Think Tank

Is California Ready for Telehealth Growth?

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A convergence of trends — health care reform, a shortage of physicians and advances in technology — will result in the rapid growth of telehealth starting this year, according to researchers.

A new report from IHS, a research and analytics company, predicts telehealth — a catch-all term describing doctors and other providers diagnosing, treating and monitoring patients remotely using computers, video and other technology — will grow eightfold in the U.S. over the next five years, from about $240 million this year to $1.9 billion in 2018.

Internationally, telehealth will grow about 18.5% per year over the next five years according to a report, “Global Telemedicine Market Outlook to 2018,” from RNCOS, a business consultancy company.

Legislators in Washington and Sacramento have responded.

U.S. Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) introduced a bill in Congress to establish a federal definition of telehealth and help states figure out how to regulate the new technology.

The Telehealth Modernization Act of 2013 (HR 3750) and two companion bills — HR 3077 by Rep. Devin Nunes (R-Calif.) and HR 3306 by Rep. Gregg Harper (R-Miss.) — are designed to “provide guidance to states as they look to utilize telehealth technologies in the safest, most secure manner possible,” according to proponents.

California may be ahead of the national curve. More than two years ago, Gov. Jerry Brown (D) signed “The Telehealth Advancement Act of 2011” (AB 415) by Assembly member Dan Logue (R-Linda), but according to market predictions the curve is about to get much sharper very quickly.

We asked stakeholders and experts if California’s telehealth policy on the right path and moving fast enough to keep up with the kind of rapid growth predicted.

We got responses from:

Doris Matsui , Co-Author Telehealth Modernization Act of 2013

California Leading, Next Step Is Getting Other States To Follow

Telehealth is increasingly becoming a critical part of the country’s health care system. It is a major contributing factor to increased health care quality, convenience, and lower costs. Telehealth has the ability to continue to transform health care delivery by improving access to care, and by removing barriers to health care delivery, including distance, mobility, and time constraints.

There is no question California is a leader on telehealth and health care delivery. Our health care systems are on the cutting edge of innovation and California’s laws are more developed than many states.  For example, California law permits doctors to care for patients via webcam, allowing doctors to reach patients who live in rural areas or have mobility issues. Additionally, the California Telehealth Network, the California Telehealth Resource Center and the Center for Connected Health Policy all offer unique expertise and valuable experience in the telemedicine field.

The task we face is getting other states to embark on the same innovative path California has already taken. To provide guidance to states and make it easier for them to utilize telehealth technologies in the safest and most secure manner possible, I introduced the Telehealth Modernization Act of 2013 (HR 3750), alongside my colleague, Rep. Bill Johnson (R-Ohio).

This bill creates a nationwide telehealth definition to provide clarity regarding the scope of health care services that can be safely delivered via telehealth. As states continue the adoption of telehealth and take positive steps toward prioritizing telemedicine, it is crucial that the federal government provide clarity in resolving the uncertainty that has resulted from a patchwork of state and local regulations, while still allowing innovation to flourish at the state level. If passed, this legislation will spur innovation and research in the delivery of health care, while improving patient care and increasing efficiency.  

This legislation is an important step toward the continued implementation of telehealth across the nation; however, additional challenges remain. Future work on telehealth will be needed on Medicare and Medicaid restrictions, originating site requirements, inconsistent reimbursement and physician licensure. 

As a member of the House Energy and Commerce Committee, I will continue to work on the modernization of the health care sector through emerging and innovative technology.  I am confident that as we further these efforts, California will continue to serve as a model for telehealth innovation and practice.

Mario Gutierrez , Executive director, Center for Connected Health Policy

Payers, Providers, Patients Need to Opt In

Is Californian telehealth policy on the right path, and is it moving quickly enough to keep pace with the field’s expected rapid growth? The short answer is, “Yes, but …”

We know that telehealth is growing, and extensive research shows that it contributes greatly to the triple aim: better care and better health at lower costs. However, the question today is not whether public policy is on the right path, but whether our public and private payers and delivery systems are moving quickly enough to recognize and incorporate these benefits.

The passage of AB 415, the Telehealth Advancement Act of 2011, the most comprehensive telehealth legislation in the country to date, held great promise that California would experience sweeping changes in the use of these communications technologies to deliver health care at all levels. This has not yet been the case. Simply put, policy reform alone is not sufficient to accomplish these changes.

For telehealth to offer its fullest advantage and operate at the levels predicted, there has to be buy-in from insurance payers, health care providers, and patient interest groups to reform their policies and practices. The biggest incentive for this to happen is the growing movement in California and across the country away from “fee-based” payment systems toward systems that reward performance and promote efficiency and quality of care.

This belief drives the Center for Connected Health Policy’s latest project: a thorough telehealth research review and synthesis focused on telehealth’s potential role to achieve the Triple Aim’s goals. The nine-month project will bring together some the country’s leading telehealth researchers and practitioners to identify, organize and vet the current body of evidence on telehealth’s influence on health care outcomes and costs. These efforts will help establish the field-tested evidence base needed to constructively influence policy and real systems change to put California ahead of the national curve.

Ultimately, California will be best prepared for telehealth technology’s predicted rapid growth if it focuses on sound, evidence-based implementation with all parties at the table. It is a mistake to presume that we can just overlay telehealth practices onto a broken health care system. Successful integration of these technologies into scalable systems of care will require a rethinking how health care is delivered and paid for, so that telehealth is recognized as an advantage for all instead of an add-on.