Livongo’s Government Affairs Mission and Priorities

Things have been moving fast in the Beltway lately as Congress and the Administration finalize and begin to implement their $2.2 trillion dollar stimulus package while already working on several more relief packages simultaneously. In the hours and days following my last post summarizing the bill and key steps it takes in advancing digital health, the Administration made a number of commendable changes that help clear the way for remote monitoring to play a central role during and beyond the COVID-19 crisis. A few highlights include:

– CMS made the process of initiating remote monitoring less burdensome on all during the Public Health Emergency (PHE) by waiving the in-person physician referral requirement; lifting the requirement for the beneficiary to have a pre-existing relationship with the provider; and allowing consent for initiation of remote monitoring services to be gathered virtually and by support staff.
– CMS opened up access to remote monitoring to more of those in need by allowing Medicare beneficiaries who have just one chronic condition – down from two previously – to access remote monitoring services during the PHE. The Office of the Inspector General (OIG) will also waive the cost-sharing mandate for beneficiaries for telehealth and remote monitoring during the PHE, lifting another barrier to access.
– CMS also signaled that some changes made during the PHE are permanent, clarifying that in perpetuity remote monitoring can be used beyond the PHE for both for chronic condition management as well as acute care management (such as COVID-19 care).

From our founding, we at Livongo have recognized the importance of partnering with the federal government to advocate for the more than 147 million Americans living with chronic conditions and provide the remote monitoring tools and technology proven to help them stay healthy. As such, we’re one of the few companies in our space that have a full-time Government Affairs office in DC and invest time and resources to help educate and promote our priorities within Congress, HHS, CMS, FDA, The White House and other federal agencies.
Our day-to-day government advocacy work centers on four issue areas:
1. Ensuring people living with chronic conditions have access to remote monitoring solutions.
The COVID-19 pandemic shines a harsh light on the vulnerability of the more than 147 million Americans living with chronic conditions and the need to fundamentally rethink how we address their health needs. With chronic conditions and mental health challenges on the rise and clinician capacity stretched thin, it’s clear that our current acute care model is outdated and ineffective. As recent CMS moves in response to the pandemic illustrate so well, the federal government can be instrumental in clearing the way for remote monitoring and digital health to help people manage their chronic conditions – at great savings to individuals and the federal government. Livongo is tirelessly working with CMS to more actively and deeply integrate remote monitoring into the Medicare program, which could include demonstration programs tested under the Center for Medicare and Medicaid Innovation (CMMI).

This also translates to ensuring that programs like the Federal Communication Commission’s (FCC) COVID-19 Telehealth Program and Connected Care Pilot Program are properly funded to ensure that as digital health technologies become the new standard of care, providers and individuals have the means to access them. Just as we invest in stabilizing and modernizing our roads and bridges, we must invest in our nation’s broadband access and digital infrastructure to ensure all Americans can benefit from digital health as the new standard of care.
2. Enabling equitable access to digital health tools for all Americans
If we examine the prevalence of diabetes, it’s clear that certain communities are disproportionately impacted by the disease. According to the CDC’s 2020 National Diabetes Statistics Report, 34.2 million people of all ages, a staggering 10.5% of the US population, has diabetes. Moreover, the occurrence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%).

Among all adults, incidence varies significantly by education level, an indicator of socioeconomic status. Specifically, 13.3% of adults with less than a high school education have been diagnosed with diabetes as compared to 9.7% of those with a high school education and 7.5% of those with more than a high school education.

Digital health technologies, especially remote monitoring solutions, offer a crucial lifeline for people in these underserved communities, helping them better manage their chronic conditions – during this emergency period and ongoing – while reducing strain on the healthcare workforce. It’s critical that all Americans, regardless of race, socioeconomic status or geographic location be able to have equitable access to digital health technology.

Specific funding opportunities must be available for community health centers, federally qualified health centers, behavioral health centers and tribal health care providers. Additionally, all individuals, whether on Medicare, Medicaid or private insurance, should have affordable access to remote monitoring and digital health technologies.

3. Expanding existing Medicare programs for diabetes prevention and management to include virtual care

Currently Medicare administers the Diabetes Prevention Program (MDPP) and Diabetes Self-Management and Training Program for beneficiaries at risk for, or living with, diabetes. To date, Medicare has not allowed these programs to be provided virtually beyond a limited number of make-up sessions, including during the public health emergency. Unfortunately, by relying solely on traditional in-person approaches, the MDPP has fallen woefully short of its stated goal of reaching 110,000 people annually – instead reaching just over 200 people in 2018.

We know that virtual programming, pairing remote monitoring with 24/7 support can be highly effective, less costly, and easily scaled to reach all Medicare beneficiaries in need of diabetes management. With diabetes on the rise in the U.S. and accounting for $1 of every $7 spent on healthcare, we will continue to work closely with CMS to demonstrate how remote monitoring and digital coaching can extend the reach, impact and cost-effectiveness of these essential programs.
4. Protecting patient privacy through transparent data gathering and sharing practices
At Livongo, we place the highest value on our Members’ trust and believe that good data stewardship is foundational for delivering the personalized experience that’s core to our service model. We believe our Members’ personal data is theirs, and theirs alone.

Unfortunately, in healthcare and elsewhere, misuse of personal data is rampant and risks undermining the consumer trust that’s required to advance data science and deliver new, ever-more-personalized care plans. But as federal regulators look to address these concerns, it’s important they do so in a way that protects privacy without adding to red tape and compliance burdens that hinder innovation. We’re committed to working with government agencies to strike the right balance and find the best path forward on this crucial issue.

At this height of the COVID-19 pandemic, we are witnessing the enormous power of the federal government to be a prime mover and catalyst of change in our healthcare system. In just a matter of weeks, we’ve seen funds authorized and regulatory barriers lifted for telehealth, remote monitoring and digital health that could otherwise have taken years to achieve. While most of these advances have been framed as temporary, they mark a watershed moment for digital health that we must seize upon and build from.

We believe that remote monitoring will be the new standard of care during, and well beyond COVID-19. Strong actions and response from the federal government have increased access and accessibility of these services. Moving forward, we must continue providing the right technology-enabled solutions that make it easier for people to stay healthy outside the walls of the traditional healthcare system.