Throughout the COVID-19 pandemic, insurers, providers and consumers turned to telehealth to temporarily replace in-person health consultations. Governors in all 50 U.S. states waived state telehealth licensure restrictions to allow cross-state care, ensuring access and continuity of care. What started as a goal to facilitate access to care during the public health emergency turned into the telehealth boom. Even now, 20 months after the first stay-at-home order, telehealth usage has stabilized at a frequency 38 times higher than pre-pandemic times. Patients turn to telehealth for various reasons: to access specialists unavailable in their home state, to ensure care in rural areas, and to remove the burden of traveling (weather cost, time, or exposure risk)—additionally, virtual care supplies provider choice during the current healthcare workforce shortage. Telehealth provides better healthcare UX in these examples. Now, to better address accessibility in the wake of expiring licensure flexibilities, many health systems are looking at ways to make telehealth cross-state care a permanent fixture of healthcare.

Telehealth Improves Access To Care

With over half of U.S. states’ licensure flexibilities expired, providers and governing agencies are discussing the impact of cross-state care and the looming telehealth cliff. There are two primary considerations in reinstating telehealth licensure restrictions. The first is how people will access care. From its inception, telehealth started to provide care to rural and underserved communities and has reduced several access barriers, such as transportation, time and cost. Telehealth makes for a better healthcare UX in these communities. Telehealth also expands access to subspecialty care, which can be geographically sparse. Individuals in states with expired telehealth licensure have taken to driving just over the state border to a neighboring state with existing waivers in place. This has resulted in a new phenomenon: the ‘rest stop televisit.’ Those who live close enough to their state border drive across state lines to make the call from their vehicle.

Telehealth Helps Continuity Of Care

Another consideration is interrupting the continuity of care. Dr. Brian Hassenfeld, the Medical Director of Digital Health and Telemedicine at Johns Hopkins, disclosed that around 10% of its one million telehealth visits had been out-of-state patients since the beginning of the pandemic. Impending licensing expirations threaten hundreds of thousands of existing patient-physician relationships. Acutely impacted are those with rare or difficult conditions who coordinate care across state lines with specialist providers in those fields. Disrupting cross-state care leaves patients potentially unmoored, particularly with mental health conditions. The COVID-19 pandemic reckoned mental health care critical to many. It interrupted established, trusted care which can be damaging to patients who cannot find clinicians accepting new patients or who are reluctant to seek out new therapists. Roy Huggins, a counselor and founder of Person Centered Tech, recognized how detrimental this might be, saying: “Needing to switch a therapist is unhelpful at best, or harmful at worst.”

In late October, the American Telemedicine Association urged the Biden administration to extend the COVID-19 public health emergency through the end of 2022, protecting telehealth coverage for Medicare beneficiaries. This recommendation followed the Centers for Medicare & Medicaid Services proposal in August, which urged the extension of telehealth coverage. The latest plea came from over 230 organizations, including Duke University Health System, Mass General Brigham, Memorial Sloan Kettering, and NYU Langone Health, led by the Alliance for Connected Care, ALS Association and National Organization for Rare Disorders. The open letter to state governors asked for the preservation and expansion of state medical licensure flexibilities for telehealth, at least until the public health emergency ends. Currently, with no federal guidance, an amalgamation of strategies has occurred. Alabama, Arkansas, Delaware and New York have maintained licensure flexibilities through emergency declarations. Connecticut will continue to acknowledge out-of-state licenses for two years for telemedicine, and Arizona will do so in perpetuity. Some states have developed partnership strategies: Arizona and Florida allow out-of-state providers to register with the state to practice telemedicine in the state, per state law. West Virginia passed a bill to allow health care practitioners licensed and in good standing in another jurisdiction to pay a fee to become registered with the appropriate medical board, allowing interstate telehealth practice.

Irrespective of impending legislation, telehealth has become a crucial resource for healthcare consumers, with increased usage and satisfaction. Patients like the improved healthcare UX of telehealth. Corporate Insight’s Health Plan Monitor survey data, gathered in June 2021, show that 93% of survey respondents were aware of telehealth, and 60% had attended at least one virtual visit over the last 12 months. This usage data is accompanied by high satisfaction, with 76% of respondents reporting they were “very satisfied” or “extremely satisfied” with their most recent telehealth visit.

Corporate Insight continues to closely monitor the digital experience across leading healthcare organizations. Within our Health Plan Monitor, we see firms promoting and encouraging digital tools to improve the health and wellness of members—including telehealth. Look to our blog for further insights on the nation’s leading healthcare firms.

Alexandra Bolshakov
All Author Posts