Top health experts talk telehealth regulation, health inequality

While the telehealth industry is booming, plenty of challenges remain, including the changing regulatory environment and the impact on vulnerable communities.

At Fierce Healthcare's "How COVID Changed Everything" event this week, our reporters caught up with experts across the healthcare industry to dive into these challenges.

We've compiled some of their key thoughts on the state of telehealth, and the future.

WATCH ON-DEMAND: How COVID Changed Everything

Here's more from Office of the National Coordinator for Health Information Technology's Micky Tripathi, Aledade's Farzad Mostashari and other top executives:

Thinking about the latest regulations

Micky Tripathi, the new national coordinator for health IT under the Biden administration, said providers and other industry stakeholders need to view the recently enacted information blocking rule, along with other interoperability rules mandated by the 21st Century Cures Act, as a “philosophy change” by putting patients in control of their health data.

headshot photo of Micky Tripathi
Micky Tripathi (Arcadia)

“This is not just a little change in a regulation that requires a little tweak. It’s really saying, we need to think about this in a fundamentally different way. You should have the mindset that you’re sharing the patients’ information unless you have a good reason not to share it,” he said.

Under the new regulations, patients should expect to have more digital interactions with the healthcare system as well as more transparency, in line with what they have come to expect from other industries, he said.

“Patients will have the ability to have apps and capabilities that are in their hands and be able to have information more at their fingertips,” Tripathi said.

In four years Tripathi said he’d like to see the industry advance data-sharing beyond just a compliance requirement. “I’d like to see the industry look at this from a strategic perspective and value-enhancing way. Organizations should look at this and say, ‘How can I use this to benefit my own stakeholders, such as patients if you’re a provider, or customers if you are a tech organization or providers participating in my network, if you are a health information network,” he said.

Using tech to address inequities

As new innovations proliferate, it's critical to ensure that experts are thinking of a diverse population of patients in their design and planning. That extends to clinical trials and other research projects.

UnitedHealth Group's Deneen Vojta
Deneen Vojta (UnitedHealth Group)

At UnitedHealth Group, that has meant launching United in Research, a project that aims to recruit a more diverse population into analyses on critical healthcare issues. One of the partners in the program is the healthcare giant's subsidiary Level2, a virtual platform aimed at improving and reversing diabetes.

Deneen Vojta, M.D., executive vice president of research and development at UHG, said that population health initiatives like United in Research and Level2 need to be able to harness their available data to ensure individual needs are addressed.

The COVID-19 pandemic has made this effort even more critical, she said, as it exposed long-standing inequities in healthcare.

"I think this is another glass of lemonade from our lemons this year," Vojta said. "The whole health equity issue was just magnified, we can’t deny it anymore."

Addressing those challenges requires platforms like Level2 to find the "needle in the haystack" that can ensure they're addressing each user's needs.

"All the needles in the haystack are signals of people could use additional support to manage their condition better," Vojta said. "That’s where we take population health, and we’re able to bring it down to the n of one. Each needle is an individual, there is no average."

How practices are faring with virtual care

Last spring, when the pandemic was surging across most of the country, primary care practices quickly shifted to virtual care. A year later and in-person visits have returned to pre-COVID levels for many practices, according to Farzad Mostashari, M.D., co-founder and CEO at Aledade.

The future of healthcare delivery will likely be a hybrid of in-person and virtual care but getting providers to make that permanent shift will still be a challenge, Mostashari said.

Farzad Mostashari
Farzad Mostashari (Aledade)

“One of the things that was a little scary was how quickly [telehealth] melted away unless you worked with the practices on new, hybrid workflows. They spent 20 years optimizing how to do in-person visits and make it efficient and quick. Once given the opportunity to go back to in-person, many practices said, ‘That’s fine, I don’t need this telehealth thing.’ We had to work with them to say, this is now a part of the armamentarium of primary care. You can deliver primary care over the phone, through a video screen, or in-person.”

He added that the future of telehealth adoption will largely depend on regulatory flexibilities and payment policies, such as a continuation of payment parity for telehealth visits, and providers making substantial changes to their workflows.

“One of our primary care doctors and a business owner in Delaware spoke to our board about her experiences, and she said, 'If there’s one good thing that came out of this horrible year, it is that it forced us to be more patient-centered, to meet patients where they are, literally.' Sometimes that meant practices had drive-thru visits or drive-thru testing, sometimes it meant porch visits or home visits. But, for healthcare to really change, we need to have the providers, physicians and nurses really embracing the change as well,” he said.

What is next for telehealth?

The pandemic caused a major boom of telehealth use after the federal government loosened restrictions surrounding Medicare reimbursement for some telehealth services.

Katea Ravega
Katea Ravega (Quarles & Brady LLP)

But what happens after the pandemic? These speakers give their thoughts on what to expect for telehealth:

"People focus on the laws and for years in the telehealth space in particular overutilization, waste cost, fraud, fear about quality … have been used to deny or restrict access to care through digital health," Katea Ravega, attorney at Quarles & Brady LLP, said. "Now coming out of the pandemic we are going to have a lot of data. Over the past year since you have had all the waivers in place, there is going to be new information to be used to develop better laws and policies in this space."
Myra Simon
Myra Simon (Avalere)

"Licensure laws in different states are one of the things that can make offering telehealth for a wide range of services a little more difficult. There are laws about who can do what in what state," Myra Simon, principal at Avalere Health, said. "The experience we had under the pandemic will lead to a lot of revisiting of state regulations to think about where we need those boundaries."