6 lessons from California on making telemedicine policy a reality

Telemedicine might be on the rise but, as many stakeholder groups have learned, creating changes in policy that will allow patients, providers and payers to use it to its full potential isn’t exactly easy.

Stakeholders in California have had some success moving telemedicine legislation forward, partially because of (PDF) collaborative policy development, according to Christine Martin, former executive director of California Telemedicine and eHealth Center.

At the Moving Telehealth Forward in Ohio event hosted last week by the Health Policy Institute of Ohio, Martin said this type of policy development was key to the creation and passing of the Telehealth Advancement Act of 2011, which California Gov. Jerry Brown signed in October of last year. It takes a structured, facilitated, data-driven approach to reaching consensus among a group of stakeholders.

“There seemed to be not one voice from all of the stakeholders about what we should be telling our policymakers about what we needed to see telehealth move forward,” Martin said.

In 2008, Martin’s team used a $20 million grant to assemble 24 major stakeholders that worked together using this approach to generate 32 action steps for effecting change in telemedicine policy. The Center for Connected Health Policy took one of those action steps to form a work group that developed recommendations that eventually became the Telehealth Advancement Act, which was sponsored by the California Rural Health Association and passed the California Legislature with no opposition.

The act updated California’s original telehealth legislation passed in 1996 to expand providers and settings, improve access to care in rural and underserved areas and allow hospitals to establish medical credentials for telehealth providers more easily.

Martin suggested six key pieces to the initiative’s success:

Bring all parties together. Although there were many different groups interested in seeing telehealth services expand in California, “there seemed to be not one voice from all of the stakeholders about telling our policymakers what we needed to see telehealth move forward,” she said. Some health plans, for example, said that no employer groups or patients were requesting telehealth benefits, so they thought people didn’t know about it. Bringing stakeholders together allowed critical interactions to take place and relationships to form.

Take time to consider different points of view. In initial discussions, many people thought that the biggest barrier to telehealth was reimbursement. But as the group learned that wasn’t the case. There were other issues like a lack of education and reluctance from payers and providers around clinical efficacy and other issues.

Seek consensus. Where other methods of policy making might be based on majority rule or the loudest voice rule, collaborative policy making seeks a negotiated, unanimously agreed upon course of action that all stakeholders were behind.

Share leadership. The legislation wasn’t passed because of CTEC’s work alone. That organization started the initiative, then Center for Connected Health Policy did the model legislation piece, and the California State Rural Health Association helped move the legislation forward.

Educate and engage people along the way. In its research, the group found that many people had never experienced telehealth — or didn’t know they’d experienced it — and patients didn’t understand what it was. Educating the masses as well as the stakeholders was a huge piece.

Inspire champions. “One champion is great, but 30 is better,” Martin said.

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