Behind the Debate over the Future of Telehealth Regulation

Following the onset of the COVID-19 pandemic, the use of telehealth exploded: rapidly becoming a primary means of providing primary and preventive care. Restrictions on the corporate practice of medicine were temporarily lifted, enabling physicians to deliver care to any patient, anywhere. New technologies and applications made televisits not only possible, but also more efficient. Hopes were high that telehealth would play a much greater role in a post-pandemic world, with the ability to reduce barriers to care and enable earlier interventions.  

Since then, a rift has arisen among health policy experts on the utility and benefits of telehealth. The nature of this debate is captured in a recent film produced by The Regulatory Transparency Project, a nonpartisan group that works to better understand and clarify regulatory policies. The discussion features Sebastian Seiguer, CEO of Scene Health, a digital health tech start-up focused on improving medication adherence in infectious & chronic diseases; Ateev Mehrotra, Associate Professor of Health Care Policy at Harvard Medical School; and Carrie Nixon, Co-Founder and Managing Partner of Nixon Gwilt Law, a law firm specializing in health innovation.  

Much of the ongoing telehealth debate centers on cost-effectiveness. Writing in The Washington Post, Paige Winfield Cunningham recently stated, “Supporters of telehealth laud its ability to reduce barriers to access, but fewer barriers to access can also mean that people use more health care, and that could come with increased costs.”  

Count Mehrotra as a telehealth skeptic. “When we've done some evaluations of some direct-to-consumer apps that you can get to do on a video visit, we find that the vast majority of the visits that happened do not replace an office visit or an ED visit. The vast majority is new utilization, and it increases healthcare spending.”  

Nixon disagrees, arguing that “if you look at the overall trajectory of telehealth, providing access to telehealth services actually reduces the overall cost of care over time.”  

Seiguer traces some of the reluctance to fully embrace telehealth to the fee-for-service payment model, which rewards in-person visits in which more medical procedures can be performed. “Providing a quality outcome or improving the quality of care is not necessarily recognized by our antiquated regulatory schemes. So just because you improve care through telehealth does not mean that the provider is going to take it up unless they're compensated for it,” he says.  

Mehrotra also believes that instead of effectively solving health disparities, telehealth exacerbates them. “If we introduce a telehealth application, and only those who are wealthy and therefore have the smartphone and know how to use Zoom, etc., they can access it. That might be helpful for them, it may improve their health, but it actually could widen those disparities because those disadvantaged populations don't have access to the technology.”  

Seiguer notes that his company’s experience has been just the opposite. Scene’s years of research and clinically validated experience have proven that video-enabled forms of Directly Observed Therapy (DOT) are powerful in disenfranchised populations, even among cohorts of patients that have historically been deemed as challenging to treat.  

Endorsed by the U.S. Centers for Disease Control and Prevention and the World Health Organization as the gold standard for tuberculosis (TB) treatment, DOT is considered the most effective strategy to ensure adherence to treatment. During DOT, health workers meet with patients to observe every dose, assist with proper administration, and engage in conversations surrounding medication problems and/or side effects.  

Long before COVID-19 turned its lens on digital health solutions, Scene partnered with hundreds of public health departments across the country, and leveraged its digital platforms to make DOT more accessible and scalable. Specifically, Scene has deep experience using asynchronous video with TB patients, and as a result the company has demonstrated comparable or superior adherence rates to in-person DOT.  

Nixon adds that smartphones are ubiquitous, and efforts are underway across the nation to improve broadband connectivity: an underpinning of successful telehealth. Nixon argues that regulations, which are needed to protect against financial abuse, also have the potential to stifle innovation and therefore negatively impact the most vulnerable.  

Scene’s platform, which uses remote video and human engagement to support patients take every dose of their medication correctly, is successfully addressing a challenge that in-person care, despite decades of awareness about medication non-adherence, has not yet solved.