Livongo: How can we get people with chronic conditions to better take care of their health?

How can we help people with chronic conditions take better care of their health?

Our changes drove 120% more enrollments in a health program

Keywords: prediabetes, diabetes, present bias, hyperbolic discounting, optimism bias

The Challenge

Imagine you are one of the 100 million adults living in the US with prediabetes or diabetes (source: 2017 CDC report). How do you manage your condition on a consistent basis?

Diabetes is a serious chronic condition that can lead to other health complications. Many of the health risks associated with diabetes can be reduced via lifestyle habits and appropriate medication, yet many diabetic people don’t take these actions. Studies show that 45% of people with Type 2 Diabetes don’t adequately manage their blood sugar, often because of poor medication adherence.

That’s one of the challenges Livongo is trying to address. The Livongo for Diabetes Program empowers people with chronic conditions to live better and healthier lives. Every new member gets a collection of resources to help manage their condition: a cellular-connected blood glucose meter, unlimited refills of strips and lancets, and access to personalized guidance from a Certified Diabetes Educator. Many of the people with diabetes who are eligible for the Livongo program are covered through their employer’s health plan, meaning they get all the program benefits at no cost! But many eligible people fail to sign up, forfeiting potentially life-saving resources.

Livongo Device & Welcome Kit


One of the primary ways Livongo communicates to individuals about their eligibility for the program is through email. It is one of the critical and most effective steps to get people to sign up for the program. Because of this, the offer’s framing is very important.

We hypothesized that changing the framing in email communications from “Join the Program” to “Claim Your Welcome Kit” would be more effective, based primarily on two behavioral principles:

  1. Social Proof — “Claim Your Welcome Kit” highlights a sense of scarcity and urgency by implying other people are claiming this limited resource.
  2. Endowment Effect — The new framing creates a sense of ownership over the limited resource.


Livongo conducted an email experiment as part of a seasonal campaign that it sends out to all eligible individuals. The control group received the original message with “Join the Program” framing.

The experimental group received a message with “Claim Your Welcome Kit” framing in the subject line, headline, call-to-action button, and email body.

Control & tests condition emails


Livongo emailed over 15,000 people with diabetes who were eligible for their program. They saw statistically significant differences in engagement between the two conditions. The “Claim Your Welcome Kit” condition increased open rates by 25% and click-through rates by 88%.

Most important, the experiment increased registration rate within 1 week of the email outreach by more than 120%.

This means people in the treatment condition signed up for the prediabetes/diabetes program covered by their employer at more than double the rate of the control group, increasing the chances of successfully managing their health condition.

The results have strongly influenced how Livongo measures the potential impact of applying behavioral principles to seemingly minor elements of their communication strategy. As a result, Livongo will continue experimenting with the “Claim Your Welcome Kit” theme across other touchpoints with their potential members, including direct mail campaigns, landing pages, and other emails.

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