Connected Nation

Unlocking telehealth potential: State policy spotlight

• Jessica Denson • Season 5 • Episode 10

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A recently released report examines how states are approaching reforms to telehealth laws – from allowing access to specialists across borders to creating more flexibility for innovation.
 
On today's installment of the Connected Nation podcast, we’ll talk with one of the co-authors of the research project – which provides a report card of sorts on how states are doing. Find out if your state is among the top performers – or the lowest.

Recommended Links:
The Cicero Institute Website
Agenda Report
Data Report
Josh Profile

Jessica Denson (00:10):

This is Connected Nation, an award-winning podcast focused on all things broadband from closing the digital divide to improving your internet speeds. We talk technology topics that impact all of us, our families, and our neighborhoods. A just release report examines how states are approaching reforms to telehealth laws from allowing access to specialists across borders to creating more flexibility for innovation. We'll talk with one of the co-authors of the research project, which provides a report card of sorts on how states are doing. Find out if your state is among the top performers or the lowest. I'm Jessica Denson, and this is Connected Nation. I'm Jessica Denson, and today my guest is Josh Archambault, a senior fellow at the Cicero Institute and Co-author of the report titled 2024 State Policy Agenda for Telehealth Innovation. Welcome, Josh. Josh Archambault (01:02):

Thanks Jessica, so much for having me. Jessica Denson (01:04):

Thank you. You have an awesome name there. Is it French? Josh Archambault (01:08):

French Canadian? Yes, Jessica Denson (01:09):

French Canadian. Thank you for talking me through trying to say it correctly. People will know if they've listened to this. Sometimes I struggle. It's the southern girl in me. Josh Archambault (01:18):

You only imagine the challenge for telemarketers when they call our house. Jessica Denson (01:22):

Oh, I bet. I bet you've been called just about everything. It's a unique name. Before we dive into this important report, I'd like to give our audience an idea of who we're talking to every time. So I'd love to dive into your background a little bit. You actually have a very strong pedigree and longtime experience in public policy, correct? Josh Archambault (01:43):

I do, yeah. After college, got a job for a governor and worked for about a year and a half for that governor at the end of the administration, which quite frankly is one of the bits of career advice I give to any young person who's interested in public policy is go in at the time of administration when all the senior people leave and you get to do all sorts of things that maybe 24-year-old wouldn't get to do normally for about 10 years. But yeah, I stayed in state government for a number of years and learned a lot through that process. Moved over to work for a state senator in the state that I live in. Got that experience as a legislative director to see how the sausage is made, if you will. And after that went to graduate school to get my master's in public policy, wanted a few more tool in my toolkit to be able to do this work. And then after that I entered the weird and strange world of think tanks, which I didn't really even know existed until I had been in state government, but have had the luxury of the last 16 years or so of my career being in state tanks, working in 35 states and in DC and trying to make as much positive impact for patients as possible. Jessica Denson (02:47):

What was something surprising when you entered public policy arena that you didn't expect something that maybe we all have our ideas of what it's like, but since you did get to work in a new office like that at the age of 24, what was something that surprised you? Josh Archambault (03:06):

Yeah, I thought data would drive many of the decisions that were made in public policy. I thought that the best argument would win the day for what ended up passing, but for folks that pay attention to politics and policy, they realized that there were many factors driving these decisions. And so I think that was probably the biggest thing for me. I kept thinking that I was missing something in the process, and really what I was missing was just the politics behind the scene initially and trying to understand the different interests that were being represented, the different perspectives by the trade associations or by special interest groups, and even the individual politics among the members that were there. I can't even tell you how many times I've heard a bill die through the process saying, I support this bill, but so-and-so killed my bill last week. And so just trying to come to appreciate the personalities and the different interests that are represented there so that if you're trying to make a positive reform and move forward, you actually have to take those things into considerations. It's not just about the numbers or whether you've got the best talking points. Jessica Denson (04:06):

Some of it is illogical necessarily, some of it's personality and trying to really work across the aisle too, even with your own party sometimes, Josh Archambault (04:17):

Sometimes, especially at the state level, which is a very different animal than down in dc, there are these factions that exist that don't get played out in the newspaper because not as many news sources cover local and state politics. But if you want to be effective, you have to become a student of that. You have to understand the playing board, if you will, and who the players are and how they feel about each other and know what's going on day to day in that building so that you can navigate it. For better or worse, the system is set up that way. And so just to be effective, you have to be aware of those things. Jessica Denson (04:49):

That's interesting. Is that kind of what drew you to the think tank side of things, the idea of working with data and advising on that level, or is that really even how think tanks work? Josh Archambault (05:02):

Yeah, well, I hesitate to say how think tanks work, they do all operate a little bit differently. Yeah, no, you're absolutely right. Why I was drawn to it. I wanted to still to try to have an impact on public policy, but sometimes you're able to have a greater impact from the outside. And so I wanted to be able to step back, take a deep breath and not deal with the issue of the day or the fire of the day, if you will, and think deeply about what are the reforms that we want to see, what's going to move society forward, what's going to be good for patients, and try to look for data sources to do that, to talk to people, put out products thinking pieces, maybe thinking 10 or 20 years ahead of where the current debate is saying this is where we should be headed.
(05:44)
But at the same time, think tanks allow you typically to still be involved in the public policy conversation. As a former staffer, if you're a citizen legislature, I mean in many states around this country, these folks have other jobs. They may be farmers or lawyers or real estate agents, and they're doing this on the side. They're not experts on these issues. And so they're constantly looking for people to come alongside them and say, help educate me on these issues. Not in a pejorative sense saying that you know everything, but I'm just looking for other people to seek out other opinions and perspectives, to give advice, to give us ideas of what we should do, what are the key problems that we need to address, and what are five or six menu options for us to pick from what might be appropriate for our state? And the think tank allows you to do that. There are other organizations, advocacy organizations, other nonprofits, you could do this sometimes from academia, there are other purchase to do this, but think tanks are really unique organizations to be able to step back, reflect, make some recommendations, but also show up in the day-to-day discussions that are happening. Jessica Denson (06:54):

And I have to say that just as an observation, being a public servant or a politician, you can't really be the expert on everything. There's no way that that's possible. There's so many different things that you have to touch on. So I would think that that is an important role for sure in just helping to educate politicians and our new or long time either way. I noticed on your resume, I did do a little bit of research. I looked you up and on LinkedIn, you were also a senior staff at the White House. How does that compare to state government for you? Josh Archambault (07:36):

Yeah, so just to be clear, I never worked at the White House, but have had an opportunity to speak with folks in governor's offices and advise people in the White House. And I think, again, it's just a different playing field, if you will. And so making sure that you understand the dynamics that are there, who's making decisions at the federal level, there tends to be a lot more staff. So there's a lot more meetings that are required. A lot of different people have to be involved in small decisions at the state level. Honestly, sometimes the decisions are being made by one or two people. At the end of the day in DC it seems like there might be a couple hundred people involved in the decision. And so as a result, it just means that you need to spend a little bit more time studying who the players are, what interests, what they're concerned about, what they're interested in, what they want to work on, and connect what you are working on to what they're most passionate about.
(08:25)
And then ultimately, a lot of the success comes from just helping them do their jobs better. The best resources outside organizations, whether it's a lobbyist or a prophet or an advocate or just a citizen, a voter is helping that person in government do their job better. So whether it's researching, saying, here's the problem and here's the specific way we would recommend, you could address this. Here's the regulation you need to change. Here's the state law that we'd recommend or federal law that you need to change. And so in the White House, there's a brighter light on it perhaps, and what eventually comes out, things get vetted a lot more, but it is a really unique opportunity to be able to impact the entire country in many of those conversations. Jessica Denson (09:05):

I want to take for just a moment, a hard left turn. And since we are talking about your background and what you do and who you are, I think an important piece, or at least from the outside of who you are and from my point of view is on the personal side, you have four children and some of 'em are adopted, some biological, and you're also a foster parent. What draws you to that? Josh Archambault (09:30):

Yeah, well, how long do we have? No, I think
(09:33)
This is personal conversations for my wife and I as we were growing our family deciding the ways that we were going to do so my wife's mother-in-Law was a foster care social worker when she was younger. And so this was something that was in our lives that we would have conversations around the dinner table. And when I worked in state government, I did some work with the foster care agency, and if I'm being honest, it was not at the forefront of my number one things I wanted to do in life given the really the tough situations that many of the families are in. But when we decided to grow our family, it was a need that we were aware of. We went to an information session and my wife and I both walked out and said, you know what? If our kids, God forbid, were ever in the foster care system, we would want people to step up and be a safe home for them.
(10:19)
And so we felt this is our part of our calling. I think many people in society can do this. We don't think we're unique or assuming superhuman or anything like that and whether people are aware of what's going on in their communities. Unfortunately, foster care is related to many of the issues that we're talking about in healthcare in general. Those that end up on Medicaid, those that end up on welfare, the homeless population, the criminal justice issues. Unfortunately, many of the individuals in our society come through the foster care system at some point. And so we felt like it was one small way that we could step into this big need in our community. And so we've been foster parents for the last eight years and have really enjoyed, even though it's tough at times, that process and being able to be an encouragement ever possible. Jessica Denson (11:04):

Well, you teed me up nicely because that was going to be my next question is having children and seeing the system, does that inform some of what you think and how you approach some of your work in the health sector? Josh Archambault (11:19):

Yeah, absolutely. I mean, certainly anybody that's had kids and feels like you're going to the doctor all the time, and so being able to have a healthcare system that a, is affordable that people can access, but making sure that there's options to make that easier with your life. Sometimes taking your kid out of school or driving them to an appointment is not possible for many people. Transportation in this country is a real challenge or is expensive. And so any of the solutions that I've worked on, many of them are trying to make sure that the system is a little bit more patient friendly, whether it's for kids or for adults and is more affordable so that as a country we can continue to have and invest in access to healthcare, but making sure that we're trying to get better outcomes. We spend a lot of money as everybody knows in this country, and unfortunately the outcomes are uneven at best. Jessica Denson (12:08):

Yeah, uneven at best is a very good way to put it. Let's talk a little bit about the Cicero Institute and your role there now as a senior fellow, share what the organization is focused on doing and your role, and then we'll get into this study that brought us together today. Josh Archambault (12:24):

Sure. So Cicero Institute is a multi-state think tank. It's headquartered in Austin, Texas, but works in about 20 states. And as we've been talking about, it's a think tank that serves, tries to be a resource for state legislators who are trying to tackle really complex problems. And healthcare is near the top of that list of complex issues in which folks are looking for answers. Cicero in particular, is interested at looking at homelessness issues, healthcare, criminal justice issues as big societal problems, looking at the incentives that are there and accountability structures around funding, and just trying to think creatively in helping state lawmakers tackle those issues in their community. Jessica Denson (13:04):

And I do want to say again, I did do a little bit of research. It is a nonpartisan public policy organization, so the idea is to be to truly step back and look at this with a neutral lens, so to speak. Josh Archambault (13:21):

Absolutely. And as we've been talking about in my experience, so many of these issues cross partisan lines, cross different interest areas, and so really it's just trying to find a solution that's going to lead to better outcomes. Jessica Denson (13:33):

Well, that brings us to today's topic, how states are approaching telehealth, specifically the development of public policy for innovation within the telehealth sphere. This report is the third annual 50 state telehealth innovation report card, so there's been a couple that have led to into this. So set the stage for us what kicked off the first one and why is it important to continue to come back to this issue and track it? Josh Archambault (13:58):

Yeah, so even before covid, I was working on telehealth policy. I think Covid really put front and center. Now almost every American's familiar generally with the concept of telehealth, and many have actually done a telehealth visit in some form or fashion. But what became clear during Covid was there was a lot of opportunities to move state laws. They were a patchwork across the country as tends to be in our 50 state experiment. And governors really stepped into that gap and granted a lot of flexibility through executive order. But the thing with executive orders is that they're not permanent, they're temporary. And so they were tied to public health emergencies that were being declared in all 50 states, and they gave these new flexibilities around telehealth to make it easier for patients to access services for a number of reasons we can get into. But what ended up happening is state lawmakers didn't quite know where to go next.
(14:52)
They thought, oh, the governor's taking care of this, and we were trying to explain to them, yes, maybe temporarily, but you actually need to have a plan of attack or a roadmap to move forward. But many of them didn't know what to do, and there was often confusion about the discussion that was happening in dc. All of the conversations that around telehealth in DC are around the Medicare program, and if you're not over 65 or the few other categories of people who are on Medicare, those rules don't apply to you. States have a unique regulatory perspective on all of this for telehealth on allowing providers to use what tools they can use. They set the rules of the road for that. They also set the rules of the road for what insurance in the individual and small business markets usually pay for. So the report came out of us just trying to be helpful to say, let's put a roadmap together for state lawmakers who want to do something on this. What are those best practices that are emerging and where are the states on those best practices? Jessica Denson (15:46):

Yeah, I think a lot of people, they misunderstand and think it's necessarily a federal issue isn't more of at the state level that the rules that affect you or I versus as you said, Medicare are different. So the overview of this report finds that quote, state legislative progress on reforming telehealth laws has stalled in 2023. Explain how so. I mean, you've kind of touched on it a little bit, but there were some points that were made at the 3000 foot level. Many reforms passed were tweaking around the edges, things like that that states legislation did not maintain flexibilities, expand upon some of that that you guys found really were stopped or are disappearing. Josh Archambault (16:35):

Yeah, so just continue the history as during covid, what ended up happening is we saw a flurry of telehealth bills that were filed in 20 21, 20 22, and a number of them passed states modernized their telehealth laws in ways that they had never done before, just really important updates. But since then in 2023, things really came to a screeching halt, and we can talk about a few states where there's exceptions to that rule, but for the most part, the bills that ended up getting filed around telehealth were what I would say, like you said, tweaking around the edges. They were only specific to one kind of provider. So there was a telehealth bill related to psychologist or the physical therapy or whatever group, insert group here, and it only pertained to something that they wanted, or there were mandate bills saying, we want to force insurers to pay for this procedure over telehealth.
(17:29)
They don't currently cover it. We want to force 'em to do it through legislation. That was largely the bills that are filed. And often, if we're being honest, the types of bills that get filed in many of these states on a number of issues is one group is pushing it, and the point of the report is to step back to say, it's actually not, you don't want to just do these one-off bills. You want to make sure broadly that your telehealth laws allow for innovation to emerge. And there's some principles to do so. Just to give you one example, you want to make sure every provider can use telehealth if you're thinking about innovative care models. So let's just take somebody with diabetes, they might want to do team-based care. It might be helpful to have their primary care doctor to have an endocrinologist, a nutritionist, all talking at the same time with the patient. Well, in person, that's really difficult, but in many states, but only the doctors are allowed to use telehealth. So you've cut off the ability for innovation. So we want to make sure that state laws allow all providers to use telehealth. Jessica Denson (18:33):

Gotcha. And when you do that, then there's no reason for anybody to pursue that because there's no payment or schedule that you can even charge for that. Right. There's a cost parity thing about this. Correct. Josh Archambault (18:50):

So there are big debates around how you pay for telehealth. And to be honest, we don't weigh in that we did in the first report. Over time, we've said there's many different factors that weigh into this report. Updated third annual report does not weigh into that issue. There are pros and cons to that innovation. Tricky. Do you require people to move in a certain direction and say you have to pay for team-based care, for example, versus to say, Hey, an insurance company, you can pay for team-based care if you want to, but you're not forced to. And that's kind of where the research sits on telehealth right now. I would say that we have some very clear ideas of where telehealth is truly lifesaving telestroke care, just amazing. I've seen lots of early studies on opioid addiction treatment and using telehealth models. It seemed to produce a lot better outcomes for patients than other traditional models, but there are other areas where we just don't know yet and the effectiveness. And so I think I personally, and this is again like I said, not covered in the report, I'm a little hesitant to mandate certain kinds of payment models for telehealth because we don't quite know yet what is all the game changers. And so I just want to make sure that the landscape allows for the innovation but doesn't mandate it at this point. Jessica Denson (20:10):

That makes complete sense. What about on the provider side of things? Are you hearing from providers what they would like to see in telehealth laws? Josh Archambault (20:19):

Yeah, I'd say it's a mixed bag for providers. It depends a little bit on what kind of provider type you are in what state you live in, which is kind of the point of the report. I mean, one of the factors that we look at in the report is looking at nurse practitioners, and this can be a controversial debate in many states on whether they can practice independent of a doctor or whether they need to be under supervision. We recommend that they be allowed to practice independently in part because then they're able to fully leverage telehealth in that way, whereas they might have to work for a doctor that doesn't want to use telehealth and they can't. The reality is in many states around this country, it's not a debate between whether you're going to see a doctor or somebody else. It's between you seeing a provider and nobody else. And so as a country, especially in rural communities, we need to make sure that these options are available, whether it's nurse practitioners in person or nurse practitioners over telehealth. So we want to make sure the regulatory landscape allows for that whenever possible. Jessica Denson (21:18):

Especially I would say rural areas is definitely an area where you may not have access to specialists without traveling hours necessarily. So is there something that's done or is there something that you guys are looking at regarding specialists or you're just saying overall providers in general? Josh Archambault (21:36):

Yeah, all of them. I mean, we cast a very wide net here because again, nutritionists, most people wouldn't think of a nutritionist over telehealth, but there can be models where it makes a lot of sense. And to be clear, it's just as important for you to be able to access a specialist who's maybe 60 miles or even quite frankly across town if transportation is a problem, if you have a disability or something like that, but also to another state. And that is another key metrics that we're looking for in states. Is there an easy process by which you, a provider can register to see patients in your states? We're in an increasingly mobile society, both for providers and for patients, and we want to make sure that you have continuation of care. And the only way to do that is to allow for cross state line telehealth.
(22:23)
The one analogy that I was thinking about a while back was think about if we did this for pilots, if we licensed pilots and said, well, you're authorized to fly from one, let's say from Boston, Massachusetts down towards Atlanta, and you can land, but you can't take off again, you have to have a Georgia licensed pilot take off. Well, what would happen? Well, first of all, we wouldn't have enough pilots to fly our planes and everything would become that much more expensive. That's what we're doing with our medical providers is we're saying, you can take off or you could see patients in one state, but you are not allowed to do it in another. And so as a result, that's where a lot of the access issues and some of the cost issues are coming from our Jessica Denson (23:03):

System. That's a great way to visualize it. So good analogy. Let's start with some of the states that are doing really well. Two of them, well, there's three, Idaho, Louisiana, and Utah that you guys specifically call out is doing great high marks. I noticed that two of them are pretty rural states. Talk about what makes them great, what they're doing right, and why you guys really called attention to those three. Josh Archambault (23:30):

Well, first and foremost, we called attention to 'em because they made changes in 2023. That's the point of the report is to call out contemporary changes that are happening. So just to go state by state in Idaho, they updated their laws to bring some clarity around how you can start a relationship. So in telehealth, there's kind of two different ways. Synchronous, which is live what most people think of, you're on a computer, maybe in a video talking to a provider, but there's also asynchronous telehealth, which means it's not live. So this can cover anything from data being sent from your wearable devices to starting a patient provider relationship over text message. And this becomes really, really important for, I've been told for those in the opioid addiction community who are trying to get clean, who might want to start a relationship over text message first before they transition into some other.
(24:20)
So they updated their laws to say, you can start a provider patient relationship in whatever way the provider and the patient deem appropriate as long as it's within the standard of care, which is important. We want to make sure it's an appropriate way to be able to seek care. The other thing that they did is they opened the door to behavioral health providers to register in Idaho to see patients across state lines. So they've opened the door to a more predictable registration process going forward, really, really important first step, and we hope they continue to build on that next session or this year moving down to Utah. Utah passed a really interesting law that allows for a across state line license to be issued, but they put some guardrails around it and it said that if the provider has not heard back from the regulatory board that they're registering with within 15 days, they're deemed automatically approved and they have some additional guardrails around you.
(25:14)
You have to have no disciplinary actions against you and follow the state laws, which are all appropriate. But I think putting those sorts of predictable timeframes is important. And we can maybe get to this later because the typical avenue to do this is through compacts, but we've heard repeatedly that compacts take, I've heard up to a year at times, to be able to get registered to see patients in another state. So to be able to at least put a predictable 15 days, I mean, I think I'd prefer it to be even shorter, but that was the political compromise that they made to say, let's at least say that within 15 days we can ensure that a patient can continue to see a provider. Maybe they move to Utah from somewhere else, they're going to be able to continue to see the provider from where they moved from, and within 15 days they'll be able to see them.
(25:59)
I think that's a smart move in the right direction. And then the final one, moving down to Louisiana. Louisiana actually updated a law that they had previously passed, and the previous law had said to the boards that oversee the doctors and all other kinds of providers said, we'd like you to issue regulations that allow for across state line telehealth, and they didn't. And so the legislator said, no, no, no. Hold on. We need to make it clear. You need to do this. And so they merely changed one word to shall not. You may issue these regulations, you shall issue these regulations to make it very clear that they want these pathways to be open for patients. And so that, again, maybe it was they had good intention and to see what happened under the first round, but really they put a bold and an underline to say, no, you shall issue these regulations. And so patients in Louisiana, as soon as those regulations are issued in 2024, we'll start to have access for the first time. Jessica Denson (26:58):

That's great. I personally love telehealth because I don't have to leave my house. It makes my day easier and I can't imagine for parents, it's got to be a positive to be able to, they don't have to worry about extra childcare, that type of thing. You brought up the compact, which was my next question. There was some movements on compacts that impact telehealth and in Hawaii, Missouri, Louisiana, you brought up Indiana. Explain what those are, why they're good and bad from your point of view in this report. Give us maybe an idea of how they work. Josh Archambault (27:40):

Sure. So for listeners that aren't familiar with compacts, these are just agreements that states are joining and they're typically tied to one kind of medical provider. So there's one for doctors, there's one for physical therapists, one for nurses, and typically those compacts allow it to be easier for you to move from one state to another and accept the license that you've gotten getting over some of this pilot issue that I mentioned before. So that's generally positive, but there is a telehealth element to it in which once you have joined a compact, if your state joins them, you can now see patients in the other compact states. But perhaps for those listeners, they started to pick up on some of the issues. They only apply to one kind of provider type. They only apply to the other states that have joined the compact. So you have to go to all 50 states, and usually these are multi-year battles between different special interest groups to get these things passed or not.
(28:35)
And then finally we have heard they take a while, not always, sometimes some of the compacts are really efficiently administered and people can get approval within a couple of weeks to be able to start to see patients. But we've regularly heard of examples of it taking six months, a year or so for providers to be set up through the compacts to be able to start to see patients in other states. And in the example I gave before where somebody moves to Utah, for example, you might need to see your provider now they may know have known you for decades. They're the ones who have the unique knowledge of your situation. And instead what we're doing is we're forcing people if they decide to move or go on vacation or whatever their provider moves is to start from square one with a provider that knows nothing about them. And so even if it's their two compact states that your provider's in and you're moving into, it might still take a while for everybody to get set up for you to be able to see them. Jessica Denson (29:32):

Makes sense. How about those states that are really falling behind? What are they not doing or is it just inaction that we're seeing from those? Josh Archambault (29:41):

Yeah, that's a great question. I mean in the report, and we do have kind of a handy little stoplight chart if you will, that ranks them. There are four states that don't have any golds for which you will, Virginia, New Jersey, New Mexico, and South Carolina. And I think as I look through what they've passed, because most states are passing laws on telehealth, I would just say they have not stepped back enough to look at the full landscape. And what they've done is they've taken this approach of passing one-off smaller reforms that deal with one kind of provider time type at a time. And ideally, I don't think we have time to do that process. It's going to take decades before we've addressed all provider types, all of the issues. And I'd much prefer, and we highly recommend that states to step back to the 30,000 foot level, look at the best practices that are being passed around their country by their counterparts, and then update their entire telehealth laws because technology will continue to evolve and they will have to go back every few years to update it. But for right now, just make sure it's flexible enough to allow for innovation to emerge. Jessica Denson (30:52):

I would invite our audience to look in the description of this podcast because I will have a link to this report. So you can look at the stoplight rating system for your state, which includes everything from laws that are innovation ready to those that need improvement, those that have barriers to innovation in place, so you could check out your own state and how things are going there. So the report, Josh also includes a toolkit designed to guide policymakers. What does that mean and what does it include and what do you hope policymakers do with that? Josh Archambault (31:24):

Yeah, so to bring this conversation a little bit full circle, part of the way that we can be a good asset is to point them in this specific direction of what we think they need to change. So for those that only have time for 30 seconds, the stoplight chart is very helpful for them to find their state and to look at the four areas that we consider in the report and say, okay, where do we actually need to make improvement? Where are we gold? Where are we blue? Or where are we red? And maybe they decide, let's tackle one of the red areas this session. Then what we do is we give some maps for each of those four so that they can see. Often we get asked, well, how do we compare to the states around us or to states like us? And so we give some perspective on how they look. And then the final piece of the toolkit in the report is an appendix, which goes state by state in the four areas and says, if you are going to change your ranking, here's the specific thing that you would need to do. You need to change this definition. You need to add this verbiage that is considered best practice so that they can go to a bill drafter or they can write a bill themselves and say, this is the specific thing that we'd like to change, and they've got that roadmap in front of them. Jessica Denson (32:35):

And in your opinion, how do better or even more aggressive telehealth laws improve a state and the quality of life for residents? Josh Archambault (32:44):

Well, I don't think anybody's read the newspaper for the last 10 years and not seen weekly articles about people struggling to afford healthcare, to access healthcare. And so I think at bare minimum, this is one of the lowest hanging fruit ways that states can allow for people to have the option. Nobody's forcing them to do telehealth. And just to be very clear, I think telehealth is wonderful, but it is not a silver bullet. It's a tool in the toolkit. You still need to go see providers for certain conditions that I just want to make that very, very clear, but in so many parts of our country, there are not the providers or the provider types that you need in your backyard. There are many people who have barriers to access care, whether it's transportation, whether it's a physical disability, whether it's a cultural issue in which you want a provider that speaks your language, and if they don't exist in your community.
(33:33)
Telehealth is really an equalizer in so many ways for so many people in communities where they don't have those options, and I don't think your geography should determine your healthcare access. Destiny and telehealth is one of the best tools to be able to help you level that playing field. That's why I think it just improves people's quality of life. Hopefully it leaves a few extra dollars in their pocket as well because telehealth in general can be delivered in a much more efficient manner than in-person services for certain services, and so we want to make sure that everybody, all Americans can access it, not just those in states that have updated their laws. Jessica Denson (34:10):

I know that telehealth isn't just on your computer, it's also going to be on your phone. It could be a telephone call or it could be other things, but how critical do you think broadband access is to telehealth's future and moving it forward? Josh Archambault (34:27):

Yeah, it's a key piece for all of this. I will say I think technology's evolving very, very quickly, and whether it's satellite, internet or others, I mean, the old days of telehealth was you would have to go to a location that had the source and connection to others to do telehealth, and now as most people, I don't think fully appreciate, to your point, you can do it on your phone, which is truly amazing, and the amount of devices, if you look at what technology companies are starting to put on the market in which telehealth can be incorporated in and collecting health data as you just live your daily life, this is going to be in the background of our lives more and more going forward, and we need to make sure that whatever that connectivity looks like, that it's accessible to people, and that data is able to be fully leveraged, whether it's with AI or human eyes or your provider or other companies that you're agreeing to give your data for research purposes. There's lots of opportunities here and we just need to make sure that data can get to where it needs to go to be analyzed and help people have better health outcomes in the long run. Jessica Denson (35:33):

What do you think is next in this area of research? What we not know about telehealth that you would really like to see researched? Maybe not necessarily just at the think tank level, but where do we really need to do a deeper dive? Josh Archambault (35:49):

Yeah, I think it's on outcomes. I mean, we need to understand where telehealth is a game changer and where it may is not so that we stop paying for the things that don't work, and this is probably a good lesson in healthcare in general. Stop paying for the things that don't deliver better outcomes and pay more for the things that deliver great outcomes. So in the telehealth research space in particular, I think this can be done by industry, I think can be done by government. I think it can be done by think tanks. We really need people laser focused on when telehealth and what kinds of tools seem to make a difference Along those lines, I think we also need to really make sure that we don't lose focus on the innovation that can come from telehealth and some of these payment mandate laws or insurer reimbursement policies at times get in the way of that or become the focal point of the conversation where I want to make sure that instead we're focused on how do we build better mousetraps?
(36:41)
How do we allow for care to be delivered in ways that it is not currently even imagined right now going forward? Because our healthcare system, I mean, I don't think anybody disagrees that we're on an unsustainable path 4.5 trillion a year, and so as a result, we have to think differently about this. Technology is one of the greatest opportunities to fix many of these issues. Again, we'll not solve all of our problems. Humans should and will be continue to be involved in this process. We just need to make sure that the regulatory environment allows for these innovations to emerge. I think telehealth is front and center of the tip of the iceberg, if you will, of opportunities to do so, and just making sure that people stay focused on that. Jessica Denson (37:25):

Are there any other areas in public policy or the health arena that you're excited about right now? Josh Archambault (37:31):

Yeah. Cicero has done a lot of work in the price transparency space. I know that's been a focal point for many bipartisan agreement on the need for that. Again, to get at this access and affordability issue, there've been a number of states that have passed some really encouraging laws as the laboratories of democracy, allowing patients to be able to, if they find a cash price that's cheaper than what their insurance company would pay to be able to go there and not be penalized for doing so and get deductible credit if they have insurance and have a deductible. There's other states that are experimenting with savings incentives of paying patients when they seek out higher value care. I think those sorts of things are really interesting and will continue to spread as this. Unfortunately, our unsustainable growth continues, and I'd like to see more and more states experiment in that space, whether it's for public employees, Medicaid recipients, those on private insurance and the individual and small group market going forward. I think if we can see what works there, then perhaps those in DC when they're ready to actually act on healthcare again at some point, can see these proven examples and mirror them. Jessica Denson (38:40):

So just to wrap our conversation for the day, what do you hope, what's the one thing or the takeaway that you hope state leaders take from this report? Josh Archambault (38:50):

In many states, there's still opportunity on telehealth is our main takeaway. So look at how your state ranks, pick the areas where you have a red or blue ranking and get to gold. There are best practices, other states who have gone before you, so you often can just look at their law and adapt it for your own. Often, sometimes a public policy that doesn't work. But in this case, in telehealth, because we're recommending kind of broad principles for what should be in the state law, it's much, much easier for states to copycat others because the needs are very similar in many of these states when it comes to telehealth. Jessica Denson (39:26):

So go for the gold. That's what we want. That's right. That's right. Well, Josh, thank you so much for talking with me today about this report. I really appreciate it. Josh Archambault (39:35):

Great. Thanks so much for having me Jessica Denson (39:42):

Again. We've been talking with Josh Embo, a senior fellow at the Cicero Institute and Co-author of the report titled 2024 State Policy Agenda for Telehealth Innovation. I'll include a link to the report and you can look up your state as well as a link to cice Road Institute's website in the description of this podcast. I'm Jessica Denson. Thanks for listening. If you like our show and want to know more about us, head to connect the nation.org or look for the latest episodes on iTunes, iHeartRadio, Google Podcasts, Pandora, or Spotify.

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