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Questions to ask Livongo before signing with them

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In 2014, the Validation Institute, then a joint property of Intel and GE, tasked me, based on Why Nobody Believes the Numbers, to develop the most sophisticated outcomes measurement course ever devised. That was not a heavy lift, because at the time no other such course existed. They named it Advanced Critical Outcomes Report Analysis, or “Advanced CORA” for short.

Five years later, the course, now called CORA Pro, remains the Gold Standard in outcomes measurement expertise. CORA Pros — and there are only 8 of us — have developed a talent not just for sniffing out questionable claims (anyone can “challenge the data”), but more importantly for identifying contradictory, implausible and even impossible claims that somehow hadn’t been noticed before. Even a simple press release can become a case study in impossibility.

CORA certification itself is very useful, and takes you halfway there. But there’s something special about CORA Pro. Once you are certified in CORA Pro, you never look at a vendor outcomes report the same way again. For instance, consider Livongo’s recent glowing press release about its outcomes. Non-CORA Pros, like whoever these people are, basically just parrot a vendor’s results uncritically with a glowing headline. They sound like Flounder.


By contrast, a CORA Pro would review Livongo’s claims thoughtfully, and ask probing questions, first about the outcomes:

  • If your goal is to reduce admissions for diabetes and reduce insulin usage across the population, why didn’t you measure admissions for diabetes, or insulin usage?
  • Why does this report show the opposite of your report from 2018? This report showed huge reductions in outpatient and no significant change in inpatient, whereas the 2018 report showed huge reductions in inpatient with no significant change in outpatient?


 

Then a CORA Pro would ask whether Livongo may be harming employees:

  • Why is your goal Hb A1c of 6.5% in conflict with the American College of Physicians and other expert bodies not funded by the diabetes industry, which advocate 7.0% to 8.0%? Perhaps they mean reaching 6.5% with diet-and-exercise, but if insulin use is going up, which is likely because they didn’t claim it was declining, clearly some employees aren’t getting the subtle nuance that they shouldn’t aim for 6.5% with medication.
  • Why is Choosing Wisely advocating fewer glucose checks if the right answer is to check multiple times a day?

Just askin’…  Because that’s what CORA Pros do.


The full list of questions can be found here.

To learn about CORA certification, click here.

And to see how we predicted many of the ways Livongo would measure outcomes using vendor-friendly metrics, click here.

 


In the immortal words of the great philosopher Pat Benatar, hit me with your best shot.

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