Regulatory Burdens: How to Let Consumer Demand Drive Innovation of Healthcare Delivery

Doctor using laptop with a stethoscope at their side
Credit: Elnur -

By Sebastian Seiguer, CEO of emocha Health

If a patient wants to see a physician in another state, it is perfectly acceptable to drive to that physician for an appointment. And yet if a patient wants to have a telehealth visit or phone call with that same physician from their home, the physician must have a license in the patient’s state. This is consumer protectionism at its finest. These restrictions have been eased during the pandemic, and I have not read a single account of how a remote consultation across state lines harmed a patient.

Telehealth technologies are by no means new, and therefore it is truly a shame that it took a once-in-a-lifetime pandemic to drive regulatory change. Telehealth provides a much-needed alternative to in-person visits. With broad adoption and regulatory reform, these important visits will become more accessible and more convenient for patients. However, this does not necessarily mean that patient outcomes will improve, given that for the most part, these visits will remain infrequent.

Telehealth is a mere starting point. To support patients with chronic and infectious diseases, healthcare must be addressed in-between physician visits. This is where revolutionary digital health technologies and services can impact healthcare’s most critical problems.

Digital platforms empower patients to take an active role in their own care, and allow them to easily and frequently communicate with a healthcare provider in short, convenient interactions. The frequency, speed, and convenience of these interactions is crucial for patients dealing with chronic diseases (six in ten Americans). These technologies are often asynchronous -- meaning non-live -- with patients using text messaging, video recordings, or reports from connected wearables.

If you believe the telehealth regulations to be absurd, the regulatory confusion for digital health technologies is tragic. Except for a few limited scenarios (congestive heart failure, transplant, and certain surgeries), health systems have little incentive to help patients in between physician visits. CMS has created various reimbursement codes for remotely monitoring patients, but the cost and complexity of complying with these restrictions scares away providers. Health insurers are meanwhile skeptical -- and rightfully so -- of codes that reimburse pure functions (such as texting) without associating the functionality with a patient outcome. Each state defines telehealth and remote patient monitoring differently; sometimes these different approaches are treated in a single regulation, but in most states, asynchronous technologies are simply not allowed.

We know that one of the most ubiquitous and pressing challenges facing our healthcare system is medication non-adherence, with data indicating that only 50% of patients with chronic illnesses take their medications as prescribed. Patients with chronic conditions including asthma, diabetes, and cardiovascular disease typically have higher rates of hospitalizations and emergency department visits due to non-adherence. Poor adherence to long-term therapies remains the most significant modifiable factor limiting effective chronic disease management. With digital adherence programs like emocha, we can not only accurately measure dose-by-dose adherence, but also help prevent excess costs associated with increased utilization of healthcare services.

Regulators must step aside and let consumer demand drive innovation of healthcare delivery. Value-based models need to accelerate and permeate so that health insurers and providers choose platforms that reduce the cost of care and improve patient outcomes.

The increasing consumer demand for multiple modalities of care, including asynchronous video appointments, represents the true next frontier of healthcare. The pandemic has piqued providers’ interest in remote engagement technologies, particularly those that fill an otherwise unaddressed role in virtual healthcare processes. It’s clear that patients will no longer accept antiquated technology approaches in health after having tried telehealth over the last year.

Pre-pandemic regulatory restrictions will resume when the public health emergency is over: particularly for Medicare, which is a major problem. The population is aging, and a physician shortage of more than 220,000 physicians is expected by 2030. While this may not be cause for concern if you are aging gracefully in Boston (440 physicians per 100,000), it is bad news if you live in rural Mississippi (190 physicians per 100,000).

Just 14% of Americans had tried telehealth last winter, before the onset of the COVID-19 pandemic. Six months later, that number had increased by 57%. Among those were more than nine million Medicare beneficiaries. We now have more than adequate technology for a telehealth visit, but we are simultaneously operating under the constraints of a massive bureaucratic machine. In order to effectively use technology to improve health, this must be remedied -- and fast.

The Protecting Access to Post-COVID-19 Telehealth Act of 2021 is inadequate. Proposed are a few preliminary, common-sense steps to ensure Medicare keeps pace with the changing dynamics of healthcare. The law would scrap most geographic and originating site restrictions, enabling patients to access telehealth from -- for example -- their own homes. And CMS would be able to continue reimbursement for telehealth services - but only for ninety days after the end of the public health emergency. Yet the law does not address burdensome interstate licensing that prevents patients from seeing providers not in their home state.

With our current regulations and reimbursement structures, digital health technologies will still need to navigate a messy and complex web of state regulations with 50 different approaches and definitions of telehealth. A more comprehensive bill is needed to address these and other issues (payment parity, for example). Moreover, while telehealth code expansion is optimal for fee-for-service models, value-based models will create innovative delivery when providers use platforms that actually help patients improve their health as opposed to implementing activities that health plans reimburse.

The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of Nasdaq, Inc.

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