Telehealth: The Pandemic Opened the Door Will it Stay Open?

Access to healthcare has been a hot button issue throughout the pandemic. Many have been concerned that it is inordinately difficult for people – especially the vulnerable – to access healthcare during a period when traditional medical services have become limited. Necessity can drive innovation in America, and one silver lining of the COVID-19 crisis has been that states were forced to make it easier for people to access healthcare. Telehealth, or the provision of medical services using remote technology, is an example of how technology was ready but the state governments that regulate healthcare were not, until the pandemic forced their hand.

In 2020, many states eased up the regulations that prevented widespread use of telehealth before the pandemic. This deregulation not only made it easier for people with access to the technology to make use of it, it also meant that precious medical resources were reserved for those who needed in-person care or could not access telehealth, which includes some members of our most challenged communities.

The question is: now that the door has been opened, increasing healthcare access while keeping medical personnel and patients safer, will that door stay open? In a handful of states, the answer is now “yes.” But it took the hard work of state-based nonprofit organizations to make that “yes” possible. In other words, philanthropy played a key role in responding to the COVID-19 crisis.

I had a chance to ask Pioneer Institute’s Senior Fellow of Health Policy Josh Archambault, President of the Libertas Institute Connor Boyack, and Senior Vice President of Policy at the Mississippi Center for Public Policy Jameson Taylor about how they worked to help ensure telehealth is part of our future, and not just a temporary response to the current public health crisis.

Question: What impact did telehealth make in your state in terms of access to healthcare during the pandemic?

Josh Archambault (Massachusetts): Massachusetts is the home to some of the most well-known medical institutions in the country that historically have had large and expensive real estate footprints that result in very expensive care. Yet the Bay State is also home to some of the leaders in telehealth.

The pandemic served as a wake-up call to our health system that telehealth is an important tool in the toolbox to deliver more patient-centered care. The practices in Massachusetts, like direct primary care providers, that had telehealth set up before the pandemic were able to serve patients well even at the height of the pandemic, while the rest of the medical system struggled to find its footing. We believe telehealth will change patient expectations in the state for the options that health systems offer, for all ages. Even Massachusetts seniors adapted quickly as the state had the highest rate of telehealth visits in the nation for Medicare fee-for-service. 

Connor Boyack (Utah): During the pandemic, Utah expanded access to telehealth service to allow more providers to use the technology, expand the modalities and the places in which telehealth can be used and improve health plan reimbursement. Additionally, Utah allowed healthcare providers in the state to use telemedicine and mHealth technology that doesn’t meet privacy and security standards set by the federal Health Insurance Portability and Accountability Act (HIPAA) or the federal Health Information Technology for Economic and Clinical Health (HITECH) Act, as long as the providers takes “reasonable care” to protect the patient’s privacy and the patient has the opportunity to decline the service.

Jameson Taylor (Mississippi): Mississippi was already suffering from healthcare access problems prior to COVID. We are a very rural state and, in some areas, it’s a challenge even to drive to a healthcare provider, even if one exists in your county. COVID, of course, exacerbated these problems, in particular putting pressure on hospitals’ ICU capacity. COVID also discouraged patients with ongoing health problems, such as diabetes, from getting care. With this in mind, our Board of Medical Licensure temporarily waived restrictions that prevented out-of-state doctors from using telemedicine to treat patients in Mississippi. In particular, they allowed physicians without a Mississippi license to practice here via telemedicine. This policy ended up being very popular with patients. So popular, in fact, that Mississippi doctors pushed back against it out of fear of losing in-state business. In addition, our Division of Medicaid loosened its restrictions on telemedicine. These changes are still in effect.

Question: Recently your state legislature took steps to ensure access to telehealth would continue. What was your organization’s role in making this possible?

Josh Archambault (Massachusetts): Pioneer worked alongside the governor’s office during the pandemic to open the door to more telehealth flexibility. With each week and with encouragement, more providers were allowed to use telehealth and some across-state line care was allowed for the first time. Importantly, during the most recent legislative debate Pioneer was one of the only groups pushing to open up telehealth but without mandates and artificially high rates. We also pushed to pair this expansion with greater scope of practice flexibility. The legislature passed a bill that followed many of the recommendations that Pioneer has been laying out in our work over the last five years and now allows nurse practitioners to practice independently including using telehealth.

Connor Boyack (Utah): We supported a state senator’s bill that would increase access to telehealth services to aid in the treatment of mental health issues. During the pandemic, the psychological toll it took on Americans, writ large, was noticeable, especially in Utah. This was a step toward ensuring that people in Utah could get access to critical services they need when they need it without having to worry about their ability to access such services.

Jameson Taylor (Mississippi): We had two primary bills moving through our 2021 legislative session. The first bill would have codified the ability of physicians without a Mississippi license to use telemedicine to treat Mississippi-based patients. This bill died early on. A second bill passed both chambers, but then died in conference at the last minute. This bill would have updated our law to allow for things like audio-only telemedicine. Our session has very tight deadlines, so it’s not unusual for a bill to take two years to pass. The good news here is that lawmakers agree we need to open up our telemedicine laws to increase options for patients. This basic consensus fostered a lot of very frank discussions about how to exactly do that. For instance, if we allow audio-only telemedicine, could someone then get access to medical marijuana simply by making a phone call? Or, how do we make sure telemedicine is saving money for our Medicaid program? I believe we will have a bill pass next year. This delay is just part of the normal process.

Question: What’s your organization’s next priority for improving access to health care in your state?

Josh Archambault (Massachusetts): Pioneer is focused on allowing across-state line telehealth in the long term, building on and improving our robust price transparency law and ensuring that Massachusetts remains a leader in life sciences and drug development. This work entails both proactive research and advocacy but also working to defeat ill-informed policy proposals that will drive up costs and/or reduce competition and access to medically necessary services.

Conor Boyack (Utah): Our next priority for improving access to health care in our state is to consider the creation of dental therapists in Utah to increase affordable access to dental care. We will also explore the option of pursuing legislation that would create remote-site pharmacies to increase access to pharmacy services in rural areas, similar to legislation that has emerged in Florida. 

Jameson Taylor (Mississippi): Of course, I will continue to be working to expand healthcare access via telemedicine. The primary issue we need to work through is how to increase the supply of healthcare services without also allowing these services to be captured by the insurance-provider continuum that leads to ever-increasing healthcare prices. For instance, telemedicine providers want to charge the same fee being charged for an in-person visit. Likewise, nurse practitioners, if they should receive full practice authority, want to charge a price that is equivalent to that charged by a physician. From my perspective, I want to increase the supply of healthcare so that access can go up and prices can go down. This is a very tricky maneuver in the current healthcare market. In addition, Mississippi is one of the last remaining states that have not expanded Medicaid. My top priority is to make sure we don’t expand, in part, because I believe expanding Medicaid will lead to worse healthcare outcomes and reduced access to healthcare.

There have been positive gains in other states, such as Ohio, and we hope to see more parts of the country move in the same direction. It would be good for those who oversee how our healthcare system works to make more options available and to leverage the technology at hand to improve access for all.

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