California’s Center for Connected Health Policy, which is the National Telehealth Policy Resource Center, has published a study which concludes that community health centers (CHC)–a general term covering Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC)–have difficulty sustaining telehealth programs to support the underserved and ill with chronic conditions including mental health without grants or other subsidies. Consultant Milliman studied five California CHCs and determined that other than financial, major impediments to successful implementation were structural: complex billing and reimbursement rules, and difficulty tracking telehealth visits through multiple EHRs that weren’t necessarily compatible with each other or with billing systems. Many of these CHCs cannot financially provide telehealth without grants or other subsidies. This study holds lessons for telehealth companies which are working with ACOs, hospital discharge programs and practices in rural areas, as well as the Indian Health Service. Study (link to PDF), Healthcare Informatics, California Healthline  Hat tip to Elizabeth Olis of Viterion Digital Health