Every idea sounds great the first time you hear it, and founders often come up with a new idea every few hours. But you can work out whether an idea deserves 10 years of your life before you spend a single day on it. The test is a handful of questions. The only ideas that pass are the ones big enough to keep you going for a decade.

At Allscripts, Glen Tullman moved doctors from handwritten prescriptions to electronic ones at scale. He founded Livongo in 2013 and took it public in 2019. A year later, Teladoc agreed to merge with Livongo in a deal that valued it at $18.5 billion . He is now CEO of Transcarent , which bought Accolade for $621 million in 2025. People pitch Tullman ideas all the time. He turns most of them down. Pitch him a better drinking glass and he’ll say, “Somebody should do that. It’s awesome. It’s just not me.”

I founded a social media agency at 22 and sold it 10 years later. Before deciding what to start next, I created a robust set of parameters . I asked Tullman how he decides which idea gets years of his life. He gave me a test of 6 questions. Here’s what each question looks like in practice.

How Glen Tullman’s validation test built an $18.5 billion company

Ask yourself if the idea changes lives at scale

Everyone joked about doctors’ handwriting, but illegible prescriptions were part of a bigger problem. The Institute of Medicine estimated preventable medication errors caused more than 7,000 deaths a year. Tullman’s team at Allscripts set a first-year goal of 100,000 electronic prescriptions. They missed it and nobody got a bonus. But by the time he left 10 years later, they were processing 700 million. “We knew electronic prescriptions, by reducing handwriting errors and other mistakes, were saving lives. We knew we made a difference.”

Livongo started by focusing on how hard it was for people to stay healthy. One big problem was the cost and availability of test strips used to check the blood sugar of people with diabetes. They sold for $35 and cost about $2 to make, so Livongo gave them away. Tullman’s youngest son Sam has type 1 diabetes. “Every day, a million people wake up healthier because of what we did, including my son.” His filter for every idea is one question. “How does somebody know you were there?” Let someone else build the better glass. Tullman’s focus is saving lives.

Give the power back to the people

Tullman deposited a check during a call on the morning we spoke. He signed the back, took two pictures, and it was done in under 30 seconds. His son Ben has never been inside a bank. “What would I do in a bank that I couldn’t do right here on my phone?” his son asked him. Tullman wants healthcare to work the same way, with people having the information and the tools at their fingertips to get answers to their health and care questions. He wants to make things like scheduling appointments with the best doctor for you as easy as simply asking your phone to make it happen.

He finds it strange that people accept less information about their health than about their dinner. “I know people who would have heart surgery on the suggestion of a single doctor, but who wouldn’t go to a restaurant without getting three recommendations from Yelp.” Every industry has a line that customers still stand in. Find yours, and put it on their phone.

Find the technology that creates abundance

In medieval Europe, books were made for clerics and scholars . The printing press made them widespread, libraries began lending them out, then eventually Google made information free and easily available for anyone. Tullman sees AI doing the same for healthcare. His friend Herman Teneja, CEO of General Catalyst, talks about how AI can create abundance in health and care. “With AI handling the billing, the paperwork, and the follow-up calls and scheduling, doctors can do what only doctors can do. While AI may be a challenge in other industries, in healthcare, where doctors, nurses, and therapists are in short supply, AI can create abundance like Google did with information.”

The goal is big and the math is simple. “We don’t actually have to lower the cost. All we have to do is stop it from growing.” People always ask Tullman if AI will take their job. “I always say, no, but somebody using AI will take your job.” Pick the idea AI makes possible for the first time.

To change the world, change the words

Early in his career, Tullman’s company started calling medical records something new. “We changed the name to electronic health records,” he said. “If you change the words, you can change the world.” Even prevention can be renamed. “Americans really don’t like prevention, but they love longevity. It’s the same thing.” It’s a rebrand, but it works. Starbucks decided small, medium and large weren’t good enough. They taught the world to ask for tall, grande and venti. “They created a category.” How could you give your industry a rebrand?

“Nobody said the iPhone was a better flip phone,” Tullman said. Aim to be a little better than another company and you end up “on a treadmill.” Established companies tie bonuses to doing the same thing a little better, so they won’t ask his favorite question. “What if we didn’t do this at all?” Give your idea a catchy name that instantly explains the value and that nobody else can use. Different, not better.

Prepare for inevitable setbacks

Growing up, people told inventor Dean Kamen that “two steps forward, one step back” was a negative, but he sees it as “one step forward with three times the experience.” Tullman thinks the same way. “I don’t really think about making mistakes. I think about it as, what did I learn?” Speed helps. “If we take enough swings and do it fast enough, maybe no one ever notices that we didn’t hit every ball out of the park or get it right the first time.”

He learned this attitude at home. Tullman is the youngest of 6 children, and at 12 his mother let him cut a hole in the roof of their two-story house for a solar panel. It never worked, and the roof never stopped leaking. She said it was awesome that he tried. Now he says, “No is the beginning of a discussion. It’s not the end of one.” Expect the steps back. When one comes, the question is what you can learn from it. 20 years later, Tullman started a solar company from scratch.

Prior to their IPO, Tullman brought on a new CEO at Livongo, The new CEO was welcoming a visitor in the lobby when he mentioned the company worked with “diabetics”. The receptionist, about 22, corrected him. “At Livongo, we work with people who have diabetes. We don’t call them by the name of the chronic condition they have. The CEO went straight to Tullman. “What an amazing culture you built that nobody’s scared to correct the CEO.”

Tullman asks the receptionist about every new hiring candidate, because “everybody matters in our companies.” He approaches problems with a beginner’s mind, like the curiosity scene in Ted Lasso. Any policy gets the same treatment, no matter how long it’s been in place. “It’s just something somebody made up when we started the company. You can change it if it’s not smart.” Ask why, then ask again.

Put your next idea through Glen Tullman’s $18.5 billion validation test

Tullman joined the Giving Pledge and is giving his money away. “It’s not what motivates me,” he said. His mother taught him that “to whom much is given, much is expected,” and he believes “purpose drives the biggest sense of commitment.” Choose the idea that changes lives, and have fun building it. “You gotta be able to laugh at yourself.”

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