Perspectives: Bridging the Gap in Rural Healthcare Through Telehealth

April 7, 2025 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic is the closure of rural hospitals and whether telehealth can bridge this access gap. The author, Hari Prasad, is co-founder and CEO of  Yosi Health, a full-service technology ecosystem that connects patients with their providers through the entire care journey before, during and after the visit, creating delightful patient experiences and modernizing the entire healthcare patient experience. 

Rural hospitals across the United States are at risk of closing especially if Medicare and Medicaid cuts are enacted. According to a March 2025 report by the Center for Healthcare Quality and Payment Reform, over the past two decades, nearly 200 rural hospitals have already closed. It’s an economic reality that could leave hundreds of thousands of Americans without local medical care.

Rural communities, which already face challenges related to limited healthcare resources, transportation, as well as staffing and economic constraints, are likely to experience even greater disparities in access to essential services. As these hospitals and clinics face potential shutdowns, telehealth is emerging as a critical tool to maintain healthcare connectivity and improve patient outcomes in these underserved areas.

The threat of rural hospital closures has far-reaching implications. For many residents, these facilities provide not only emergency care but also routine health services, chronic disease management, and preventive screenings. With the loss of a nearby hospital, patients are often forced to travel long distances for care—a situation that can delay treatment and exacerbate health conditions. Additionally, the closure of rural hospitals often leads to increased pressure on remaining facilities, further straining resources and limiting access.

Telehealth, which allows patients to connect with healthcare providers through digital platforms, offers a promising solution to these challenges. By enabling virtual consultations, remote monitoring, and digital care coordination, telehealth can mitigate some of the negative effects of hospital closures. It provides patients with timely access to medical advice and treatment without the need for long, costly journeys to distant facilities.

In my experience at Yosi Health, we are witnessing a notable trend: rural healthcare providers are increasingly turning to telehealth as a means of bridging the access gap. Digital tools and virtual care platforms have evolved to support not only routine consultations but also more complex care management needs. For example, remote patient monitoring is now being used to track chronic conditions such as diabetes and hypertension, ensuring that patients receive ongoing care – without the constant need for in-person visits.

Furthermore, telehealth solutions are proving effective in reducing hospital strain. By diverting non-emergency cases from overcrowded emergency departments, these platforms help ensure that hospital resources are preserved for patients in critical need. Virtual visits can also lead to more efficient use of healthcare resources, allowing providers to manage larger patient loads with improved workflow efficiencies.

There are, however, challenges that must be addressed for telehealth to reach its full potential in rural areas. One of the key issues is the digital divide. While broadband expansion initiatives and improved rural telecommunications infrastructure are making strides, many rural communities still lack reliable internet access—a crucial component for successful telehealth implementation. Policymakers at the state and federal levels, including considerations in the Federal 2026 budget, are beginning to recognize the importance of investing in these areas. Such investments are essential to ensure that telehealth can serve as a viable alternative to in-person care in rural settings.

Another challenge is ensuring that telehealth services are fully integrated with existing healthcare systems. Interoperability between telehealth platforms and electronic medical records (EMRs) is vital to maintain a seamless flow of patient information, which in turn supports continuity of care. As more healthcare providers adopt digital solutions, the need for standardization and robust data exchange protocols becomes increasingly important.

Ultimately, while telehealth is not a complete substitute for all in-person care, it is a powerful tool that can help maintain continuity in the face of rural hospital closures. By improving access to care, reducing travel burdens, and alleviating pressure on overstretched facilities, telehealth can play a central role in preserving the health of rural populations.

The ongoing evolution of telehealth technology offers a hopeful outlook for rural healthcare. As innovations continue to improve service delivery and integration, it is imperative for stakeholders—providers, policymakers, and technology developers alike—to collaborate in expanding these solutions. In doing so, we can help ensure that rural communities are not left behind, but instead have access to the high-quality, timely care they deserve.

For Perspectives editorial and additional opportunities such as supporting TTA through advertising, contact Editor Donna.

Perspectives: As police step back from mental health calls, telepsychiatry steps forward

March 26, 2025 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Our hot topic today is community mental health crisis response, and the role that telepsychiatry can play in an integrated approach to  prevent crises from escalating. Today’s contribution is from Andy Flanagan of Iris Telehealth. As CEO, he drives strategy, operations, and culture, leveraging his extensive healthcare and leadership experience. A four-time CEO with a background in global health tech, he holds degrees from Northwestern and the University of Nevada, Reno.

Law enforcement is stepping back from mental health crisis response. Sacramento County Sheriff recently announced deputies will no longer respond to non-criminal mental health calls, citing a recent Ninth Circuit Court ruling that questioned police involvement where no crime has occurred.

Sacramento isn’t alone. In Austin, Texas, the police union president declared that “the Austin Police Department must stop responding to mental health calls,” as reported by Fox 7 Austin.

Law enforcement is underequipped for mental health crises. But who should respond instead? How do we build a system that connects people in crisis with appropriate care?

The answer lies in creating integrated crisis response systems that combine trained mental health professionals, community resources and telepsychiatry to ensure people in crisis get immediate access to appropriate care, regardless of location or timing.

The current crisis

In Austin alone, police responded to 34,000-52,000 mental health calls annually since 2020. Nationally, the burden is immense, with behavioral health-related emergency department (ED) visits doubling from 2011 to 2020, now reaching approximately 47 visits per 100 people.

When law enforcement withdraws from mental health response, this pressure shifts to already strained emergency departments. Without alternative systems in place, people experiencing mental health crises have nowhere to turn except hospital EDs, leading to overcrowding, extended wait times and less-than-optimal care environments for behavioral health needs.

First responders face an impossible task. Most receive minimal mental health training — often just 40 to 120 hours — compared to the years of specialized education mental health clinicians receive. This gap creates dangerous situations like the DeSilva case that prompted the Ninth Circuit ruling.

A better approach

Communities are discovering more effective models for mental health crisis response. The nationwide 988 Suicide and Crisis Lifeline provides immediate access to trained counselors, while integrated crisis response systems — like Austin’s approach of offering mental health services as a 911 option — show promising results. When Austin callers select mental health services, they’re connected with Integral Care clinicians who conduct assessments, provide support and deploy mobile crisis teams when needed. According to Fox 7 Austin, 87% of these calls are resolved without police involvement.

Specialized mental health professionals are the cornerstone of these systems. These experts bring the right training and perspective to de-escalate situations, connect individuals to appropriate resources and provide trauma-informed care. Unlike law enforcement, their approach centers on therapeutic intervention rather than control and containment.

Technology bridges access to specialized services. Telepsychiatry enables immediate access to mental health expertise, even when providers aren’t physically present. Digital platforms can connect crisis responders with psychiatrists for real-time consultation, ensuring appropriate assessment and care planning from the first point of contact. This is particularly valuable for rural communities with provider shortages, where in-person mental health specialists may not be readily available.

The role of telepsychiatry

Telepsychiatry platforms connect patients directly to behavioral health expertise before crises escalate. Today’s technology enables immediate access to qualified mental health professionals through smartphone apps, community centers and EDs. Modern systems incorporate AI-driven analytics to optimize patient scheduling and resource allocation without replacing clinical judgment.

The benefits are immediate for patients who receive specialized care within 30-45 minutes versus traditional ED visits taking 2+ hours. Healthcare providers gain psychiatric expertise without maintaining 24/7 in-house specialists, addressing a critical gap where 54% of U.S. hospitals have no psychiatrists available for ED and inpatient consultation services. When telepsychiatry is effectively implemented, health systems experience reduced boarding times, lower admission rates and improved emergency department throughput. One hospital avoided more than $1.7 million in boarding costs with a 281% return on investment, while another reduced psychiatric patient length of stay by 70%.

Technology works best when enhancing human expertise, not replacing it. A recent Iris Telehealth survey found 41% of respondents would feel comfortable receiving treatment recommendations from AI-powered mental health tools, and 33% would leverage these tools if integrated into services they already use (think telehealth platforms or primary care visits).

As law enforcement rightfully steps back from mental health crisis response, we must step forward with integrated solutions that combine human expertise and technology. Telepsychiatry represents one critical piece of a comprehensive approach connecting people in crisis with appropriate care.

For Perspectives editorial and additional opportunities such as supporting TTA through advertising, contact Editor Donna.

Perspectives: Telehealth Expands Access to Addiction Treatment and Specialized Care, But Navigating Regulations Remains Key

March 18, 2025 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Telehealth extensions, especially for controlled substances, are hot topics and here is another Perspectives on this topic. Today’s contribution is from Nate MacLeitch, CEO and founder of QuickBlox, an AI communication platform. He is a seasoned business leader with deep expertise in telecom, media, software, and technology, having held leadership roles at WIN Plc (now Cisco) and Twistbox Entertainment (now Digital Turbine). He also advises and invests in startups and holds degrees from UC Davis and the London School of Economics.

Telehealth’s really made a huge difference in who can get good medical care. By enabling health system leaders to connect more patients to doctors, 91% now report having a telehealth program in place.

Even so, accessibility to prescriptions and proper healthcare remains a critical issue in the US. A systematic review of 185 studies found that 54% of cases indicated how disability or chronic health conditions create barriers to medication access. Race contributed to 28% of reported barriers, while income and education levels were factors in 30% of the studies. Furthermore, half identified a lack of available treatment or healthcare practitioners as a significant structural barrier.

The Drug Enforcement Administration’s (DEA) recent announcement to make permanent three telehealth regulations increases access to vital medical services—particularly addiction treatment, specialized care, and care for veterans. Here’s what telehealth providers need to know.

The DEA’s latest ruling

Telehealth is a necessary avenue to solve accessibility barriers, however, it comes with its own challenges. Patient safety and preventing the diversion of medications into the illicit drug market are at the heart of the DEA’s amendments. See the three latest rules below:

Expansion of buprenorphine treatment via telemedicine encounter

The allowance of initial buprenorphine prescriptions via telephone consultations for up to a six-month supply addresses a critical need in combating opioid addiction. This removes a major barrier for individuals seeking treatment, particularly in rural or underserved areas.

Practitioners must note that the requirement for subsequent in-person visits ensures a balance between accessibility and safe patient care. Further telemedicine prescriptions following this period may be permitted but will first require an in-person visit to a medical provider.

Telehealth platforms should be designed to facilitate these initial consultations, seamlessly integrate with existing healthcare systems, and automatically notify patients and practitioners when the six-month window is completed.

Special registrations for telemedicine and limited state telemedicine registrations

The introduction of special registrations for telemedicine, including the ability for medical practitioners to prescribe Schedule III-V controlled substances without prior in-person evaluations, significantly broadens the scope of telehealth. This helps patients struggling with conditions such as sleep disorders, diarrhea, and anxiety to receive ongoing medication management.

For Schedule II medications, which are more addictive and prone to diversion to the illegal drug market, the DEA established an advanced telemedicine prescribing registration. Certain Schedule II medications are prescribable via telehealth but require the medical practitioner to be board-certified in one of the following specialties: psychiatrists; hospice care physicians; physicians rendering treatment at long-term care facilities, and pediatricians.

While the DEA currently only allows certain types of doctors to use telehealth to prescribe controlled medications, it asks the public to comment on any needs and reasons for expanding this list. The agency’s consideration in making it easier to use telehealth for treating complicated health problems is a good sign for the future of virtual healthcare.

In the meantime, telehealth providers can help clients and partners identify practitioners’ certifications and monitor and restrict prescription types based on their associated authorities within the platform.

Continuity of care via telemedicine for Veterans Affairs patients

The clarification regarding continuity of care for Veterans Affairs patients via telemedicine is a welcome development. By extending the provider-patient relationship established during an initial in-person visit to all US Department of Veterans Affairs (VA) practitioners using telehealth, the VA is streamlining care coordination and improving veterans’ access to required medication.

Telehealth providers must support secure communication and data sharing between platforms and the VA system, further enhancing the continuity of care for veterans.

How automatic notifications can help

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Teladoc to buy Catapult Health in all-cash, $65 million deal

February 6, 2025 | by

Teladoc lets loose with the cash, snaps up Catapult Health to get into preventative health services. Teladoc’s agreement with Catapult to acquire them for $65 million is their first significant purchase move by Teladoc since the $18.5 billion Livongo buy in 2020 and the first for new CEO Chuck Divita, who joined Teladoc last year. The strategy, as alluded to at the JP Morgan conference, is to widen the product breadth to deepen impact on healthcare outcomes.

Catapult is positioned significantly earlier in patient health than Teladoc, as their Virtual Checkup sends at-home diagnostic kits to employees or health plan members to return as a form of an annual checkup, for instance. The kits test for blood glucose, cholesterol, and blood pressure, plus BMI calculated by height and weight. If a condition is diagnosed, a virtual consult with a licensed provider is scheduled, and the employee is directed into an appropriate program or to their primary care provider. Employers and plans get data on the patient/member group to refine approaches and close care gaps. Earlier diagnosis and management save both employers and payers money–a claimed $1,400 over a three-year period.

The integration into Teladoc is logical as the ongoing patient management is planned to be steered to Teladoc and its programs/providers. Catapult at present has no app–their management approach is 1:1 on a video consult scheduled between the employee/member and Catapult’s provider.

Compared to the Livongo buy, Catapult is snack-sized. The deal is $65 million in cash, with an additional $5 million contingent earnout consideration. The transaction was 2.2 times Catapult’s trailing 12-month revenue through Q3 2024. Closing is expected to be this quarter. Catapult is private and over 15 years raised a modest $26.4 million from exiting investors Jeffrey Smith, Michael Woods, University of Colorado Health, and Health Enterprise Partners. As is becoming standard, there is no transition mentioned of Catapult employees, including CEO David Michel, except for a statement that it will operate within the Integrated Care segment of Teladoc. Catapult is based in Dallas and claims 3,500 employers and other organizations that cover 3 million lives.

Will Teladoc do better than they did with integrating Livongo? In the release, Teladoc stated that Catapult clinicians “will be able to directly enroll eligible members into Teladoc Health’s diabetes, hypertension, pre-diabetes and weight management programs, and seamlessly refer them to Teladoc’s virtual mental health therapists and primary care providers.” One can only hope that this integration goes better than Livongo’s. Former CEO Jason Gorevic touted it as seamless as late as mid-2022, but it turned out to be a potholed road with Livongo’s execs taking the money and running, then gradually losing (or cutting) most of its operational expertise in the chaos. Teladoc also aggressively leveraged Livongo and Teladoc’s longitudinal capabilities at the wrong time to the wrong markets 1) during an economic downturn and 2) to buyers not wanting their ‘premium spread’ but preferring less comprehensive but targeted solutions from competitors that were easier and cheaper to implement. The point of Catapult Health was, after all, to save employers money. We’ll see if a new Teladoc crowd has learned that hard lesson and to move softly, softly on the upselling. CNBC, Healthcare Dive, FierceHealthcare    For a more in-depth look at Teladoc’s and Amwell’s struggles in a changed market, see our 9 April 2024 article on What Happens Next in telehealth.

Updates: ATA on telehealth policy priorities, UHG investor group demands denied care report, DOJ sues Walgreens on illegal Rx dispensing, VA nominee supports Oracle EHR deployment, RFK Jr. HHS nomination hits Senate

January 24, 2025 | by

ATA urges nine telehealth priorities for the Trump Administration’s consideration. Acknowledging that HHS expanded Medicare telehealth flexibilities at the start of the pandemic in 2020 in the previous Trump Administration, the American Telemedicine Association’s list is long and detailed.

#1 was to withdraw last week’s Drug Enforcement Administration’s (DEA) proposed rule, “Special Registration for Telemedicine and Limited State Telemedicine Registrations”. This would create a framework for the remote prescribing of controlled substances that in ATA’s view, would create “untenable restrictions and significant barriers to care”.

The remaining eight include flexibilities that were part of the 2020 rules.

  1. Permanently Allow for the Remote Prescribing of Controlled Substances
  2. Work with Congress to Make Permanent the Medicare Telehealth Flexibilities
  3. Ensure Affordable Telehealth Services for the Commercially Insured
  4. Ensure Affordable Telehealth Coverage for Part-Time, Contracted Workers Who Don’t Qualify for Health Care Coverage
  5. Ensure All Provider Home Addresses Remain Confidential
  6. Expand the Medicare Diabetes Prevention Program
  7. Reinstate Virtual Cardiopulmonary Rehabilitation Programs
  8. Release Updated Regulatory Guidance on Medicare Telehealth Flexibilities

Additional details are in the ATA Action letter to President Trump and Vice-President Vance and the ATA release.

An institutional investor interest group demands a report on delayed and denied care from UnitedHealth Group. This takes the form of a proposal for the 2025 proxy that the UHG board of directors prepare a report on these practices that create increased costs and ‘macroeconomic risks’.  The proxy is usually filed in April for a meeting that is typically in June. UHG will respond at that time it files the proxy.

The group proposing the report is the Interfaith Center on Corporate Responsibility (ICCR). ICCR represents 300 faith-based institutional investors, such as asset managers, pension funds, and foundations, with over $4 trillion in invested capital. This institutional shareholder action is in the aftermath of the Brian Thompson assassination, which revealed widespread consumer anger about UnitedHealthcare’s practices in high rates of claims denials, including their use of AI in the review process, and prior authorizations to restrict utilization. UHG ignores this at its peril. By the time proxies are released and the shareholder meeting occurs in June, the trial of the assassin may be underway, putting this issue back in top news.  ICCR release, Healthcare Dive

Walgreens’ Mound of Misery gained a few hundred cubic yards with a lawsuit filed 16 January by the Department of Justice (DOJ) over improper dispensing of opioids and and other unlawful medications over more than a decade. The civil lawsuit filed in the US District Court for the Northern District of Illinois alleges that Walgreens and subsidiaries dispensed millions of unlawful prescriptions, violating the Controlled Substances Act (CSA). Since Walgreens then sought reimbursement from Federal healthcare programs, they violated the False Claims Act (FCA). The time frame is from August 2012 to the present. Specific allegations include that Walgreens pressured pharmacists to fill prescriptions despite clear ‘red flags’, in excessive quantities, and lacking a legitimate medical purpose and that they ignored the pharmacists and their own internal data. One of the red flags were prescriptions for the ‘trinity’ of an opioid, a benzodiazepine and a muscle relaxant. There are also four different whistleblower actions against Walgreens under the qui tam (on behalf of the government) provisions of the FCA that have been consolidated. If successful, Walgreens could face civil penalties of up to $80,850 for each unlawful prescription filled in violation of the CSA, plus treble damages and applicable penalties for each prescription paid by Federal programs in violation of the FCA. Timing and Walgreens’ response are not yet available. This lawsuit could be a massive stumbling block to the rumored Walgreens/WBA sale.  DOJ release, Healthcare Finance 

The VA Secretary nominee recommits to resuming the 2026 rollout of the Oracle Cerner EHR. Former House Representative for Georgia Doug Collins told members of the Senate Veterans’ Affairs Committee at his nomination hearing Tuesday that he would look at the Oracle Cerner EHR deployment with ‘fresh eyes’ and that “there’s no reason in the world we cannot get this done.” On 20 December, the VA formally stated that they were starting planning now for deployment in four Michigan facilities — Ann Arbor, Battle Creek, Detroit, and Saginaw–for implementation by mid-2016. He was critical of what has transpired to date in the limited deployment as ‘not acceptable’ and pointing out that VA facilities needed modernization of their computer systems. But perhaps a little overoptimistically, he’d like to see a faster implementation in 2016, though it should be done properly and not rushed. NextGov/FCW, Healthcare IT News

And in the Warp Speed World that is now DC, Robert F. Kennedy Jr. is scheduled to testify next Wednesday (29 January) before the Senate Finance Committee on his nomination as Health and Human Services Secretary. At HHS, he would supervise the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). He has promised major reforms including food safety and chemical additives, as well as the relationships between FDA and pharmaceutical companies. Healthcare Dive  Meanwhile, during the transition, HHS froze external communications or work-related appearances by staff. This is fairly standard procedure until review procedures are set up, but apparently no one planned for this in advance. This has derailed two conferences (AFCEA HIT Summit and the HHS Industry Summit) that were scheduled for this month and February. Exceptions to this are ‘mission critical’ and emergency communications. NextGov/FCW

Perspectives: Three Strategies to Bring Digital-First Care to Patients Through Telehealth

January 22, 2025 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s contribution is from Jessica Wagner, Chief Operating Officer at RXNT, who leverages extensive customer insight, product expertise, and organizational experience to address challenges in the healthcare industry. With a background spanning roles in product management, sales, and marketing, she is dedicated to delivering software solutions that simplify operations for healthcare organizations, enabling them to focus on patient care. Wagner holds a Master’s in Technology Management from Georgetown University and a Bachelor’s in Philosophy from Palm Beach Atlantic.

This article highlights the findings of their recently published report, “Tracking the Impact of Technology on Patient Satisfaction Within the US Healthcare System”, available for download here.

Today’s patients expect flexible, convenient, digital-first healthcare experiences. Telehealth can address many of these needs by reducing travel time, eliminating long waits, and allowing remote consultations. However, if practices fail to communicate telehealth’s availability and benefits, patients may remain unaware or skeptical.

Our 2024 survey report uncovered that difficulty scheduling appointments (42%) and long wait times (38%) are two leading causes of patient dissatisfaction—barriers that telehealth can help overcome by offering quicker and more flexible access to care. On top of that, over half of patients surveyed believe introducing more technology would improve their healthcare experience, and 35% say they’d consider switching providers for better digital services.

When telehealth flexibilities are a core component of your business strategy, it shows patients you’re committed to facilitating the modern, seamless care experience they expect. Here are three steps your practice can take to make this happen:

1. Promote Telehealth Services on Your Website’s Landing Page

Your website is your digital front door. When patients land on your homepage—new or existing—they should see whether you offer telehealth and how they can access it. Showcase telehealth with a bold call-to-action button, short explanatory text, and clear benefits:

  • Explain “Why Telehealth?”
    Use bullet points or a concise paragraph to clarify common patient questions and the benefits of telehealth, such as reduced travel time, minimized exposure risks, and convenient, timely appointments from anywhere.
  • Highlight Ease of Scheduling
    2 in 5 patients say it’s hard to get in touch with healthcare professionals for appointments. Highlight that your telehealth booking process is designed to be quick and simple with no phone tag necessary.
  • Offer Patient Testimonials
    If available, share—in a HIPAA-compliant manner—a testimonial or quote from a patient that shows how telehealth saved time, money, or both.

2. Update Online Profiles and Manage Reviews; Include Your Telehealth Services

Patients increasingly rely on online reviews and listings to find providers they can trust. Ensure that Google My Business, Healthgrades, WebMD, Yelp, and more reflect your telemedicine appointment options so that potential patients know you’re ready to meet their digital preferences.

  • Emphasize Digital Convenience
    Fifty-five percent of patients prefer using a mobile application to manage appointments. On each profile, detail how you make remote care accessible, whether via a proprietary app or a web-based portal.
  • Mention Text and Email Reminders
    Nearly 9 in 10 consumers say they find text notifications valuable. If your practice utilizes text reminders for telehealth, call it out under the “Services” section or description.
  • Provide Easy Booking Links
    Link directly to your telehealth scheduling tool to simplify the process. The fewer clicks it takes, the more likely patients are to book a virtual consultation.

3. Offer Telehealth for Every Applicable Client Appointment

Sometimes, patients need an extra nudge to try telehealth. Encourage staff, particularly receptionists or schedulers, to mention remote appointments whenever it’s clinically appropriate.

  • Alleviate Communication Woes
    Poor communication with healthcare providers is the top complaint among unsatisfied patients. To combat this, telehealth platforms often include built-in messaging features that give patients a direct line of communication to manage care and help reduce missed connections.
  • Showcase Time Savings
    Highlight how telehealth can minimize time off work or away from family. The more you can personalize these perks, the greater the likelihood that patients will opt in. As an example, write something like, “Have your appointment from home in 15 minutes.”
  • Normalize Telehealth as a Standard Option
    Even in routine appointment reminders or automated messages, include “Switch to a telehealth appointment!” prompt. Present virtual care as routine to foster acceptance among those who might otherwise only consider in-person visits.

Meeting Patient Needs in a Modern World

Telehealth has become a vital part of modern healthcare strategy. Showcasing its benefits in as many places as possible will highlight its convenience and reinforce your commitment to meeting the changing needs of your patients.

Our survey data suggests that effectively communicating your telehealth offerings can provide a significant competitive edge. In today’s healthcare space, success means delivering it on patients’ terms: where, when, and how they need it.

Federal budget continuing resolution battle derailed or delayed some telehealth extensions, physician fee increase, PBM reforms (updated 21 Dec)

December 19, 2024 | by

Updated for the final bill passed 21 December. It’s one day to the Friday 20 December shutdown deadline for the expiring Federal budget extension. How can this be? The continuing resolution (CR) that would extend Federal budgets to 14 March 2025 is running into severe headwinds in Congress. Conservative Republicans in both houses, plus President-elect Donald Trump, and DOGE co-heads Elon Musk and Vivek Ramaswamy have come out against the 1,547-page CR.

Nearly all legislators have NOT read it, to no one’s surprise. Instead of a clean CR that extends the budget, it’s hung like a Christmas tree with ornaments like provisions on health care (discussed below).  Among the ornaments: permitting year-round sales of E15 ethanol fuel (a really bad idea), $100 billion in badly needed disaster aid, the rebuilding of the wrecked Francis Scott Key Bridge in Baltimore–and, outrageously, a pay raise for Congress members, the concealment of information given to the House around the events of 6 January 2021 (Section 605), and the refunding of the Global Engagement Center (GEC) in the State Department that censored social media accounts! (Somehow the spending-free requirement requiring AM radio in all vehicles sold in the US, a linchpin of our national Emergency Alert System, was forgotten.) All of these should have been handled in discrete bills passed much earlier (or defunded as planned), reducing the CR to a manageable 100 pages or less. Why wasn’t it?

For context, the current 118th Congress ends on 3 January 2025. New Members will be sworn in on that date if not before (in the case of vacant seats). Control of Congress will remain with Republicans in the House and switch to them in the Senate. The 119th Congress is able to immediately address this on 3 January.

If the government shuts down after Friday–most of it is on vacation or out of session anyway–what continues are essential functions such as the military, government benefits, Medicare, the VA, and law enforcement. Non-essential employees won’t be coming into work. National parks, for instance, will be closed–but it is winter.

In healthcare, what was tossed on the tree at various points:

In telehealth, the American Telemedicine Association (ATA) applauded, perhaps too early, the following measures:

  • 2-year extension of Medicare telehealth flexibilities (Ed.–for geographic and originating sites plus types of providers)
  • 2-year extension of first dollar coverage of High Deductible Health Plans-Health Savings Accounts (HDHP-HSA) tax provision (Ed.–commercial coverage)
  • 5-year extension of Acute Hospital Care at Home program (Ed.–originally developed during the pandemic. The Hospital at Home Users group has a webinar at 4pm Thursday–direct link to registration– to discuss contingencies around delay or no extension. )
  • Allows cardiopulmonary rehabilitation services to be furnished via telehealth at a beneficiary’s home under Medicare in 2025 and 2026
  • 5-year extension of the Medicare Diabetes Prevention Program (MDPP) Expanded Model through 2030 and allows beneficiaries to participate virtually and in-person (Ed.–This consists of a one year course that promotes dietary changes, physical activity, and other behaviors to help people lose weight. Providers are paid both for sessions attended and weight loss outcomes. The big guns behind this are Teladoc, which has a lot riding on this, and Omada Health.)
  • Enacts the SPEAK Act which facilitates guidance and access to best practices on providing telehealth services accessibly

The Medicare physician fee schedule (Medicare PFS) has a 2.5% increase. This counteracts a 2.8% decrease enacted in November.

Bonuses to alternative payment models and a reauthorization of the SUPPORT Act for dealing with the opioid crisis.

PBM reforms. The bonuses would be paid for by transparency requirements for pharmacy benefit management (PBM) companies, including banning spread pricing in Medicaid and ensuring Part D plan sponsors delink PBM fees from the price of a drug. The PBM trade lobby charges that the delinking alone will increase premiums in Part D by $13 billion and benefit drug manufacturers.

Updated: Mario Aguilar in the STAT HealthTech newsletter reported the inclusion of a required GAO report on wearable devices: “Within 18 months, the government accountability office must produce a report on “(1) the potential for such devices to accurately prescribe treatments; (2) an examination of the benefits and challenges of artificial intelligence to augment such capabilities; and (3) policy options to enhance the benefits and mitigate potential challenges of developing or using  such devices.” I sent a few messages trying to figure out what exactly the deal is, but the language has been attached to telehealth legislation since at least May.”

FierceHealthcare 16 Dec, 16 Dec. Fox News  CBS News    

Update 21 December   A much-contracted and simplified bill was passed on Friday 0’dark:30 by first the House then the Senate for the presidential signature. The full text of the bill is here. The healthcare provisions included were in Division C, table of contents on page 91, and extended through 31 March 2025. Only three were extended–the rest have to wait for a bill or bills in regular order:

  • The Special Diabetes Program (Sec. 3102)
  • Telehealth flexibilities (Sec. 3207)
  • Hospital care at home (Sec. 3208)

More to develop when the 119th Congress convenes on 3 January.

Perspectives: How Telehealth is Transforming Access for Limited English Proficiency (LEP) Patients

December 13, 2024 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s contribution is from Mark Knudsen, the president of AMN Language Services. Mark brings experience from previous roles at AMN Healthcare, Synzi, and Stratus Video. He holds a Master of Arts (M.A.) in Theological Studies at Regent College. AMN Healthcare Language Services (AMN LS) is a healthcare language solutions provider that offers a range of services for patients with limited English proficiency, hearing impairments, or deafness. 

For millions of Americans with limited English proficiency (LEP), accessing healthcare can feel like trying to solve a puzzle with missing pieces.

Telehealth, once considered a temporary solution to the pandemic, is filling in those gaps, removing language barriers that have long hindered LEP patients from understanding their care. It is clearly here to stay.

The integration of medically trained language interpreters into many telehealth platforms has been making it easier for LEP patients and those who are deaf or hard of hearing to converse with healthcare providers in their preferred language, and ultimately, providing better quality care for patients. This access is essential for effective diagnosis, treatment, and follow-up, helping patients understand their health information.

In rural or underserved areas, where access to specialized healthcare is limited, telehealth becomes especially valuable. Finding qualified bilingual providers or medically qualified interpreters who speak specific languages in these regions is often challenging. Telehealth overcomes this obstacle by connecting LEP patients with language-appropriate care from professionals across the country. This not only reduces travel burdens but also minimizes misunderstandings that could lead to incorrect treatments, offering patients a reliable, culturally competent care experience.

Telehealth’s cost-effectiveness is another advantage. Telehealth consultations are generally more affordable than in-person visits, and the built-in interpretation services help lower access barriers for patients. For healthcare organizations, telehealth also presents a scalable, sustainable approach to language access, allowing them to provide high-quality care to diverse populations without the logistical challenges and costs of in-person interpretation.

However, telehealth still faces challenges in ensuring equitable language access. Some platforms lack sufficient language and accessibility features, creating frustrations for LEP patients. Additionally, some healthcare providers may try to “shortcut” interpretation by relying on family members or unqualified bilingual staff instead of trained medical interpreters. While this may seem practical in the moment, it’s not an adequate substitute for professional interpretation, can lead to misunderstandings that compromise care, and in most cases is considered a violation of the patient’s civil rights under the Affordable Care Act.

Integrating language services seamlessly into the telehealth workflow is also key. If language support isn’t user-friendly, it can create extra burdens for both patients and providers. Patients may struggle to navigate complex systems to request interpretation, while providers may face disruptions. Without careful integration, telehealth’s potential for LEP populations is limited by poor user experience.

To fully realize telehealth’s potential, care delivery platforms must prioritize accessibility and patient experience, designing features that provide equitable access to quality care. This means genuinely understanding the needs of LEP and deaf or hard-of-hearing patients and offering effective communication channels.

Telehealth is becoming a staple in healthcare and the focus is shifting toward making it a permanent, optimized part of healthcare delivery and integrating it with existing platforms such as EHR systems. Incorporating language interpretation services into these platforms could clearly streamline workflows for clinicians, making it easier to connect patients with the right resources with a click of a button.

Additionally, integrating language services into telehealth workflows could not only improve the patient experience and patient care but also improve clinician satisfaction by reducing administrative burdens, allowing them to focus on patient care rather than logistical issues. This streamlined process can lead to higher job satisfaction and potentially reduce burnout rates for physicians and nurses alike.

The future of telehealth lies not just in maintaining its accessibility but in reimagining how it can serve every patient, regardless of language or ability. The responsibility rests on healthcare providers and tech innovators to forge a path where language and hearing impairments are no longer obstacles to quality care. The real challenge now? Not simply to sustain telehealth, but to elevate it to a level where it is genuinely inclusive, fully intuitive, and universally transformative.

Perspectives: Virtual Nursing Optimism Grows, But Providers Remain in Early Stages

December 10, 2024 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s contribution is from Lisbeth Votruba, MSN, RN, CAVRN, the Chief Clinical Officer for AvaSure. She is a pioneering nurse executive committed to continuous improvement of healthcare and the diffusion of new technologies to drive patient and staff safety. Her Master of Science in Nursing is from Columbia University School of Nursing. In this article, Ms. Votruba reviews the state of virtual nursing in US health systems and how they can progress into a system-wide strategy for integrating virtual care into widespread clinical use. AvaSure is an intelligent virtual care platform that deploys AI-powered virtual sitting and virtual nursing solutions and is a trusted partner of 1,100+ hospitals with experience in over 5,000 deployments.

Looking at healthcare news headlines, one might think inpatient virtual care is ubiquitous and everyone else is saving millions of dollars through virtual nursing. Or one might get the impression the nursing shortage is over because AI is easing administrative strain. It turns out the truth lies somewhere in the middle. 

A new survey reveals that most health systems remain in the early stages of virtual nursing adoption in acute care settings. In 2024, just 10% of hospital leaders and 14% of IT leaders have reached the phase where virtual care is a standard part of care delivery. In both groups, 30% reported no virtual care.

Those were among the major takeaways from two recent surveys of 369 hospital clinical and information technology leaders on the topic of inpatient virtual care.

Over the last year and a half, hospital leaders grew more firmly committed to the concept of virtual nursing with those believing it will be an integral part of care delivery, growing from 66% to 74%. However, as of October 2024, one out of three respondents had yet to implement virtual care in any inpatient department.

Progressing through the early stages of virtual care
Based on survey results and firsthand observation, most providers are still in the early exploration phase, which is stage 2 of the 5-stage Inpatient Virtual Care Maturity Model (see graphic). The 5-stage process represents a blueprint for care model redesign led by change-management-oriented, outcome-focused leaders.

Few survey respondents have progressed to stage 3, strategic advancement, in which providers establish infrastructure and advance virtual care use for admission, discharge, education, mentoring, and rounding. None has advanced to stage 5, mature virtual care, which is characterized by full integration of virtual care with an emphasis on optimizing workflows, operational efficiency, and outcomes.

Key survey findings

Despite these slow steps toward inpatient virtual care maturity, the annual survey revealed that:

  • 74% of hospital leaders believe virtual care is or will become integral to care delivery models in acute inpatient care, up from 66% in last year’s survey.
  • Hospital leaders continue to prioritize virtual nursing, with an average ranking of 6.2 on a prioritization scale of 1 to 10. Among health IT leaders, the average ranking was 6.
  • 46% of hospital leaders are piloting or have implemented virtual care for inpatient acute care, up from 38% a year ago.

Virtual care use cases and metrics
Hospital leaders consider the top use cases for virtual care to be virtual sitting (39%), patient discharge (33%), admission documentation support (32%), high-acuity monitoring (18%), patient education (18%), and virtual consults (18%).

Survey respondents’ most frequently cited metrics to measure the success of virtual care programs include patient safety, patient experience, workload burden for staff, patient outcomes, patient flow, nurse retention, workforce costs, and nurse safety, satisfaction and retention.

The use of virtual care solutions to reduce burnout among nurses and other clinicians is consistent with the US Surgeon General’s advisory on building a thriving health workforce. Researchers estimate that annual burnout-related turnover costs are $9 billion for nurses.

The path to virtual care maturity requires not just investing in new technology; it also requires organizational alignment, solid change management processes, and buy-in at all levels of the organization. Adopting an intelligent platform that seamlessly blends remote and in-person care with AI-powered virtual sitting and virtual nursing could be a critical step towards accelerating virtual care maturity. However, making a significant difference requires more than just adopting technology; it also calls for establishing specific objectives and taking deliberate steps to build these initiatives.

About the survey:

The Virtual Care Insight Survey was conducted online within the U.S. by Joslin Insight on behalf of AvaSure between September 19 and October 7, 2024. The survey received responses from 340 healthcare professionals primarily working in acute care settings. At least 30% were nurse leaders or key decision-makers (collectively referred to as hospital leaders). This study’s sample data is accurate to within +5.3 percentage points using a 95% confidence level.

To complement the survey of hospital leaders, AvaSure gathered insights from 29 hospital IT leaders (mostly CIOs) regarding Inpatient Virtual Care Adoption.

The full survey report is available for download here: https://avasure.com/resource/2024-virtual-care-insight-survey-report/

Midweek news roundup: Optum exiting telehealth, laying off; Advocate Health selling MobileHelp; VA notifying 15M veterans re Change PHI breach, Oracle moving to Nashville–maybe? (updated)

May 1, 2024 | by

Optum Virtual Care closing, staff layoffs in progress. Optum Everycare CEO Jennifer Phalen on an 18 April internal conference call announced that the unit would close. According to sources, some employees would have layoff dates in July. No further details were available on other layoffs or plans for integrating Virtual Care’s capabilities into other Optum units, except for generalities. “We are com­mit­ted to pro­vid­ing pa­tients with a ro­bust net­work of providers for vir­tu­al ur­gent, pri­ma­ry and spe­cial­ty care op­tions,” and “We con­tin­u­al­ly re­view the ca­pa­bil­i­ties and ser­vices we of­fer to meet the grow­ing and evolv­ing needs of our busi­ness­es and the peo­ple we serve.” a spokesper­son for Unit­ed­Health said to End­points, a biopharma publication from the University of Kansas which broke the story.

For Optum, this is the second shoe drop about layoffs and closures in less than two weeks. Reports from social media and layoff-specific boards indicated that thousands were being laid off, from their plans to urgent care and providers [TTA 23 Apr]. These were not confirmed by Optum nor by UnitedHealth Group. It’s not known if this unit’s closure was included in the total. 

The larger picture is that it is symptomatic of the sudden growth, then equally sudden consolidation, of general telehealth. Optum opened the unit in April 2021 as the pandemic entered year 2. Utilizing existing capabilities, UHG claimed it facilitated more than 33 million telehealth visits in 2020, up from 1.2 million in 2019. The number looks sky high but in that time of practices closing it was a free-for-all in telehealth–and ‘facilitating’ is a nebulous catchword that could mean a practice using Facetime, telephones, or an EHR/population health platform module. Commercial claims for telehealth have remained at 4 to 5% since (FAIR Health, Jan 2024). Even during the pandemic’s first year, telehealth claims hit a peak of 13 percent in April 2020 that dropped fast to 6% by August 2020. Well over 60% are for behavioral telehealth claims.

A leading indicator: Last June, Optum Everycare’s CEO from their 2021 start, Kristi Henderson, a former Optum SVP for digital transformation, departed to become CEO of Confluent Health, a national network of occupational and physical therapy clinics. It was about as far away as one could get from telehealth, digital transformation, and Amazon Care, her former employer that expired in 2022.

Apparently, UHG and Optum see no further need for a virtual care specialty unit, instead integrating it into plans and other Optum services. According to MedCityNews, industry analysts aren’t surprised. Both Amwell and Teladoc have had well-known struggles. The latest: Walmart, after investing millions into their unit that included full clinics and a virtual care service, also made news on 30 April that it is closing both. Also greatly on UHG’s mind: cleanup after the Change debacle, making Mr. Market happy, and the looming antitrust action by DOJ. Becker’s, Healthcare IT News, 

In another sign that healthcare investors are selling off ancillary businesses, Advocate Health is selling PERS provider MobileHelp. It “no longer fit the strategic priorities of Advocate Health” according to their 22 April audit report (see document pages 10 and 13) and was authorized last December.

Advocate, through its investment arm Advocate Aurora Enterprises, acquired both MobileHelp, one of the earliest mobile PERS, and sister company Clear Arch Health, a remote patient monitoring provider, in April 2022. Cost was not disclosed at that time but later was reported to be $290.7 million. The plan at the time was to combine both MobileHelp and Clear Arch with a senior care/home health provider earlier acquired by Advocate for $187 million, Senior Helpers. That company was sold in March to Chicago-based private equity firm Waud Capital Partners for an undisclosed amount. The MobileHelp sale is expected to close later this year. Buyer and price are not disclosed. The expected loss on the MobileHelp sale was figured into FY 2023 as part of an asset impairment write-down of $150 million, which Advocate said was “related to the expected loss on the sale of MobileHelp.” The PERS and RPM business is a largely consolidated ‘cash cow’ type of business that (Editor’s prediction) will be snapped up by another player like Connect America, Alert One, or a smaller player like ModivCare. Milwaukee Business Journal, Becker’s, Crain’s Chicago Business (requires subscription)

VA admits that some veterans may be affected by Change Healthcare data breach, PII/PHI disclosure. While Department of Veterans Affairs Secretary Denis McDonough at this time believes that “there’s no confirmation yet” that veteran data was exposed, the scope of the Change Healthcare breach has led VA to formally alert via email 15 million veterans and their families of the possibility. The email also included information “about the two years of free credit monitoring and identity theft protection” that Change Healthcare is offering to those affected by the attack. The VA maintains that the attack resulted in only a temporary delay in filling 40,000 prescriptions but did not cause “any adverse impact on patient care or outcomes,” according to a department spokesman. NextGov/FCW 26 April, 23 April 

In related news, HHS as of 19 April had not received any notification from Change Healthcare nor UHG. They are required to file a breach report as providers and also as covered entities. They have 60 days from the breach occurrence on 21 February to report, which is coming right up. Becker’s

If Larry said it, it must be true…assemble the moving boxes. At an Oracle conference in Nashville last week, Oracle chairman Larry Ellison said to Bill Frist of investment firm Frist Cressey Ventures that he planned to move the company to that city as “It’s the center of the industry we’re most concerned about, which is the healthcare industry.” It’s their second public Larry and Billy meetup in the last few months, the last in November at the Frist Cressey Ventures Forum where Ellison had previously touted Nashville. Ellison is investing in and building a 70-acre, $1.35 billion campus on Nashville’s riverfront. Oracle is currently HQ’d in Austin, Texas having moved in 2020 from Redwood City, California but with extensive facilities remaining in the state. Texas and Tennessee have one thing in common–a superior business climate. Both are long on lifestyle, though Austin is not as temperate (read, hot) as Nashville. What Nashville has that Austin doesn’t is being a healthcare hub. At least in Ellison’s view, healthcare is where it’s at and so is Nashville. So as long as he’s running Oracle from his manse on Lanai, Oracle does what Larry says. Healthcare Dive, Healthcare IT News, The Tennessean

More fun facts about Larry Ellison and Nashville: David Ellison, his son, is founder of Skydance Media, a major Hollywood production company (Mission: Impossible and others) and negotiating a zillion-dollar merger with Paramount Pictures. David’s wife is a singer trying to make it in Music City and they have a home there. Kind of like the age-old trend of moving the HQ near where the CEO’s living. On moving the HQ to Nashville from Austin, this would affect perhaps 2,500 workers based there currently. Most of Oracle’s workers are dispersed and work remotely. 6,400 of former Cerner-ites are still in Missouri and 7,000 remain in California. Big hat tip to HIStalk—scroll down and see more about Larry and Billy’s talk, which also covered cybersecurity, the NHS (which uses Cerner), and automating hospitals and the hospital-payer interface.

Two studies: Telehealth underutilized, underbilled, even during pandemic–and accounted for only modest increases in costs, quality

April 24, 2024 | by

A newly published study in April’s Health Affairs Scholar points to telehealth’s surprisingly low reimbursable takeup among tradtional Medicare beneficiaries–even during the pandemic. This study evaluates E&M (evaluation and management) Current Procedural Terminology (CPT) billing against codes that were established during the pandemic to pay providers for telehealth (e-visits in the study), 99421-99423. It also broke down e-visits by different clinician types: primary care, medical specialties, surgical specialties, behavioral health, nurse practitioners, and physician assistants, and counted the most frequent diagnoses. E-visits constituted less than 0.1% of E&M services in the monitored period, 2020-22.

Key findings:

  • E-visit billing hit an absolute peak in April 2020 of 728 monthly encounters per 100,000 beneficiaries. It dropped off dramatically by summer 2020 and later stabilized to approximately 90 monthly encounters per 100,000 beneficiaries.
  • Only 0.8% of Medicare beneficiaries who received an E&M service were billed for at least one e-visit.
  • E-visits constituted 0.09%, 0.05%, and 0.05% of all E&M services in 2020, 2021, and 2022.
  • Primary care providers accounted for over 50% of the billing.
  • Approximately 30% were billed at the highest level of clinician time, requiring at least 21 minutes.
  • Hypertension was the most common diagnosis addressed in e-visits (21%), followed by diabetes (2.3%) and COVID-19 (2%).
  • Surprisingly, fewer beneficiaries receiving e-visits lived in rural areas.

HealthExec

Note to Readers: for those puzzled by the absence of mental health diagnoses, FAIR Health’s monthly telehealth tracker which during the pandemic showed Covid/respiratory diagnoses first, then mental health–and mental health as #1 in about 5% of claims since then –FAIR uses a different methodology. It tracks medical claims for private health plans only, not traditional Medicare, Medicare Advantage, or Medicaid. It also does a comparison on CPT 99213, comparing a specific procedure provided via telehealth to the same procedure provided in an office. 15 April methodology release

Editor’s Note, strictly anecdotal: As someone who worked as the sole marketer for a management services company with primary care ACOs during the period in early 2020 when HHS was turning out new codes nearly hourly to create telehealth flexibilities in Medicare, there was considerable confusion around codes and what they covered. Our teams, sourcing from HHS and the AMA, had our hands full to correctly specify and document the CPT codes established at that time. I know because I worked on said documentation that we condensed into a two-page fast guide and then into presentations. Many of the codes were telephonic. My conclusion about this study is that it was very narrow and tracked too few codes. Other factors: practices had difficulty using audio/video telehealth with their patient populations–if the practices had it, patients weren’t ready (tech barriers) or willing to use. Some of the practices reported that they didn’t bill for telehealth encounters during this confused time, trading off reimbursement for overall patient care and marking up quality metrics such as Annual Wellness Visits.

A second telehealth study, published this month in Health Affairs, looked at health systems to assess whether telehealth increased or decreased healthcare spending and usage by Medicare beneficiaries. The study defined by quartile health systems that had high telemedicine usage versus those with higher in-person usage, based on 2020 visits. Their conclusions tracked the changes between the 2019 baseline, 2020, and 2021-22. This study found only a modest increase after 2020 in visits and spend in the highest quartile of telemedicine usage for patient care.

  • In 2020, patients in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use.
  • Patients in the highest quartile had modest increases in office visits, care continuity, and medication adherence, as well as decreases in ED visits, relative to patients of health systems in the lowest quartile.
  • During 2021–22, relative to the lowest quartile, patients in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase)
  • That group also had a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease)
  • Per patient per year spending increased by $248 (1.6 percent relative increase)
  • They also had increased adherence for metformin and statins.
  • There were no clear differential changes in hospitalizations or receipt of preventive care.

The researchers contend their findings confirm that the flexibilities around telehealth instituted during the pandemic for Medicare beneficiaries should continue past their scheduled expiration at the end of 2024. The moderate spending increase is also confirmed by another study through 2021 by the Medicare Payment Advisory Commission found that geographic areas with higher telemedicine uptake had a spending increase of $165 per patient and a 3 percent relative increase in total clinical encounters. Healthcare Dive

ATA requests expediting of revised proposed rule on controlled substance telehealth prescribing; announces Nexus 2024 meeting 5-7 May

April 4, 2024 | by

ATA and 200 organizations request from DEA a revised proposed rule on controlled substance teleprescribing–stat. The American Telemedicine Association (ATA), in a 2 April letter (PDF link) with over 200 signatories, requests that the DEA quickly issue a revised proposed rule for industry comment.

Last October, the Drug Enforcement Administration (DEA) and Health and Human Services (HHS) extended for the second time pandemic flexibilities for prescribing controlled substances through 2024. The proposed rule issued in May had 38,000 comments, which overwhelmed DEA and HHS. The two agencies were unable to come up with a revised proposed rule by end of year and punted to 2024. The final rule is scheduled to be issued by this fall.

The 2 April letter advocates continuing many of the pandemic flexibilities due to care shortages and disruptions to patient care. If DEA were to create a special registration process for telehealth prescribers as many have proposed, transitioning and training would be needed to minimize disruptions in care to providers and patients in time for the new rule to take effect in 2025.

The controversy is around permitting and regulating the prescribing of controlled substances through telehealth. The pandemic rules suspended the Ryan-Haight Act restrictions that required in-person evaluations/visits prior to prescribing. Legally, that cannot continue. The extension of pandemic flexibilities permitted clinicians to prescribe Schedule II–V controlled medications via audio-video telemedicine encounters, including Schedule III–V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder. ATA release   HealthcareDive 4 April

ATA is also resuming an in-person spring conference, Nexus 2024, 5-7 May, at the Phoenix Convention Center in Arizona. It will have 300 speakers on 30+ topics. The meeting is being pitched to primarily care delivery and provider organizations. An overview of the conference is in the ATA release. More content information here (PDF link). Online registration (attendee and exhibitor) or email AmericanTelemedicine@​xpressreg.net

News roundup #2: Bright.md sells remaining customers to 98point6; Netsmart EHR up for $5B possible sale; Caregility intros two new telehealth systems

January 19, 2024 | by

More from JP Morgan’s Healthcare Conference (JPM), CES, and after:

Bright.md’s remaining assets sold to 98point6. Now stay with your Editor as we sort through this. Bright.md was sold, we thought, to Cigna’s Evernorth MDLIVE telehealth unit last October, announcing at HLTH that MDLIVE would add Bright.md’s asynchronous telehealth technology to their platform. Evidently, Bright.md had other assets not included in that sale, namely the right to service 17 asynchronous telehealth provider customers such as Baptist Health and UAB Medicine. Those customers have been purchased by 98point6, a company that last year transitioned out of direct care into being a licensor of real-time and asynchronous telehealth, plus other software for clinical decision support and EMR integration.

98point6 pivoted last March by selling their physician group, self-insured employer business, and an irrevocable software license to Transcarent, in a deal worth potentially $100 million. What they bought from Bright.md can only be interpreted as those 17 customers were not obliged to go with MDLIVE in that earlier transaction. Those 17 customers now will license 98point6’s asynchronous telehealth. 98point6’s purchase price is 45% in cash and 55% in equity. 98point6 is also taking on six former Bright.md staff in commercial and sales. Another small puzzle is that the Bright.md website remains unchanged with last entries in July 2023 and no mention of MDLIVE. The company’s most recent LinkedIn posts also end in July 2023, yet a sample of the executive staff indicates that they remain employed at Bright.md. Axios, 98point6 release

Netsmart Technologies exploring $5 billion sale. The company is reportedly exploring a sale of its EHR and related software business via Goldman Sachs and William Blair in the coming weeks which could fetch up to $5 billion. The EHR has an estimated 754,000 users at community health centers, behavioral health centers, hospice care, and non-profits. This year’s EBITDA is estimated to be about $250 million. 

The current owners, GI Partners and TA Associates, bought it between 2016 and 2018, but its roots go back to 1992 (with an acquired company back to 1968). It went public in 1996, moved private in 2006, then went through various private equity owners including Allscripts, moving from NYC to Great River, Long Island and presently to Overland Park, Kansas. If the sale, likely to another group of PE investors, is successful, it would demonstrate signs of life in the dead healthcare M&A market.  Reuters   Axios’ sources estimate closer to a $4 billion sale

Another during CES announcement came from Caregility, which announced two new point of care telehealth edge devices. The APS200 Duo is the company’s first dual-camera, all-in-one system with onboard edge computing and a dedicated graphics engine. The new APS100 Pro is a second generation model of their all-in-one system with a wide-angle camera for remote patient observation. This can be upgraded with the APS FlexCam, an external high-definition 40x power zoom video camera for virtual nursing programs and remote patient examinations. The devices connect to the Caregility Cloud virtual care platform with multiple audio and video streams for clinical and care applications supporting workflows in acute and ambulatory settings. Release. Caregility also contributed a Perspectives on virtual nursing and telehealth in November.

News roundup: Apple Watch flagships cease sale due to Masimo ITC ruling (updated); Noom, WW enter GLP-1 telehealth business; Oracle sees health side up despite Cerner drag; Cigna has multiple bidders for MA business

December 21, 2023 | by

Apple Watch Series 9 and Ultra 2 going off sale in the US this week, upholding the ITC patent ruling favoring medical device developer Masimo. On 26 October, the International Trade Commission (ITC) ruled that Apple in the Series 6 and later violated Masimo’s patents on pulse oximetry (SpO2) sensors and software. [TTA 27 Oct] While this is awaiting presidential approval in the 60-day review period which ends on Christmas Day, Apple proactively restricted US sales of its flagship Series 9 and Ultra 2 watches which contain the blood oxygen sensors. (The SE model does not and continues to be available for direct sale.) According to 9to5Mac, online sales end on 3 pm Eastern Time on Thursday 21 December, while in-Apple Store sales stop after Christmas Eve. Of course, this won’t stop resales of existing stock through outlets like Amazon, Best Buy, and eBay. Under the ITC order, Apple cannot import either model after 25 December as the ITC issued a Limited Exclusion Order (LEO) plus a Cease and Desist Order (CDO). 

The ITC is rarely vetoed by the White House in patent actions. After that point, Apple is free to appeal in Federal District Court, which is highly likely and where the deepest pockets usually win. Also HIStalk 20 Dec and Strata-gee 21 Dec

There are other wrinkles with Masimo, though. Strata-gee.com earlier this month (13 Dec) timelines Masimo’s patent difficulties with the US Patent and Trademark Office’s Patent Trial and Appeal Board (PTAB) ruling against the very same patents, decisions upheld by the Federal Circuit Court. The PTAB also ruled against Masimo in the requested review of two Apple patents. Apple’s retaliation is to threaten lawsuits on Masimo’s new smartwatches. The icing on this messy cake is the November Delaware Chancery Court decision against Masimo, awarding $17.8 million in legal fees to activist investors/shareholders Politan Capital Management and Politan Capital NY LLC in a board fight that culminated in two seats to Politan directors.  One can sense that Apple is biding its time, though they could end all of this by negotiating a royalty to Masimo. Updated: see report on the stay effective 27 December here.

Noom and WW enter the weight loss drug-by-telehealth race. Ozempic and Wegovy, GLP-1 agonists, are increasingly popular in off-label use for obesity to produce weight loss, prescribed and managed by telehealth teams.

  • Noom, previously stressing behavioral change via app coaching direct-to-consumer, in October announced at HLTH Noom Med, a drug-focused program prescribing medications such as Saxenda (liraglutide), Wegovy (semaglutide), and the new Zepbound (tirzepatide), a dual GLP-1/G1P, all of which are injectable medications along with other GLP-1 medications such as Ozempic.
  • WW or WeightWatchers last week announced the WeightWatchers Clinic program. Via their recently acquired telehealth weight loss platform Sequence, it will offer weight loss meds and team management.  

They join Teladoc in developing weight loss programs, though Teladoc supports a physician-based care product for employers [TTA 21 April]. Both Noom and WW emphasize that member patients must qualify for the programs based on weight, BMI, and medical condition. Participants are educated through materials, coaching on behavioral management, managing appetite, and nutrition, especially in maintaining adequate protein as these medications not only induce weight loss, but also muscle loss (sarcopenia). One hopes that their teams are also knowledgeable on how these medications that slow down digestion to induce a feeling of fullness don’t mix well with surgical sedation, and that they issue cautions to patients before elective surgery. MedCityNews, FierceHealthcare, Forbes   

Noom has also replaced most of its top management since its new CEO joined in July. There’s a new CFO, chief technology officer (CTO), general counsel, two senior VPs (corporate development and partnerships, healthcare sales and services) a senior director of brand and communications, chief growth officer, chief product officer, and head of people. FierceHealthcare

Oracle Q2 results miss forecasts in rebuilding Cerner. Oracle Health, including the former Cerner, and slowing cloud growth were the culprits in their fiscal Q2 2024. Total revenue was $12.9 billion, up 5% in US dollars (4% in constant currency). Analysts expected $13.05 billion. Excluding Cerner, growth would have been 6% though Oracle did not separately break out revenue for the Cerner EHR business. Investors have noted two consecutive quarters of off-track growth and a weaker forecast for the remainder of the year. According to CEO Safra Catz and chairman Larry Ellison on the earning call, many upgrades and “modernizations” are being made to Cerner Millenium that will wrap up this FY. Half of Millenium customers will be moving over to Oracle Cloud Infrastructure (OCI) by February. They are also “rewriting” Cerner’s health and data intelligence platform, Cerner HealtheIntent, to get into population-scaled health management. ‘Transforming healthcare’ is an expensive proposition indeed. No word on the VA.  FierceHealthcare, Oracle release

And a quick follow up on Cigna’s sale of their Medicare Advantage business. Two payers so far–Health Care Service Corp. (HCSC) and Elevance–are reported to be bidding for Cigna’s MA business. The value of the business is estimated to be about $3 billion and with just under 600,000 members as of September. Both HCSC and Elevance are much larger players in MA. HCSC has over 1 million MA members in Blue Cross Blue Shield affiliates in Illinois, Texas, New Mexico, Oklahoma, and Montana. Elevance, the former Anthem, has over 2 million MA members. Bidding is expected to close this week. While MA is losing money for Cigna, they could refuse to sell if bids are unsatisfactory. FierceHealthcare, Becker’s

Walgreens’ transformation continues: new CEO enters, CIO exits, launches Virtual Healthcare in 9 states

October 11, 2023 | by | 2 Comments

This week of HLTH has not been short of Big News from WBA, perhaps cleverly to ace out CVS, Amazon (facing retail monopoly charges from the FTC and 17 states), and Walmart. Regaining the lost momentum at Walgreens Boots Alliance will be a heavy lift.

Enter Tim Wentworth as CEO from retirement. Mr. Wentworth formerly helmed Express Scripts, coming on after that company’s acquisition of pharmacy benefits manager Medco. When Express Scripts was acquired by Cigna in 2018, he headed their health services area, now Evernorth, retiring from there at the end of 2021. He is exactly what executive chair Stefano Pessina (and the board) ordered–a younger executive (63) with CEO experience, energy, through-the-ranks background, and deep, deep experience in pharmacy management, payers, and healthcare. To CNBC on Tuesday, Mr. Wentworth said, “What made me decide to come back was a chance to lead this iconic brand and company at a time when it’s not in a steady state. It’s a massive platform…they touch almost 10 million people a day.” Plus undoubtedly an offer hard to refuse! He starts on 23 October. Walgreens replaced Roz Brewer, who departed 31 August [TTA 19 Sep], in record time. Her interim replacement, former pharma exec Ginger Graham, returns to her lead independent director spot on the WBA board. WBA release, 

Walgreens recently missed earnings estimates for its Q3 ending in May [TTA 28 June] with underperformance problems in retail consumer sales and urgent care CityMD. They have been selling peripheral businesses and investments, with plans to lay off 10% (500) of its workforce. It doesn’t help the bottom line that Walgreens last month settled a class action lawsuit about its long-ago Theranos clinics in Arizona for a tidy $44 million.

There’s trouble from the streets to the suites right now. Pharmacy workers walked out on 300 Walgreens locations this past Monday through Wednesday. Their big issues are short-staffing and overwork. Demands are, according to an organizer talking to the AP: to improve transparency about shifting hours and schedules; to set aside training hours for new team members; and to adjust tasks and expectations at each location based on staffing levels. They are also organizing for union representation. Walgreens isn’t alone in this–CVS has also faced pharmacy worker walkouts. Fortune  At the executive level, chief information officer Hsiao Wang left suddenly on 2 October after one year after a recent leave of absence. His departure was confirmed by Walgreens to industry publication PYMNTS. Neal Sample, a consultant and former CIO at Northwestern Mutual with experience at Express Scripts, will be stepping in on an interim basis. Retail Dive. This follows on Walgreens’ chief financial officer James Kehoe July departure after five years to join financial services firm FIS in August. Mr. Wentworth’s HR experience will come in handy on these issues.

On a positive note, WBA announced Monday at HLTH that its Walgreens Virtual Healthcare will start up in nine states later this month. Via their website, Virtual Healthcare will provide on-demand consults with providers on common medical conditions and for prescriptions. It will be available in California, Florida, Georgia, Illinois, Michigan, Nevada, North Carolina, Ohio, and Texas, which represent almost half of the US population as well as Walgreens’ pharmacy customer base. It will be primarily clinician chat-based, with synchronous video visits for select conditions. Conditions treated include seasonal allergies, COVID-19 or flu, erectile dysfunction, hair loss, birth control, and other common health needs. Cash only–$33 for chat with video visits $36 to $75, which puts it in line with Amazon Clinic’s cash charge of $35 and $75 respectively. Insurance may come in the future. WBA has had telehealth through VillageMD locations and has actually had tele-dermatology service since 2016. Walgreens’ move, though, is a little tardy given Amazon Clinic’s national rollout after privacy issues delayed it on 1 August [TTA 1 Aug] and CVS’ Virtual Primary Care nationally with Amwell a year ago [TTA 12 Aug 22]. Healthcare Dive

Two studies: telehealth’s ‘generation gap’ and $22B target for healthcare generative AI–by 2032

October 11, 2023 | by

J.D. Power notices that older users aren’t all that comfortable with telehealth. On a 1,000 point scale, pre-boomers (!) and Boomers, score a 671 while Gen Y and Gen Z score 714 for an average of 698. Those surveyed liked telehealth for convenience (28%) and receiving care quickly (17%). 

Issues for the older group are trust, digital channels, and appointment scheduling. The latter two are, in this Editor’s view, interface related, with many telehealth providers neglecting mobile and tablet-friendly platforms, making typefaces large enough, and backgrounds contrasty enough.

CVS leads in satisfaction, surprisingly, in direct to consumer telehealth providers (744), with MDLIVE (Evernorth/Cigna) coming in at 741 and Amwell 739. CVS’ telehealth is provided by Amwell. Where telehealth is provided by a health plan, the numbers were extremely close. UnitedHealthcare scored the best (702), with Kaiser Foundation Health Plan immediately behind at 701 and Humana at 695. UnitedHealthcare uses Included Health’s Doctor on Demand, Teladoc for Kaiser. The June-July survey included over 5,400 telehealth users within the last 12 months. Healthcare Finance, J.D. Power study page (subscription required for report).

Generative AI for healthcare projected to be a $22 billion business by 2032 from $1 billion today. Generative AI is defined as AI that produces text, images, and other media, based on text, audio, and image data supplied to it. The PYMNTS and AI-ID “Generative AI Tracker” points to current uses in complex drug discovery acceleration and medical researcher capabilities. To realize its potential in other healthcare areas, tech companies must team up with payers, providers, and others to train large language models on healthcare-specific data and establish robust benchmarks. The PYMNTS study is available for download here. Healthcare IT News