• February 9, 2023

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

By Sebastian Seiguer, CEO of Emocha health

If a patient wants to see a doctor in a different condition, it is perfectly acceptable to drive to that doctor to make an appointment. And yet, if a patient wants to have a telemedicine visit or a call to the same doctor from home, the doctor must have a license in the patient’s state. This is consumer protection at its finest. These restrictions were eased during the pandemic, and I haven’t read a single report on how a remote consultation across state lines harmed a patient.

Telehealth technologies are by no means new, so it really is a shame that it took a one-time pandemic to drive regulatory changes. Telemedicine offers a much-needed alternative to face-to-face visits. With full legislative adoption and reform, these important visits will become more accessible and convenient for patients. However, this does not necessarily mean that patient outcomes will improve, as these visits remain infrequent for the most part.

Telehealth is just a starting point. To support patients with chronic and contagious diseases, health care must be provided between doctor visits. This is where revolutionary digital health technologies and services can impact the most critical health care problems.

Digital platforms enable patients to take an active role in their own care and allow them to communicate easily and frequently with a healthcare provider in short and convenient interactions. The frequency, speed, and convenience of these interactions are critical for patients dealing with chronic diseases (six out of ten Americans). These technologies are often asynchronous – that is, not live – with patients using text messages, video recordings, or reports from connected wearables.

If you think telehealth regulations are absurd, the regulatory confusion surrounding digital health technologies is tragic. With the exception of a few limited scenarios (heart failure, transplant, and certain surgeries), healthcare systems have little incentive to help patients between visits to the doctor. CMS has created various reimbursement codes for remote patient monitoring, but the cost and complexity of complying with these restrictions discourage providers. Health insurers are rightly skeptical of the codes that reimburse pure functions (such as SMS) without linking the functionality to a patient result. Each state defines telemedicine and remote patient monitoring differently. Sometimes these different approaches are addressed in a single regulation, but most states simply do not allow asynchronous technologies.

We know that one of the most ubiquitous and urgent challenges facing our healthcare system is drug non-compliance, with data only hinting at this 50% of the patients for chronic illnesses, take your medication as directed. Patients with chronic conditions such as asthma, diabetes, and cardiovascular disease typically have a higher rate of hospitalizations and visits to the emergency room due to non-compliance. Poor adherence to long-term therapies remains the main modifiable factor limiting effective management of chronic diseases. With digital adherence programs such as Emocha, we can not only measure dose-wise adherence precisely, but also help to avoid additional costs associated with increased use of health services.

Regulators need to step aside and let consumer demand drive healthcare innovation. Value-based models need to be accelerated and penetrated so that health insurers and providers choose platforms that reduce care costs and improve patient outcomes.

Increasing consumer demand for a variety of care modalities, including asynchronous video appointments, is the healthcare industry’s next frontier. The pandemic has sparked vendors’ interest in remote engagement technologies, especially those that play an otherwise unaddressed role in virtual health processes. It is clear that after trying telemedicine over the past year, patients will no longer accept outdated technological approaches in health care.

The 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 shortage of more than 220,000 doctors is expected by 2030. While this isn’t a cause for concern if you are aging gracefully in Boston (440 doctors per 100,000), it is bad news if you live in the Mississippi countryside (190 doctors per 100,000).

Straight 14% of Americans had tried telemedicine last winter before the COVID-19 pandemic broke out. Six months later, that number was up 57%. There were more than nine million Medicare beneficiaries. We now have more than enough technology for a telemedicine visit, but at the same time we are working under the terms of a massive bureaucratic machine. To use technology effectively to improve health, it needs to be addressed – and quickly.

The protection of access to the Post-COVID-19 Telemedicine Act of 2021 is inadequate. Some preliminary, sensible steps are suggested to ensure Medicare keeps pace with changing health care dynamics. The law would lift most of the geographic and original location restrictions and allow patients to access telemedicine from home, for example. And CMS could continue reimbursing telehealth services – but only for ninety days after the public health emergency ended. However, the law doesn’t regulate the onerous interstate licensing that prevents patients from seeing providers who are not in their home state.

With our current regulations and reimbursement structures, digital health technologies must continue to navigate a chaotic and complex web of government regulations with 50 different approaches and definitions of telehealth. A more comprehensive invoice is needed to address these and other issues (e.g. payment parity). While extending the telemedicine code for fee models is optimal, value-based models will create an innovative deployment when providers use platforms that actually help patients improve their health rather than implement activities that are reimbursed by health plans.

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

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