, Microsoft—all of these large companies. Some people think of them as tech companies, but Amazon is not a tech company, they’re a consumer experience company.
For us at Transcarent, it’s all about the consumer experience that we’re building. In the future, the companies that win will be the ones that provide people with unbiased and transparent information, trusted guidance, and accessibility. Think about what Amazon did—they didn’t just give us the option to buy Amazon stuff, but said, you can buy anything you want from virtually every provider on Amazon—even things that competed with their own offerings. They just wanted to put the consumer in charge.
Looking at Epic [Systems], you don’t want a scribe to sit there and help a doctor use Epic; that’s a massive failure and says you created software that’s so bad you need someone else to use it. Imagine if I said to you that I have this new product called Google, and anytime you want to use it, call me to come over and help you use it. That’s what has been [deemed] acceptable in healthcare. We want a healthcare system that we can navigate on our own.
To that end, as a former EHR vendor executive, how do you view the new federal interoperability rules, and its core missions to improve patient data access and information sharing? Are they well-intended and designed?
Anything we can do to make information more available and more accessible to not only health consumers, but to their physicians, is important to do. This is a patient safety issue, because [what happens] if you show up in an ER and your information is in another system that I can’t get to? That said, I don’t think the rules alone are enough to force real interoperability. The buyers of those EHRs will have to [assert] that it’s ridiculous your EHR can’t talk to another one. So they have to go to the vendors and tell them it’s not a technology issue; you’re not sharing the information because it [hurts your business].
There are great companies out there that are building on top of the existing EHRs, [telling customers] to treat your EHR like a data repository; we’ll be the smart front and back end, and we will kind of be like the app store that allows you to build around the existing system that’s so hard to navigate. Those [EHR] companies aren’t innovating the way the industry needs them to. So the federal regulations will be somewhat helpful, but the problem is if I send you a big data file, that doesn’t help you to deal with all the different terminology issues and the like. That has to be done more systematically by the vendors.
